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BackgroundPretreatment drug resistance (PDR) can limit the effectiveness of HIV antiretroviral therapy (ART). The aim of this study was to assess the prevalence of PDR among HIV-positive individuals that initiated antiretroviral therapy in 2014–2020 in southwestern China.MethodsConsecutive cross-sectional surveys were conducted in Qinzhou, Guangxi. We obtained blood samples from individuals who were newly diagnosed with HIV in 2014–2020. PDR and genetic networks analyses were performed by HIV-1 pol sequences using the Stanford HIV-database algorithm and HIV-TRACE, respectively. Univariate and multivariate logistic regression models were used to explore the potential factors associated with PDR.ResultsIn total, 3236 eligible HIV-positive individuals were included. The overall prevalence of PDR was 6.0% (194/3236). The PDR frequency to NNRTI (3.3%) was much higher than that of NRTI (1.7%, p ConclusionsThe overall prevalence of PDR was medium, numerous cases of the same DRMs among genetically linked individuals in networks further illustrated the importance of surveillance studies for mitigating PDR.

The aim of this review is to describe long-term HIV epidemiology and prevention trends in Guangxi, a provincial-level region located along a major drug trafficking corridor in southwestern China. Between 1996 and 2006, HIV transmission in Guangxi was primarily fueled by Injection Drug Use (IDU). Since 2006, heterosexual sex has become the dominant mode of HIV transmission, followed by drug injection. Moreover, older, heterosexual adults appear to be at increased risk for HIV. The vast majority of new HIV cases are attributed to local HIV subtypes already circulating within Guangxi (93%), though imported subtypes are associated with younger age groups. Since 2011, HIV incidence in Guangxi has stabilized, due in part to HIV prevention efforts that include expanded HIV testing, antiretroviral treatment, and other intervention measures. Between 1996 and 2017, Guangxi, China experienced dramatic changes in the primary HIV transmission mode and at-risk age group. Due in part to local and National AIDS control and prevention campaigns, HIV incidence trends in Guangxi no longer appear to be increasing.

Background: Some cases retested positive for SARS-CoV-2 following negative testing results and discharge, which attracted widespread concern. However, the potential risk factors associated with re-detectable positive tests in a large sample of cases who recovered from COVID-19 has not been well estimated. Methods: A total of 745 discharged COVID-19 cases were enrolled between 30 January and 9 September 2020 in Guangzhou, China. Data on the clinical characteristics, comorbidities, drug therapy, RT-PCR testing, and contact modes to close contacts were collected. Re-positive cases were confirmed by guidelines issued by China. The re-positive rate of in different settings was calculated. Univariable and multivariable logistic regression models were used to explore the potential risk factors associated with COVID-19 re-positivity. Findings: Among 745 discharged cases, 157 (21.1%; 95%CI, 18.2% to 24.0%) were retested positive with 55 (35.0%) of asymptomatic, 15 (9.6%) of mild, 83 (52.9%) of moderate and 4 (2.6%) of severe at the first admission. The median time from discharge to re-positivity was 8.0 days (IQR, 8.0 to 14.0 days). Most re-positive cases were without clinical symptoms and lymphocyte cell counts increased than before. The likelihood of re-positive testing for SARS-CoV-2 RNA was significantly higher among cases with younger age (OR, 3.88; 95%CI, 1.74 to 8.66, 0 to 17 years old), asymptomatic severity (OR, 4.36; 95%CI, 1.47 to 12.95) and without clinical symptoms (OR, 1.89; 95%CI, 1.32 to 2.70, without fever). Interpretation: We found that the re-positive rate of COVID-19 was relatively high, and they were re-tested positive with median days 8.0 to 14.0 post-discharge. Re-positive results were mainly observed in young cases without severe clinical symptoms. These findings suggest that a significant proportion of cases could carry virus fragments for a long time, and effective management, such as prolonged quarantine phase of discharged cases, is necessary. Funding Statement: The Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme; the Construction of High-level University of Guangdong; Young Elite Scientists Sponsorship Program by CAST; the National Natural Science Foundation of China; the Zhejiang University special scientific research fund for COVID-19 prevention and control. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was reviewed and approved by the Ethics Committee of GZCDC. As required by the National Health Commission of China, CDCs were responsible for the work for an ongoing public health response to COVID-19, and our cohort study was based on the data by GZCDC. Patients were informed about the surveillance before providing written consent, and data were collected and anonymized for analysis. All analysis of personally identifiable data took place onsite at the GZCDC.

Background: WHO has recommended that antiretroviral therapy be provided to all HIV patients to reduce future HIV transmission at the population level. Aside from the HPTN 071 (PopART) community based randomized trial which indicated that universal testing and treatment can reduce HIV incidence at the population level, such a public health strategy has not previously been studied in real-world settings. Methods: In this longitudinal phylogenetic-network study in Guangxi, China, the longitudinal baseline and follow-up data was collected from HIV patients in 2014 and newly diagnosed HIV patients from 2015 to 2018, respectively. We used a genetic distance threshold of 0.75% to analyze the proportions of genetic linkage between annual newly diagnosed HIV patients with HIV patients at baseline stratified by treatment. Findings: Among 804 newly diagnosed HIV patients during 2015-2018, 399 (49.6%) of them genetically linked to HIV patients at baseline during 2014-2017. The overall proportion of genetic linkage between newly diagnosed HIV patients during 2015-2018 with untreated and treated HIV patients at baseline during 2014-2017 was 6.2% and 2.9%, respectively. The prevention efficacy in HIV transmission for treated HIV patients was 53.5% (95% CI: 42.0%-65.0%). There was no significant reduction in HIV transmission among treated HIV patients on dropout or with missing viral load measures. Interpretation: Combined with the HPTN 071 (PopART) study, our study results strongly support the feasibility of treating all HIV patients for future reductions in HIV transmission at the population level in real-world settings. Comprehensive intervention prevention programs are urgently needed. Funding Statement: This study was supported by the Guangxi Science and Technology Bureau (Grant AB16380213), Guangxi Medical and Health Project (Z20170126), National Natural Science Foundation of China (Grants 11971479, 81460510 and 81360442), Guangxi Bagui Honor Scholarship, Ministry of Science and Technology of China (2018ZX10721102-006, 2018ZX10715008), and Chinese State Key Laboratory of Infectious Disease Prevention and Control. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The institutional review board (IRB) of the Guangxi CDC approved this study.

ObjectivesChina has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults.DesignObservational retrospective cohort study.SettingData from 2011 to 2013 in Guangxi, China.ParticipantsPatients aged ≥18 years (n=25 732) were selected.ResultsA total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir–ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based.ConclusionsOur study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens.

This study aimed to identify the association of unsafe sex behaviors with HIV infection among the male clients who purchase commercial sex in low-cost sex venues. A cross-sectional study was conduct in a southern province of China among male, low-cost commercial sex clients, who were over 50 years old. Participants were interviewed using a structured questionnaire and had completed HIV testing. Among the 3,485 participants, the prevalence of HIV was 2.96% (95% confidence interval: 2.40–3.52%). The associated risk factors studied for HIV infection included (1) not currently married; (2) use of counterfeit TCMs with sildenafil; (3) noncondom use during commercial purchased sex; and (4) recent engagement of commercial sex within past week. Given the high prevalence of HIV infection among the study group, more political policy intervention and health education should be considered for the identified subpopulation (over 50-year-old men in low-cost commercial venues, counterfeit TCMs with sildenafil and...

Background: China has ambitious to achieve significant reductions in HIV transmission and HIV-related mortality by adopting the World Health Organization's “Treat All” approach. Such a prevention strategy is needed future study on regional scale. Methods: An observational cohort study of HIV epidemiology and treatment databases was used to study the effectiveness of antiretroviral therapy on the transmission of HIV in serodiscordant couples in Guangxi of China. Results: A total of 7713 couples were entered into the cohort study analysis which included 1885 couples in the treatment-naive cohort and 5828 couples in the treated cohort. During the follow-up of 18985.29 person-years from 2003 to 2014, the average incidence of HIV was 2.4 per 100 person-years (95% CI 2.1–2.6). HIV seroincidence rate was significantly higher among the treatment naive group (4.2 per 100 person-years, 3.7–4.8) compared with the on treatment group (1.6 per 100 person-years, 1.3–1.8). An overall 45% reduction in risk of HIV transmission among serodiscordant couple was associated with ART treatment (adjusted Hazard Ratio [HR] 0.55, 95% Confidence Interval [CI] 0.44–0.69). Treatment prevention had significantly effectiveness for most baseline characteristics of index partners, such as for male, female, age above 25 years, education below high school, farmer, infected by heterosexual intercourse. Conclusion: Treatment-as-prevention can be implemented in the real-world on a national or regional scale, but ART adherence and comprehensive harm reduction while implementing this strategy require further study. Keywords: HIV, ART, Sero-discordant couples, Transmission, Cohort study

To explore demographics, clinical and medication profiles, patients’ social support, and perceived health status in HIV/TB coinfected patients in Guangxi, China. We performed a cross-sectional study in the HIV clinic of the Guigang City People's Hospital (N = 150). Health professionals conducted face-to-face interviews and collected data from patients’ electronic medical records regarding patients’ demographic, clinical, and medication information, as well as their social support and perceived health status. We classified all HIV/AIDS patients into HIV monoinfected and TB coinfected, at a ratio of 2:1. Compared with the HIV monoinfected, patients with HIV/TB coinfection were more likely to be older, male, less educated, unemployed, carrying health insurance, having advanced stage of HIV infection, longer history with HIV, and other opportunistic infections. Patients coinfected with TB were also more likely to hold a negative belief that their HIV treatment could prevent exacerbations, and reported significantly worse emotional/informational support, social interaction, and perceived health status. Better social support and better self-efficacy to the HIV treatment adherence was significantly associated with better perceived health status among patients with HIV and TB coinfection. Having HIV/TB coinfection was associated with poorer perceived general well-being and mental health, particularly in those undergoing TB therapy. Our findings suggest the need for mental health referrals and medication management for coinfected individuals, as well as further efforts and policies to improve coordinated care.