Objective To evaluate liver injury in patients with hepatitis C virus (HCV)/human immunodeficiency virus (HIV) coinfection in Dehong Prefecture,Yunnan Province.Methods A total of 4 784 HIV-infected patients were enrolled in this study.Baseline aspartate aminotransferase (AST),alanine aminotransferase (ALT) and AST-to-platelet ratio index (APRI) before HIV treatment were collected to analyze the relationship between HCV infection and liver injury.Data were analyzed by x2 test and nonparametric rank sum test when appropriate.Risk factors for liver injury were analyzed by multivariate Logistic regression.Results Totally 4 784 patients were included,of which 30.2％ (1 447/ 4 784) were anti-HCV positive,41.7％ (1 996/4 784) had liver dysfunction and 13.3％ (636/4 784) had liver cirrhosis.Prevalence of liver dysfunction (61.1％,821/1 343) and cirrhosis (24.1 ％,323/1 343) were significantly higher among anti-HCV-positive patients than anti-HCV-negative patients (31.5％,974/3 092,X2=341.223,P＜0.01;7.5％,231/3 092,X2=235.457,P＜0.01,respectively).Multivariate Logistic regression showed that anti-HCV-positive patients suffered significantly higher risk of liver dysfunction (OR=1.99,95％ CI:1.66-2.37) and liver cirrhosis (OR=2.41,95％CI:1.90-3.04).Conclusion Patients with HCV/HIV in Dehong Prefecture coinfection had a higher risk for liver injury.

OBJECTIVETo understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.

METHODSFrom December 20, 2010 to March 10, 2011, the system sampling method was used to get the cases. A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi, Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture, Yunnan province were interviewed, and the demographic characteristics, quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared. A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.

RESULTSOf the 462 cases, 239 cases were from standard MMT clinic, and 223 cases were from the extension MMT clinic. Among them, 117 cases were new research objects into the group during the investigation. Among the clients of extension MMT clinic, 96.7% (147/152) of them were males, 37.5% (57/152) were Dai nationality, and 61.2% (93/152) were married, 38.8% (59/152) with primary school education, 95.4% (145/152) lived with their family or relatives, 96.7% (147/152) could arrive at the clinic from their habitation within 15 minutes. The positive detection rates 72% (13/18), 71% (24/34), 58% (30/52), 29% (15/52), 14% (6/44), 14% (4/29), 15% (5/34), 17% (6/35), 6% (2/33), 16% (5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ(2) = 61.04, P < 0.05). The period of retention of the clients in extension MMT clinics was 175-days averagely, with an average retention 122 days of when withdrawing. The retention rates of the clients were 52% (37/71)and 61% (28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively. There was no difference in the retention rate between those of two types of clinics (χ(2) = 0.82, P = 0.37) .

CONCLUSIONMost of the clients in extension MMT clinics lived with their family or relatives, and spent less time on the way to the clinics. After 9 months methadone maintenance therapy, the quality of life of clients in extension clinics was improved while addiction among them decreased. The extension clinic was an effective strategy for retention in remote areas.

China ; Cohort Studies ; Demography ; Heroin Dependence ; Humans ; Male ; Methadone ; Opiate Substitution Treatment ; Quality of Life ; Substance-Related Disorders ; Treatment Outcome

OBJECTIVETo explore the impacts of antiretroviral treatment on drug use and high risk sexual behaviors among HIV-positive MMT clients.

METHODSA 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.

RESULTSA 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.

CONCLUSIONART 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.

Anti-HIV Agents ; China ; Condoms ; Cross-Sectional Studies ; HIV Infections ; HIV Seropositivity ; Humans ; Organometallic Compounds ; Protective Factors ; Risk Factors ; Risk-Taking ; Sexual Behavior ; Sexual Partners ; Substance-Related Disorders ; Unsafe Sex

Objective To understand the current status of receiving no methadone maintenance treatment (MMT) and influencing factors in HIV infected injecting drug users (IDUs) in Dehong Dai and Jingpo autonomous prefectures,Yunnan province.Methods Data of survival of IDUs with AIDS in Dehong were collected from "Chinese National Comprehensive HIV/AIDS and Care Information System" in December,2014.Results There were 987 IDUs who should receive MMT,the majority of them were males (94.6％,934/987),aged 35-44 years (53.0％,523/987) and farmers (77.2％,762/987).Among the 987 IDUs,60.2％ (592/987) received no MMT.Multivariate logistic regression analysis showed that being female (OR=2.66,95％CI:1.21-5.87),in Jingpo ethnic group (OR=3.05,95％CI:1.97-4.71) were the major risk factors for receiving no MMT;not being farmers (OR=0.46,95％CI:0.31-0.70),in Dai ethnic group (OR=0.53,95％CI:0.36-0.79),diagnosed HIV infection history ≥ 10 years (OR=0.60,95％CI:0.45-0.81) were the major protective factors for receiving no MMT.The reasons for receiving no MMT included long distance journey (289,48.8％),fear of exposure (124,20.9％),poor daily medication compliance (59,10.0％),fear of side effects (47,7.9％),others (73,12.3％).Conclusions The proportion of receiving no MMT in IDUs with AIDS in Dehong was high.Being female and farmer,in Jingpo ethnic group,low educational level,short diagnosed HIV infection history were influencing factors for receiving no MMT.The effective intervention measures should be taken to further improve MMT coverage according to the different characteristics of the patients.

Objective To understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.Methods From December 20,2010 to March 10,2011, the system sampling method was used to get the cases .A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi , Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture , Yunnan province were interviewed , and the demographic characteristics , quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared.A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.Results Of the 462 cases,239 cases were from standard MMT clinic ,and 223 cases were from the extension MMT clinic . Among them,117 cases were new research objects into the group during the investigation .Among the clients of extension MMT clinic ,96.7%( 147/152 ) of them were males , 37.5%( 57/152 ) were Dai nationality , and 61.2%(93/152) were married,38.8%(59/152) with primary school education,95.4%(145/152) lived with their family or relatives ,96.7%( 147/152 ) could arrive at the clinic from their habitation within 15 minutes.The positive detection rates 72%(13/18),71%(24/34),58%(30/52),29%(15/52),14%(6/44),14%(4/29),15%(5/34),17%(6/35),6%(2/33),16%(5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ2 =61.04, P<0.05).The period of retention of the clients in extension MMT clinics was 175-days averagely , with an average retention 122 days of when withdrawing.The retention rates of the clients were 52%( 37/71 ) and 61%(28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively.There was no difference in the retention rate between those of two types of clinics (χ2 =0.82,P=0.37).Conclusion Most of the clients in extension MMT clinics lived with their family or relatives , and spent less time on the way to the clinics.After 9 months methadone maintenance therapy , the quality of life of clients in extension clinics was improved while addiction among them decreased.The extension clinic was an effective strategy for retention in remote areas.

Objective To understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.Methods From December 20,2010 to March 10,2011, the system sampling method was used to get the cases .A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi , Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture , Yunnan province were interviewed , and the demographic characteristics , quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared.A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.Results Of the 462 cases,239 cases were from standard MMT clinic ,and 223 cases were from the extension MMT clinic . Among them,117 cases were new research objects into the group during the investigation .Among the clients of extension MMT clinic ,96.7%( 147/152 ) of them were males , 37.5%( 57/152 ) were Dai nationality , and 61.2%(93/152) were married,38.8%(59/152) with primary school education,95.4%(145/152) lived with their family or relatives ,96.7%( 147/152 ) could arrive at the clinic from their habitation within 15 minutes.The positive detection rates 72%(13/18),71%(24/34),58%(30/52),29%(15/52),14%(6/44),14%(4/29),15%(5/34),17%(6/35),6%(2/33),16%(5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ2 =61.04, P<0.05).The period of retention of the clients in extension MMT clinics was 175-days averagely , with an average retention 122 days of when withdrawing.The retention rates of the clients were 52%( 37/71 ) and 61%(28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively.There was no difference in the retention rate between those of two types of clinics (χ2 =0.82,P=0.37).Conclusion Most of the clients in extension MMT clinics lived with their family or relatives , and spent less time on the way to the clinics.After 9 months methadone maintenance therapy , the quality of life of clients in extension clinics was improved while addiction among them decreased.The extension clinic was an effective strategy for retention in remote areas.

Objective: To obtain HIV incidence among injection drug users (IDU) and female sex workers (FSW) in Dehong Prefecture, Yunnan Province during 2009-2017. Methods: We recruited drug users and female sex workers from all sentinel surveillance sites across Dehong Prefecture during 2009-2017. A total of 10 480 IDU and 18 126 FSW in Dehong Prefecture were recruited by fingerprint technique. Data about drug uses, commercial sexual behavior, sociodemographic characteristics was collected by structured questionnaire. HIV-positive patients who were long-term infected or with CD4⁺ T cell count was ≤200 were not included for further HIV incidence testing. Also, those who self-identified as on antiretroviral treatment (ART) or AIDS cases were also excluded. A total of 841 and 157 plasma specimens from IDU and FSW that met the inclusion criterion were finally included, respectively. Limiting antigen avidity enzyme immunoassay(LAg-Avidity EIA) were performed to calculate the HIV incidence among these two sub-populations. Results: A total of 3 444 IDU were HIV-positive, among which 884 (25.7%) were Burmese with age of (30.4±7.7), and 2 560 were Chinese with age of (36.6±7.3). Among 228 HIV-positive FSW, 109 (47.8%) were Burmese with age of (27.1±6.3), 119 (52.5%) were Chinese with age of (29.9±11.1). For IDU, the estimated HIV incidence among Burmese in 2009-2010, 2011-2012, 2013-2014, 2015-2017 was 4.20% (95%CI: -0.55%-8.95%), 7.75% (95%CI: 2.95%-12.55%), 11.79% (95%CI: 5.38%-18.20%), 10.30% (95%CI: 5.67%-14.94%), respectively, while Chinese were 3.11% (95%CI: 1.59%-4.64%), 0.03% (95%CI: -0.03%-0.08%), 1.55% (95%CI: 0.54%-2.57%), 0.58% (95%CI: -0.06%-1.04%), respectively. In 2009-2011, 2012-2014, 2015-2017, estimated HIV incidence among Burmese FSW was 0.22% (95%CI: -0.21%-0.64%), 1.24%(95%CI: 0.15%-2.32%), 0.55%(95%CI: 0.01%-1.08%). Whereas, estimated HIV incidence among Chinese FSW was 0.62% (95%CI: 0.25%-0.98%), 0.11% (95%CI: -0.04%-0.26%), 0.22% (95%CI: 0-0.44%). Conclusion HIV incidences among Chinese IDU and FSW are on the downward trend, while Burmese IDU and FSW seem to be gaining momentum.

Objective: To study the prevalence and correlates of unprotected sexual intercourse within HIV serodiscordant couples in Dehong prefecture, Yunnan Province, China, in 2014. Methods: This study was based on the follow-up investigation of "the AIDS cohort of seronegative spouses of HIV-infected individuals in Dehong prefecture" in 2014. The 1 520 participants were HIV seronegative spouses from all five counties/cities of Dehong prefecture who voluntarily participated in the cohort. Inclusion criteria included: having a HIV-positive spouse; ≥16 years of age; having had sexual intercourse with spouse in the past year; and being a resident of Dehong prefecture. Information on HIV-positive spouses were also collected through the local AIDS epidemic database. Chi square analysis was performed to compare differences in the rates of unprotected sexual intercourse between participants with different characteristics and lifestyle choices. Multivariable logistic regression model analysis was performed to determine correlates with unprotected sexual intercourse. Results: The 1 520 participants had a mean age of 38.7±9.4, compared with 39.7±8.9 for their HIV-positive spouses. Among the HIV-positive spouses, 77.8% (1 183/1 520) had been infected for more than 3 years, and 87.6% (1 332/1 520) had received antiretroviral therapy. The prevalence of unprotected sexual intercourse within serodiscordant couples over the past 12 months was 16.1% (244/1 520). The prevalence of unprotected sexual intercourse correlated with the level of education of HIV-negative spouses (illiterate vs. middle school and above, OR=1.58, P=0.044), the number of years since diagnosis of HIV-positive spouses (short vs. long, OR=1.6, P=0.006), antiretroviral therapy of HIV-positive spouses (no vs. yes, OR=2.78, P<0.001), the frequency of sexual intercourse per month (high vs. low, OR=1.66, P=0.019), and whether the couple had children (no vs. yes, OR=1.72, P=0.007). Conclusion The prevalence of unprotected sexual intercourse within serodiscordant couples in Dehong prefecture was relatively high in 2014. Factors found to correlate with the occurrence of unprotected sexual intercourse within these couples included illiteracy of HIV-negative spouses, short time since diagnosis of HIV-positive spouses and lack of antiretroviral therapy, high frequency of sexual intercourse and no children.

Objective:To understand the incidence of diabetes and influencing factors, the trend of FPG change and risk for mortality in HIV-infected individuals after antiretroviral therapy (ART) in Dehong Dai and Jingpo Autonomous Prefecture (Dehong).Methods:The HIV/AIDS treatment database was collected from China Information System for Disease Control and Prevention. This retrospective cohort study was conducted in HIV-infected individuals with access to ART in Dehong during 2004-2020.The Cox proportional hazard regression model was used to analyze the incidence density of diabetes, the influencing factors and risk for mortality in HIV-infected individuals with access to ART, mixed linear effects model was used to analyze the trend of FPG change and predict FPG in those with different glucose metabolic status at baseline survey. Statistical analysis was performed using software SAS 9.4.Results:A total of 8 763 HIV-infected individuals were included, in whom 8 432 (96.2%) had no diabetes, 331 had diabetes. The incidence density of diabetes was 2.31/1 000 person years. Multivariate Cox proportional hazard regression analysis revealed that 30- 59 years old, BMI ≥24.0 kg/m 2, Efavirenz (EFV) based initial treatment regimen and impaired fasting glucose (IFG) at baseline survey were significantly and positively associated with incidence of diabetes. Mixed effect model revealed that FPG was positively correlated with the duration of ART, age and baseline FPG. Suffering from diabetes was a risk factor for mortality in HIV-infected individuals both at baseline survey and during follow-up. Conclusions:The risk for diabetes increased in HIV-infected individuals who were 30-59 years old, baseline BMI ≥24.0 kg/m 2, received EFV based initial treatment, and IFG in HIV-infected individuals after antiretroviral therapy in Dehong, 2004-2020. It is important to pay close attention to their blood glucose, and patients with high blood glucose should receive treatment as early as possible.

Objective An approach for analysis of hepatitis C virus (HCV) quasispecies using Hiseq high-throughput sequencing (hereinafter referred to as Hiseq sequencing) technique was developed and then applied to investigate a possible case of HCV needle sharing transmission. Methods One case of HCV antibody seroconversion (P1) was found in a methadone clinic on January 15, 2015. Four HCV antibody positive injecting drug users (IDUs), P2 to P5, suspected to be involved in needle sharing transmission with P1 during the period (after March 24, 2014) that P1 may be infected with HCV were investigated, and another 28 HCV antibody positive IDUs were selected as controls (C1 to C28). These controls came from the same methadone clinic or lived in the same town with P1. The RNAs were extracted from the plasma specimens and then reverse-transcribed into cDNA. After HCV subtyping, Hiseq sequencing was performed to detect and sequence the HCV quasispecies (263 bp) in the specimens with the same subtype as P1. The frequency of quasispecies was counted and ranked. Intrapersonal and interpersonal genetic distance and phylogenetic tree were calculated. Results The HCV subtype of specimen P1 was 3b. All the other specimens with the same subtype were P2, C7, C12, C14, C15, C16, C19, C20 and C28. Hiseq sequencing was successfully performed in 9 out of these 10 specimens, and 249 753 to 1 086 333 (average 869 608) cleaned sequences representing 3 to 172 (average 48) unique HCV quasispecies were obtained. The medians (P50) of intrapersonal genetic diversities from the 9 specimens were 0.4% to 12.3%. The P50 (P25, P75) of genetic diversities between P1 and the other 8 specimens were 19.0% (18.4%, 19.8%), 10.4%(2.8%, 18.3%), 19.6% (17.8%, 21.4%),24.9% (23.8%, 26.1%), 19.8% (18.7%, 20.7%), 20.1% (18.9%, 21.2%), 20.6% (20.0%, 21.1%), 23.6% (22.4%, 24.8%). There were no significant difference between the genetic diversities of P1 and P2 and those of P1 and other 7 specimens (H=9.40, P=0.100). The genetic diversities between few HCV quasispecies from P1 and few ones from C7 were 0. Phylogenetic tree analysis indicated that there was no HCV transmission relationship between P1 and P2, but there was HCV transmission relationship between P1 and C7. Conclusion With the feature of high-throughput, easier operation and lower cost, Hiseq sequencing technique has high practical value in tracing HCV transmission at the quasispecies level.