Sex Specific Mortality in HIV/AIDS Patients Receiving Antiretroviral Therapy & Risk Factors in Xinjiang Uygur Autonomous Region

OBJECTIVE:

To analyze the sex specific mortality in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART) and risk factors in Xinjiang Uyghur autonomous region (Xinjiang), and provide evidence for the evaluation of the effect of HAART.

METHODS:

A retrospective analysis was conducted on the mortality and survival of 8 061 male cases and 6 001 female cases of HIV infection, who received HAART during July 2004-June 2013 in Xinjiang. The information of the cases were downloaded from national antiretroviral therapy reporting sub-system in national HIV/AIDS reporting system. Cox proportional hazard model was used to identify the risk factors of deaths.

RESULTS:

The male cases were older and had lower CD4 value at baseline compared with the female cases. The major transmission route was injecting drug use in males, but sexual contact in females. The overall mortality of the male cases was higher than that of the females, which was 10.87/100 person-years during the first three month after receiving HAART, and 7.00/100 person-years two years later in males, but 4.77/100 person-years during the first three month and 3.00/100 person-years two years later in females. The results from Cox analysis showed that the risk factors were the CD4 value at baseline and transmission route. Compared with the cases who had lower CD4 value (CD4<200 cells/µl) at baseline, the HR for the cases who had higher CD4 value (CD4≥350 cells/µl) was 4.08 (95% CI: 2.96-5.62) in males and 5.11 (95% CI: 3.16-8.35) in females. Compared with sexual transmission, the HR for IDUs was 1.99 (95% CI: 1.66-2.40) in males and 1.77 (95% CI: 1.24-2.52) in females. The results of cumulative survival analysis showed that in conventional treatment group (CD4<350 cells/µl) , the five year survival rates were 81% and 87% for the males and females infected through sexual contact and 66% and 75% for the males and females infected through injecting drug use, and in early treatment group (CD4≥350 cells/µl) , the five year survival rates were 97% and 98% for the males and females infected through sexual contact and 86% and 97% for the males and females infected through injecting drug use.

CONCLUSION:

In Xinjiang, the higher mortality in male HIV infection cases receiving HAART was related with lower CD4 value at baseline and higher infection rate through injecting drug use. Besides the weak intention for treatment and poor compliancy would be the deeper risk factors.

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By:  Ni M1, Chen X2, Ma Y2, Hu X2.

• 1Center for AIDS and STD Control and Prevention, Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi 830011, China; Email: xjnmj@126.com.
• 2Center for AIDS and STD Control and Prevention, Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi 830011, China. 
• Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Sep;36(9):971-5.

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Study on Gay Identity Status & Its Association with Sexual Behaviors among Men Who Has Sex with Men in Xinjiang Uygur Autonomous Region

From May to August in 2013, an anonymous questionnaire survey with convenience sampling was conducted among MSM in Urumqi, Kashgar, Aksu and Yining cities of Xinjiang. Those who were ≥ 16 years of age and claimed to have male-to-male sex behaviors were eligible for the survey. A total of 1 467 participants were recruited...

The MSM with positive ego-identity accounted for 44.7%, and positive social-identity accounted for 29.1%. For ego-identity, Uyghur MSM were less positive than Han MSM was 0.43 (0.32-0.58) ) ; those who were over 20 years of age when accepting their sexual orientation were less positive than those who were younger than 20 years of age when accepting their sexual orientation (OR (95%CI) was 0.61 (0.47-0.80) );and homosexuals were more positive than bisexuals was 1.98 (1.50-2.61) ). For social-identity, Hui MSM were less positive than Han MSM was 0.61 (0.42-0.88) ); those whose education level was higher than college were less positive than those with junior high education; famers/herdsmen were more positive than students was 4.17 (2.13-8.17) ); the divorced/widowed were more positive than the singles was 2.40 (1.34-4.29) ); those who were over 20 years of age when accepting their sexual orientation were less positive than those who were younger than 20 years of age when accepting their sexual orientation. Among the MSM with negative ego-identity and negative social-identity, the proportion of planning to get married with women was 66.8% (267/400) and 76.5% (306/400), respectively, which were higher than those with positive ego-identity (33.2% (133/400)) and positive social-identity (23.5% (94/400)) ; their proportion of intending to have offspring was 62.0% (287/463) and 73.4% (340/463), respectively, which were higher than those with positive ego-identity and social-identity (38.0% (176/463), 26.6% (123/463)) (χ(2) = 39.61 and 7.90, respectively, both P values were <0.05). Among the MSM with negative social-identity, the proportion of looking for male sexual partners in toilets or parks was 18.1% (188/1 040), in bathhouse or sauna was 17.3% (180/1 040), and through internet was 82.0% (853/1 040), which were higher than those with positive social-identity (8.9% (38/427), 9.8% (42/427) and 61.6% (263/427)) (χ(2) = 66.78, P < 0.01).

In 2013, the gay identity of MSM in Xinjiang was relatively poor, and the factors associated with it included ethnicity, occupation, marital status and education level. The MSM with negative identity tended to involve in risk sexual behaviors, and had increased risk of HIV infection.

Via:  http://ht.ly/S8dGm

By: Ni M1, Hu X, Li Z, Ma Y, Chen X, Hu X.
1Xinjiang Center for Disease Control and Prevention, Urumqi 830011, China. 

Analysis of Factors Associated with Antiretroviral Therapy Intiation & Its Timeliness among HIV Sero-Discordant Couples in High HIV Prevalence Regions, China

A total of 10 213 HIV-positive individuals were included in this study, among whom 73.9% were males and 26.1% were females, 66.4% had initiated ART and 33.6% had not. There were 1 733 serodiscordant couples who were reported during January 1, 2012 to October 31, 2013 had initiated ART. Among those 64.9% had successfully initiated ART within two months of receiving their HIV diagnosis and 35.1% had not. 

Multivariate logistic regression analysis showed that those being male were 0.81 less likely to initiate ART, as compared with those being female. Those being Yi ethnicity were 0.29 less likely to initiate ART, as compared with those being Han ethnicity. Those being Uygur ethnicity were 1.57 times more likely to initiate ART, as compared with those being Han ethnicity. Those engaging the other jobs were 0.85 less likely to initiate ART, as compared with those being peasant. Those being diagnosed in medical institutions were 0.61 less likely to initiate ART, as compared with those being diagnosed in VCT. Those having CD4(+)T cells of 250-349, 350-550 and > 550 were 0.75, 0.17, 0.10 less likely to initiate ART, respectively, as compared with those having CD4(+)T cells of < 250. Those having duration of follow-up of 13-36 months and ≥ 37 months were 0.55 and 0.32 less likely to initiate ART respectively, as compared with those having duration of follow-up of ≤ 12 months. 

Multivariate logistic regression analysis showed that those being Yi and Uygur ethnicity were 0.63 and 0.40 less likely to initiate ART timely respectively, as compared with those being Han ethnicity. Those being infected through injecting drug use were 0.64 less likely to initiate ART timely, as compared with those being infected through heterosexual intercourse. Those being diagnosed in other institutions were 0.58 less likely to initiate ART timely, as compared with those being diagnosed in VCT. Those having CD4(+)T cells of 250-349, 350-550 and > 550 were 0.75, 0.44, and 0.31 less likely to initiate ART timely respectively, as compared with those having CD4(+)T cells of < 250.

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