Search

OBJECTIVE: To investigate the application status and trend of anti-HIV drugs in outpatient department of this hospital, and analyze the application rationality. METHODS: Retrospective analysis method was performed to analyze the number, gender, age and frequency of visits of AIDS patients, patients with pre-exposure prevention and post-exposure blockade of HIV infection in outpatient department of the hospital from 2016 to 2020. According to the defined daily dose method recommended by WHO, defined daily dose system(DDDs), consumption sum of self-paid drugs, defined daily cost (DDC) and consumption sum ranking / DDDs ranking (B/ A) of all anti-HIV drugs in this hospital were analyzed and evaluated. RESULTS: From 2016 to 2019, the number of outpatients in this hospital for AIDS patients and patients with pre-exposure prevention and post-exposure blockade of HIV infection increased year by year, and decreased slightly in 2020. From 2016 to 2020, among the anti-HIV drugs in outpatient department of this hospital, the top five drugs ranked by DDDs were tenofovir, lamivudine, efavirenz, lopinavir, ritonavir and and zidomivir divudine, all of which were national free drugs, and the DDDs of tenofovir, lamivudine and efavirenz ranked the top three. The DDDs of self-paid drugs were relatively low, and the DDDs of some self-paid drugs increased in 2019, such as emtricitabine and tenofovir, and rilpivirine. The dosage and DDDs of elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide fumarate increased significantly in 2020. The DDC of self-paid drugs was higher, ranging from 40 yuan to 96 yuan, of which the DDC of rilpivirine was 40 yuan, and the DDC of dotiabalamib was 96 yuan; the B/ A of self-paid drugs were <1. CONCLUSIONS: The varieties of anti-HIV drugs in outpatient department of the hospital can basically meet the clinical needs, and the application of anti-HIV drugs is basically reasonable. [ABSTRACT FROM AUTHOR]

As for the HIV prevention, Chinese government has implemented a special policy, which is called "Four Types of Free Service and One Kind of Special Care." "Four Types of Free Service" is to provide free anti-HIV drugs, free counseling and preliminary screening, free prevention of mother-to-infant HIV transmission and free HIV testing of newborn babies, and free education. "One kind of Special Care" is to give assistance to the people infected with HIV/ AIDS and their family members, who are in financial difficulties. In 2006, the Regulation of the Prevention and Treatment of HIV/AIDS was promulgated by Chinese State Counsel, which makes the protection of the rights of the persons with HIV/AIDS legitimized. This special protection has helped relieve the severe state in this field. But it also gives us such an impression that AIDS is so dreadful and infectious, which makes those with HIV/AIDS live in lonely state and deepens the discrimination against them. Thus, the special protection for them in policy and law should be changed to general protection. In order to transform the special protection into general protection, the persons with HIV/AIDS should be included by disabled law, and such legal protect models from international community could be introduced. The first model, of which French law is an example, is to give "health status or handicap" in anti-discrimination law an amplified interpretation, in order to make those persons with HIV/AIDS included in disabled people. The Canadian law belongs to the second model, according to which the discrimination against persons with HIV/AIDS is regarded as the discrimination against disabled people based on judicial interpretation. The third model is accepted by UK, Australia and Hong Kong, which stipulates that those persons with HIV and AIDS should be regarded as disabled people. Because China has no anti-discrimination law, it is impossible to have legislative or judicial interpretation. So it is suitable to adopt the third model in China, that is to perfect The Law of the Protection of the Disabled Persons of the People's Republic of China as to incorporate those people with HIV/AIDS into disabled people. But at present this law still holds such view that disability is just physical defect, other than "social disabilities" or "the result of suppression of human rights." Therefore, it is needed to change our understanding of "disabilities" before perfecting the law of the protection of disabled persons. In addition, there are still some structural factors which hinder the Unified Rights Protection of Persons with HIV/AIDS and Disabled Persons. In China, both the people with HIV/AIDS and disabled group belong to vulnerable group, and have the burdens of discrimination from society, so it is possible that they both would have the worry that it will deepen the discrimination against them when these two groups are included in the same law system. Furthermore, China Disabled Persons' Federation, founded in 1988, is an official and formal organization, which has made great achievement in rights protection of its members. While the State Council AIDS Working Committee, the official organization for the people with AIDS, was founded in 2004, and its subordinate organizations are weak, scattering over the places with high rates of HIV incidence. The real force supporting the rights protection of the persons with HIV/AIDS lies in all kinds of grassroots organizations, which, however, lack money and legal discourse. Although some organizations are legally registered as Folk-Run non-Enterprise Units, they must pay business taxes to the government, which makes their running harder. Thus, in order to unify the rights protection of both groups, it is necessary to change the concept of the government that the government should govern everything, to change its misunderstanding of grassroots organizations, and to strengthen their role in civil society.' [ABSTRACT FROM AUTHOR]

Objective: To explore the causes of secondary drug resistance among HIV infected persons who were receiving antiretroviral therapy in Shandong province, and provide evidence for the improvement of antiretroviral therapy strategy. Methods: A case-control study was designed with 1∶2 matching on case and control groups. Household and face-to-face interview were conducted in October, 2015. All the study subjects were screened from both the drug resistant database of antiretroviral therapy of Shandong provincial laboratory and national comprehensive HIV/AIDS database in Shandong. The sample size was estimated as 330 cases including 110 drug resistant and 220 non-drug resistant cases. Subjects were people living with HIV/AIDS (PLWHA) aged 15 or older and received antiretroviral therapy for more than 6 months with records of virus load (VL). Subjects who presented VL above 1 000 copies/ml would receive drug resistance testing. Subjects who were confirmed resistant to with secondary drug, were selected as case group, the rest subjects with non-secondary drug resistance would form the control group. EpiData 3.1 software and SPSS 22.0 software were used to establish a database. Related influencing factors were analyzed with non- conditional stepwise logistic regression model. Results: A total of 288 cases were enrolled, including 103 in the case and 185 cases in the control groups, with average age as (37.62±1.06) years and (37.90±0.74) years old, respectively. Most of them were male, married/cohabitant, with education level of junior/senior high school or below and under Han nationality. Results from the multivariate logistic regression model showed that ORs (95 %CI ) of receiving antiretroviral therapy for 1-3 years, or more than 3 years were equal to 8.80 (3.69-21.00), 3.00 (1.20-7.53), compared with receiving antiretroviral therapy less than one year, respectively. OR (95 %CI ) of Among the PLWHA that with missing rate above 25.0 % on medication, the OR appeared as 15.41(4.59-51.71), compared with not missing medication. OR (95 %CI ) among those who took the medicine themselves was 0.22 (0.07-0.74). Conclusions: Factors as duration of treatment, missing rate on medication and taking medicine by oneself were of influence on secondary drug resistance. Other factors as duration on antiretroviral therapy longer than 1 year, missing rate above 25.0 % on medication, were related to the risk on secondary drug resistance. However, if the medicine was taken by oneself, it served as a protective factor for secondary drug resistance. It is necessary to strengthen the intervention and health education programs related to antiretroviral therapy.

Objective: To explore drug resistance of different viral loads, and investigate the relationship between drug resistance and CD4(+)T cell counts in patients with HIV antiretroviral therapy (ART) in China from 2003 to 2015. Methods: Data were extracted from the Chinese National HIVDR Surveillance database from 2003 to 2015. For this study, the data collected were as follows: having received ART for ≥12 months; 18 years or older; demographic characteristics, information of ART, CD4(+)T cell counts, viral load (VL) and HIV drug resistance of a total of 8 362 patients were collected. Multi-variables non-conditional logistic regression model was used to study the relationship between viral load, HIV drug resistance and CD4(+)T cell counts. Results: Participants with age of (41.8±10.5) years were enrolled in this study. Among them, 59.9% (5 009 cases) were men. The percentage of CD4(+)T cell counts <200 cells/μl in the total population was 17.9% (1 496 cases), the highest was in VL ≥1 000 copies/ml with drug resistance, which was 43.0% (397/923) , followed by VL 50-999 copies/ml with drug resistance, which was 31.1% (69/222), and the lowest was in VL 50-999 copies/ml without drug resistance 13.2% (273/2 068). Compared to VL 50-999 copies/ml without drug resistance, VL<50 copies/ml, VL 50-999 with drug resistance, VL≥1 000 copies/ml without drug resistance, and VL ≥1 000 copies/ml with drug resistance, the OR (95% CI ) of CD4 <200 cells/μl were 0.9 (0.7-1.0), 3.2 (2.3-4.4), 2.6 (2.1-3.2), and 4.9 (4.0-5.9), respectively. Among 222 patients with VL 50-999 and HIVDR, the most frequent antiretroviral drugs were EFV and NVP, both of which were NNRTI, and whose percentage both were 94.1% (209 cases). The most frequent mutations were M184V/I (NNRTI), and the percentage was 26.1% (58 cases). The second one was K103N (NNRTI), and the percentage was 22.5% (50 cases). The percentage of V32L/E (PI) and V82A (PI) were lower, they were 0.9% (2 cases) and 0.5% (1 case) respectively. Conclusion: Decreased CD4(+)T cell counts were associated with HIV drug resistance at low viraemia. In the case of low viral load, the most vulnerable were the NNRTI antiviral drugs such as EFV and NVP.

Objective: To investigate the predictors that reduced the survival time on HIV positive TB patients during their first year's anti-TB therapy., Methods: A retrospective study was conducted to review 519 TB/HIV co-infection patients from an Internet based TB surveillance system. We collected information of demography, HIV status, CD4+ lymphocytes count, antiretroviral therapy (ART), sputum smear results of diagnosis and around 2 months' initiation of anti-TB therapy, et al. Wilconxon rank sum test was used to compare the difference of age and CD4+ lymphocytes, count and Cox Uni-variable, and Multi-variable analysis were used to compare the different distribution of rest of risk elements between the groups of death and survival; survival function also has been used to evaluate the top 4 risk elements that have made negative impact on the survival time of HIV positive TB patients during their first year's anti-TB therapy., Results: Among 519 TB/HIV patients, 84 (16.18%) were dead, 435 (83.82%) survived. Median age (P50 (P25-P75)) in survival was 51.0 (41.0-65.0), while in death was 45.0 (35.0-60.0) (U=-2.68, P=0.007). There was significant difference between survival and death. Median CD4+ lymphocyte count in survival and death (P50 (P25-P75)) were 69.00 (26.00-131.20) and 114.50 (35.00-245.00), respectively, significant difference also has been observed. Based on the Cox analysis, patients with less than 2 months' intensive anti-TB therapy, poor treatment adherence, less than 4 months continue anti-TB therapy and sputum smear positive around 2 months initiation of anti-TB therapy had higher risk of death, the Relative Risk value (RR) were 1 100.40 (95% CI: 105.62-11,470.00), 52.91 (95% CI: 27.42-102.13), 49.43 (95% CI: 6.38-382.81), and 15.83 (95% CI: 2.55-98.40), respectively. Log-rank test results showed that there were significant difference between survival and death groups with anti-TB intensive therapy duration (Log-Rank value was 236.0, P<0.001), adherence (Log-Rank value was 302.9, P<0.001), and sputum smear results around 2 months' anti-TB initiation (Log-Rank value was 7.55, P=0.006)., Conclusion: Known HIV positive, less CD4+ lymphocyte count, not initiation of ART, sputum smear positive, around 2 months' initiation of anti-TB therapy, not enough anti-TB therapy duration of intensive and continue period and poor treatment adherence were the predictors of death of HIV positive TB patients in the first year's anti-TB therapy.

Objective: To conduct a cost utility study on the HIV/AIDS 'one-stop service' at county level., Methods: Financial records and questionnaires were used to collect the information about the resource allocation and the effectiveness of antivirus treatment (ART) during the two period which were January 2012-June 2013 and July 2013-December 2013 in the three pilot counties providing 'one-stop service'. Treeage Pro 2009 was used to build the Markov model to simulate the evolution of 5 different HIV statuses, including HIV infection, AIDS, HIV infection receiving ART, AIDS receiving ART and death. And compared the cost-utility ratios between current ART process and 'one-stop service' process. National and local epidemic data and literature review were used to provide the parameters in the model, including prior probabilities of each status, transferring probabilities among each status, health utility values and investments of each status and discount rate., Results: The expenditures related with 'one-stop service' in the three counties were 2 627 339, 209 969, and 191 658 RMB, respectively between July and December, 2013. The average periods from HIV infection confirmation to ART initiation was reduced from 8 weeks to 18, 10 and 16 days, respectively. The percentage of receiving ART within 30 d among those qualified were increased from 46.7% (63/135) to 64.3% (45/70) in county A, from 40.0% (16/40) to 69.4% (25/36) in county B, and from 9.5% (4/42) to 50.0% (19/38) in county C. If current process was applied, the CUR in three counties would be 10 391.89 RMB/quality adjusted life years (QALY), 6 271.42 RMB/QALY and 3 515.94 RMB/QALY, and these would be 10 825.08 RMB/QALY, 8 522.30 RMB/QALY and 10 414.65 RMB/QALY with application of 'one-stop service'., Conclusion: 'one-stop service' could decrease the interval between HIV infection confirmation and ART initiation and increase the percentage of receiving ART among people living with HIV(PLHIV), more QALYs would be obtained with more resources invested.

Objective: To explore the impacts of antiretroviral treatment on drug use and high risk sexual behaviors among HIV-positive MMT clients., Methods: A cross-sectional study was conducted in patients undergoing ART (ART-experienced) and patients not undergoing ART (ART-naive) attending MMT in 5 clinics in Yunnan Honghe and Dehong prefectures in 2014. A questionnaire was designed to collect socio-demographic characteristics, ART and MMT information and sexual and drug use behaviors within 3 months before the investigation was conducted. Logistic regression analysis was conducted to identify the predictors for drug use and risky sexual behaviors., Results: A total of 328 cases were included in the analysis, among which 202 were ART-experienced and 126 were ART-naÏve. Among 152 respondents who were sexually active, 61 (40.1%) reported having unprotected sex (UPS) with their regular partners in the prior 3 months. A total of 57.6% (189/328) of the respondents used drugs in the prior 3 months. Multiple logistic regression analysis revealed that younger than 35 years old (OR = 3.57, 95% CI: 1.23-10.37), fertility desire (OR = 4.47, 95% CI: 1.49-13.41), partner being HIV-positive (OR = 4.62, 95% CI: 1.80-11.86), length of MMT attendance less than 5 years (OR = 2.92, 95% CI: 1.14-7.53), agreed that it was necessary to use condom no matter the viral load is high or low (OR = 0.14, 95% CI: 0.04-0.51) were protective factors of UPS in the prior 3 months. Multiple logistic regression analysis revealed that being Han (OR = 0.46, 95% CI: 0.24-0.89), feeling having good health status (OR = 0.39, 95% CI: 0.18-0.85), being enrolled in ART (OR = 0.32, 95% CI: 0.17-0.60) were protective factors for drug use in the prior three months, having contact with drug using friends (OR = 4.41, 95% CI: 2.31-8.29), having experience of missing an MMT dose (OR = 3.47, 95% CI: 1.92-6.29), and not satisfied with current MMT dose (OR = 13.92, 95% CI: 3.24-59.93) were risk factors for drug use during the prior three months., Conclusion: ART was not associated with risky sexual behavior and drug use in the prior 3 months in this population. Future interventions should promote ART among this population, and provide education at the same time to prevent the emergence of cross infections and drug-resistant strains.

Objective: To study the drug sensitivity and analyze the replication kinetics of HIV-1 B and CRF07&#95;BC subtypes with I132L or T139K/R mutations., Methods: The amino acids in position 132 and 139 of reverse transcriptase (RT) region of the infectious clone PNL4-3 (HIV-1 B subtype) were changed to L and T/R through site mutagenesis. Combined with the previously constructed infectious clone of HIV-1 CRF07&#95;BC subtype with I132L and T139K/R mutations in RT region, mutated PNL4-3 infectious clones were transfected into 293T cells. The infection ability of mutated clones was detected. The drug sensitivity to NNRTIs (TMC-125, DLV, NVP, EFV) and the properties of replication kinetics were also evaluated., Results: The mutated infectious clones were constructed including PNL4-3-RT-I132L, PNL4-3-RT-T139K and PNL4-3-RT-T139R. The I132L and T139K/R mutations in HIV-1 B and CRF07&#95;BC infectious clones reduced their drug sensitivity to NNRTIs, which accompanied with the increase of EC50 (concentration for 50% of maximal effect). In subtype CRF07&#95;BC, I132L mutation increased EC50 by 2.55, 19.35, 28.05, 6.13 fold, T139K mutation increased EC50 by 4.67, 3.66, 7.35, 3.30 fold, and T139R mutation increased EC50 by 1.82, 4.69, 25.12, 1.89 fold, respectively. In subtype B, I132L increased EC50 by 3.91, 4.61, 6.38, 3.56 fold, T139K increased EC50 by 3.13, 1.78, 2.26, 2.10 fold, T139R increased EC50 by 5.79, 3.99, 5.78, 2.75 fold, respectively. Similar as wild type PNL4-3, the replication ability of 132L/139K/139R mutated infectious clones reached the peak in day 11. However, compared to wild type BC-WT, I132L/T139R mutations delayed the peak time to day 14 and 21., Conclusion: The novel drug resistance associated mutations I132L and T139K/R can reduce the drug sensitivity to NNRTIs in subtype B and CRF07&#95;BC, and the replication ability of CRF&#95;07BC declined by I132L mutation.

Objective: To explore factors influencing mortality rate of HIV/AIDS and to improve the effectiveness of antiretroviral therapy (ART)., Methods: By means of retrospective cohort study and the AIDS control information system, HIV/AIDS case reports and antiviral treatment information of 4 cities in southern Shanxi province up to end of December 2012 were selected, to calculate the mortality rate and treatment coverage based on further data collected, along with analysis using the Cox proportional hazards survival regression., Results: 4 040 cases confirmed of HIV/AIDS were included in this study. The average age was (36.0 ± 12.9) years, with 65.3% being male, 56.5% being married, 73.5% having junior high school education or lower, 58.4% being peasants, 54.3% with sexually transmitted infection (40.1% were heterosexual, 14.2% were homosexual), and 38.9% were infected via blood transmission (20.2% were former plasma donors, 16.2% blood transfusion or products recipients, 2.4% were injection drug users). Overall mortality decreased from 40.2 per 100 person/year in 2004 to 6.3 per 100 person/year in 2012, with treatment coverage concomitantly increasing from almost 14.8% to 63.4%. Cox proportional hazards survival regression was used on 4 040 qualified cases, demonstrating the top mortality risk factor was without antiretroviral therapy (RR = 14.9, 95% CI: 12.7-17.4). Cox proportional hazards survival regression was made on 1 938 cases of antiviral treatment, demonstrating that the mortality risk of underweight or obese before treatment was higher than those of normal and overweight cases (RR = 2.7, 95% CI: 1.6-4.5), and the mortality of those having a CD4(+) T-lymphocyte count ≤ 50 cells per µl before treatment was more than 50 cases (RR = 2.6, 95% CI: 1.5-4.5); Cox proportional hazards survival regression was made on 2 102 cases of untreated cases, demonstrating the mortality risk of those initially diagnosed as AIDS was higher than those initially diagnosed as HIV (RR = 3.4, 95% CI: 2.9-4.0)., Conclusion: The ART could successfully make lower HIV/AIDS mortality rate, indicating effective ART can further decrease mortality.

Objective: To compare the HIV suppression rate after initiating antiretroviral treatment(ART) among AIDS patients at different immunological levels and to analyze the related factors., Methods: Data on AIDS patients initially starting antiretroviral therapy during 2008 and 2013 were collected from Chinese HIV/AIDS integrated control system. All the participants were divided into early treatment group(baseline CD4(+)T cell counts between 351/µl and 500/µl) and conventional treatment group(baseline CD4(+)T cell counts ≤ 350/µl). The rates of comprehensive virologic suppression at different time nodes after the initiation of ART were analyzed accordingly. Unconditional logistic regression model was adopted to examine the factors associated with the failure of viral suppression after 6 months after initiation of ART., Results: A total of 16 103 cases were selected, among which, 1 581 cases were early treatment group, and 14 522 cases were conventional treatment group. A total of 9 428 cases were males, 6 675 cases were females, and the sex ratio was 1.41: 1. The age was 47.2 ± 11.7, and 71.55% (11 522/16 103) of cases were married or cohabiting, 57.22% (9 214/16 103) were transmitted by blood. 81.26% (13 086/16 103) were cures in the township or village treatment institution, and 77.17% (12 426/16 103) received the ART regimen as Stavudine(D4T) or Zidovudine(AZT)+Lamivudine(3TC)+Nevirapine(NVP) or Efevirenz(EFV). After 0.5, 1, 2, 3, 4, 5 and 6 years after the initiation of ART, the rates of virologic suppression in the conventional treatment cohort were 72.6% (3 008/4 144), 73.9% (4 758/6 443), 74.1% (3 641/4 915), 74.9% (2 819/3 766), 76.1% (1 729/2 272) and 78.2% (492/629), respectively. While the rates of viral suppression in the early treatment cohort at the same time nodes were 65.5% (315/481), 65.4% (448/685), 68.8% (223/324), 66.0% (155/235), 71.4% (110/154) and 61% (30/49), respectively, and the differences between the two groups were significant (P < 0.05) except at the fourth year. Non-conditional logistic regression analysis showed that in the conventional treatment group, factors associated with low HIV suppression rate were male (OR = 1.23, 95%CI:1.07-1.42) , longer time interval from confirmed HIV infection to received ART (OR = 1.26, 95%CI:1.16-1.36) , using D4T/AZT+ DDI +NVP/EFV as initial treatment regimen (OR = 3.00, 95%CI:2.26-3.98) and nearly missing doses for 7 days at treatment of six months (OR = 1.97, 95%CI:1.22-3.18) and factors associated with high HIV suppression rate were infected through homosexual transmission route (OR = 0.57, 95%CI:0.35-0.90) and treated in the county level medical institution or above (OR = 0.61, 95%CI:0.50-0.75) . Among early treatment group, cases who received treatment at county level medical institution or above had high HIV suppression rate (OR = 0.43, 95%CI:0.23-0.80) and objects with longer time interval from confirmed HIV infection to receive ART had low HIV suppression rate (OR = 1.43, 95%CI:1.09-1.88)., Conclusion: The viral suppression efficacy among AIDS patients with different baseline immunologic levels after treatment was similarly satisfactory. AIDS cases who received ART at county level medical institution or above had better viral suppression effect and patients with longer time interval from confirmation to treatment had poor HIV suppression effect.

Objective: To analyze the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment (ART) in Liangshan prefecture during 2004-2012., Methods: A retrospective cohort study was conducted to analyze the information of AIDS patients who initially received ART. Data on patients was collected from the Chinese AIDS Antiretroviral Therapy DATAFax Information System. Life table was applied to calculate the survival proportion, and Cox proportion hazard regression model was used to identify impact factors that were related to the time of survival., Results: Among 5 525 AIDS patients who initially received ART, the median age was (34.5± 9.0) year old, with 73.9% being males, 65.8% were infected through injecting drug use, time from HIV tested HIV positive to starting ART was (23.0±20.1) months. 287 cases died of AIDS related diseases, and their median time of receiving ART was (12.7±10.6) months, and 32.8% of them died within the first 6 months of treatment. Cumulative survival rates of the patients who had received ART in 1, 2, 3, 4, 5 years were 97%, 93%, 89%, 88%, 84%, respectively. Results from multivariate Cox regression showed that female patients who received ART were at a lower risk to the death of AIDS related diseases(HR = 0.556, 95%CI:0.367-0.872), when compared to the males. Patients infected with HIV through injecting drug use were at a higher risk to death (HR = 1.569, 95% CI:1.061-2.321) when compared to those who were infected through heterosexual transmission. Patients with baseline CD4(+) T cells counts at <50 cells/mm(3) (HR = 11.996, 95% CI: 6.714-21.435) or 50-200 cells/mm(3) (HR = 2.481, 95%CI:1.620-3.798) were at a higher risk to death than those with CD4(+)T cell counts ≥350 cells/mm(3). Patients without pulmonary tuberculosis were at a lower risk to death(HR = 0.511, 95% CI:0.330-0.791)when compared to those with pulmonary tuberculosis a year before starting the treatment., Conclusion: Antiretroviral treatment could prolong the survival time of AIDS patients and with a better rate on survival. Programs on follow-up and CD4(+)T cell counts for AIDS patients should be conducted regularly, as well as timely initiated the antiretroviral therapy.

Objective: To analyze the outcome among HIV-infected children following antiretroviral treatment in Shandong province., Methods: From the national AIDS antiviral treatment database during April 2009 and December 2013, 50 children who were according to antiviral treatment in Shandong province were classified as the cases. Regular follow-up observation and test were conducted among children under antiretroviral therapy before treatment,0.5(th), 1(th), 2(th), 3(th), 6(th), 9(th), 12(th) months after treatment, and then one time after every 3 months follow-up after one year. The height and weight of the children under antiretroviral therapy and normal children (2010 national student physical health survey results)were compared during different times. And the height and weight of the follow-up period of situation, the CD4(+)T cell count and viral load, regular physical examination results, the incidence of opportunistic infections were compared with baseline data., Results: Among the 50 children under antiviral therapy, male accounted for 54.0% (27/50) , female 46.0% (23/50) , the youngest was 2 years of age, the oldest was 15 years old, and all of them were transmitted by the mother-to-child route and none received mother-to-child prevention. The shortest treatment time lasted five months, the longest 61 months, with a median 25 months. The height of the baseline, 12(th), 24(th), 36(th) months after antiviral treatment were ( 111.9 ± 23.4), (118.1 ± 20.9), (127.1 ± 13.9), (135.4 ± 10.2)cm, and weigh were ( 20.6 ± 8.7), (23.8 ± 6.3), (27.8 ± 7.2), (30.7 ± 5.5) kg, respectively. The height and weight of the treated children were higher than those in the baseline (P < 0.05), but lower than those among the children without HIV infection. The CD4(+)T lymphocytes level of the baseline, 3(th), 6(th), 12(th), 24(th), 36(th) months after antiviral treatment were 224.0, 279.5, 465.0, 581.0, 640.0, 728.0/µl, the CD4(+)T lymphocytes level after antiviral treatment were higher than the baseline (P < 0.05). Hemoglobin and AST were significantly different between children received treatment after 24 months and those in the baseline (P < 0.05), baseline and 24(th) months after treatment the hemoglobin value were (106.6 ± 22.2), (125.2 ± 5.8), and the AST measurements were (42.1 ± 23.1), (23.4 ± 15.6). Baseline and 12(th), 24(th) months after treatment, the median of viral load were 10 000.0, 105.0,0.0 copies/ml , and the ratio of viral load ≤ 400 copies/ml were 50% (4/8) , 65% (22/34) , 88% (14/16) , respectively, the results of viral load had significant difference among 12(th), 24(th) months after antiviral treatment and baseline (P < 0.05). The incidence of opportunistic infections was 62% (31/50) before treatment, and 12% (6/50) after the antiviral therapy., Conclusion: Antiviral therapy can effectively improve the immunity and reduce the incidence of opportunistic infections which is helpful to improve the quality of life among HIV-infected children following antiretroviral treatment in Shandong province.

Objective: To investigate the impact of heroin for antiviral treatment, drug resistance, mutation types and frequency in HIV/AIDS patients in Guangxi Zhuang Autonomous Region., Methods: HIV/AIDS patients were recruited in Methadone Maintenance Treatment Clinics, HIV/AIDS Clinic and HIV Voluntary Counseling and Testing Center Liuzhou and Baise city from April 2008 to October 2009. The patients were grouped by the situation of antiviral treatment and use of heroin. A total of 435 HIV/AIDS patients were recruited, among which 108 cases in antiviral treatment and heroin group, 93 cases in antiviral treatment and never using drug group, 105 cases in no antiviral treatment and using heroin group, 129 cases in no antiviral treatment and never using drug group. The effect of antiviral treatment was evaluated by questionnaire survey, viral load measurement and CD4(+) T lymphocyte count. HIV-1 RNA from plasma was extracted, and then the pol genes were amplified and sequenced. The sequences were analyzed for HIV-1 genotype drug-resistance., Results: For the patients who received antiviral treatment, the viral load in heroin group was higher than that in never using drug group (lg (2.61 ± 1.24) vs lg (2.08 ± 0.80), t = 3.54, P < 0.05) , and the percentage of viral load lower than 1 000 copies/ml in heroin group was significantly less than that in never using drug group (63.9% vs 86.0%,χ(2) = 12.76, P < 0.05). For the patients who received antiviral treatment, the difference has no significance in CD4(+) T lymphocyte count between heroin group and never using drug group ((337.92 ± 181.66) vs (326.14 ± 254.98), t = 0.38, P = 0.703). For the patients who didn't receive antiviral treatment, the difference also has no significance in CD4(+) T lymphocyte count between heroin group and never using drug group ((373.73 ± 155.97) vs (337.53 ± 209.26), t = 1.47, P = 0.143). For the patients who received antiviral treatment, there was no difference in the percentage of the CD4(+) T lymphocyte count more than 350/ml between heroin group and never using drug group (48.1% vs 43.0%, χ(2) = 0.53, P = 0.466). 319 HIV-1 pol gene sequences were obtained. Among the patients who received antiviral treatment, the mutation frequency of M184V/I, T215Y/F, L210W and T69N/S in heroin abuser group were significantly higher than that in never using drug group (14.9% (11/74) vs 4.4% (3/68), 12.2% (9/74) vs 1.5% (1/68), 12.2% (9/74) vs 1.5% (1/68) and 10.8% (8/74) vs 1.5% (1/68) respectively) (P < 0.05)., Conclusion: Using heroin may promote HIV replication, reducing the virological response to antiviral treatment and increasing the frequencies of drug resistance loci among HIV/AIDS patients.Heroin rehabilitation may benefit from the antiviral treatment and obtain better antiviral effect.

Objective: To evaluate the changes of body composition in male patients with human immunodeficiency (HIV)-related lipodystrophy (LD) syndrome (HIV-LD) switching from stavudine (d4T) to zidovudine (AZT) or tenofovir (TDF) by Dual-energy X-ray absorptiometry (DXA)., Methods: A total of 47 men with HIV-LD who had been exposed to stavudine (d4T) were enrolled in our study from May 2007 to September 2013 in Peking Union Medical College Hospital. Twice DXA assessments were administrated with interval of at least 12 months. All patients were divided into two different treatment regimens, either AZT group switching from d4T to zidovudine (AZT) or TDF group switching from d4T to TDF. Parameters of body composition in two groups were evaluated by DXA., Results: Compared with baseline level, lower limb lean mass increased significantly after treatment [(15.4 ± 1.7) kg vs (16.0 ± 1.7) kg, t = 2.781, P < 0.01] and lower limb fat mass had a small decrease(P = 0.05) in AZT group. In TDF group, there were significant increases both in upper limb fat mass [(0.6 ± 0.3) kg vs (1.0 ± 0.7) kg, t = 2.422, P < 0.05] and lower limb fat mass [(1.8 ± 0.8) kg vs (2.6 ± 1.7) kg, t = 2.369, P < 0.05]. In AZT group, change of lower limb fat mass was generally small (median -0.04 kg, -4.55%). In TDF group, increase of lower limb fat mass and percentage of lower limb fat gain were even greater (median 0.46 kg, 27.41%). In a visual comparison of DXA results between AZT and TDF recipients, more fat gain of leg fat mass was seen in patients who switched from d4T to TDF (U = 2.954, P < 0.01)., Conclusions: Compared with AZT group, TDF group led to a more increase in leg fat mass. Replacing d4T with TDF translates into an improvement of lipodystrophy. Although fat mass did not show a significant increase in AZT group, lean mass had improved after switching treatment, indicating AZT as a possible alternative agent of d4T. Body composition in men patients with HIV-LD can help to adjust the treatment regimen.