Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.

Objective:To analyze the epidemiological characteristics of newly reported HIV/AIDS cases in Henan province during 2010-2018, and to provide theoretical evidence for strategies on prevention and control.Methods:Information about newly reported HIV/AIDS cases in Henan between January 1, 2010 and December 31, 2018 were collected from the National Comprehensive HIV/AIDS Information System. Excel 2010 and software SPSS 23.0 were used for data cleaning and statistical analysis.Results:During 2010-2018, a total of 41 223 HIV/AIDS cases were newly reported in Henan, and the number of newly reported HIV/AIDS cases increased from 3 087 in 2010 to 5 910 in 2018. Sexual contact was the predominant transmission route in newly reported HIV/AIDS cases, and the proportion of sexual transmission increased from 50.6 % (1 564/3 087) in 2010 to 98.8 % (5 839/5 910) in 2018. The proportion of heterosexual transmission firstly increased from 44.9 % (1 387/3 087) in 2010 and then declined to 65.7 % (3 885/5 910) in 2018, and the proportion of MSM behavior related transmission increased from 5.7 % (177/3 087) in 2010 to 33.1 % (1 954/5 910) in 2018. Among the newly reported heterosexual transmitted cases, the proportion of cases with non-marital heterosexual behaviors increased from 69.4 % (962/1 387) in 2010 to 91.7 % (3 562/3 885) in 2018 ( χ2=657.802, P<0.001). The number of newly reported HIV/AIDS cases in young people aged 15-24 years and old people aged ≥60 years increased year by year. The youth cases were mainly infected by MSM behavior transmission (52.7 %, 2 561/4 856), and heterosexual transmission was the main infection route of the elder cases (86.4 %, 5 907/6 833). Among the elder cases infected by heterosexual transmission, cases with non-marital heterosexual behaviors were mainly males, the number of male cases increased from 122 in 2010 to 738 in 2018, and sex composition ratio was between 82.2 % and 91.0 %, while the sex composition ratio of female cases was increased from 9.0 % (12/134) in 2010 to 17.8 % (160/898) in 2018. Conclusions:From 2010 to 2018, the number of newly reported HIV/AIDS cases in Henan increased. Sexual transmission had become the main transmission route. AIDS prevention and control should focus on the control of non-marital heterosexual transmission and MSM behavior transmission, and to pay more attention to young people and people aged 60 years and above.

Objective: To explore the survival status and influencing factors on former plasma donors (FPD) living with HIV/AIDS after initiation of antiretroviral therapy (ART) during 2002-2017 in Henan province. Methods: A retrospective study was conducted, using data from the ART database of national comprehensive HIV/AIDS information system. The inclusion criteria on patients would include HIV/AIDS cases with current residence in Henan province, route of infection being blood-borne (plasma collection), initiation of ART between 2002 and 2017, and 15 year-olds or above. According to the time of initation on antiviral treatment, observation was carried on between January 1, 2002 and December 31, 2017. Outcome of observation was defined as death caused by AIDS or related diseases. Life Table was used to estimate the survival rate and Kaplan-Meier method was used to draw the survival curve. Log-rank test was used to compare the univariate intergroup survival rates while Cox proportional hazards regression model was used to analyze the influencing factors on survival status among deaths due to AIDS or related diseases. Excel 2010 software and SPSS 23.0 software was used for data cleaning and statistical analysis. Results: A total of 25 825 HIV/AIDS patients were enrolled in this study. During the follow-up period, the overall mortality was 3.9/100 person year (8 354/214 796.3), among all the patients. The accumulate survival rates of 1 year, 4 years, 8 years, 12 years and 16 years after the initiation of ART were 91.2%, 80.1%, 71.2%, 65.7% and 61.5%, respectively. The results from the multivariate Cox proportional hazards regression model analysis showed that male vs. female (aHR=1.46, 95%CI: 1.39-1.53); aged 45-49 years group and aged 60 and older years group of initiating ART vs. aged 15-44 years group of initiating ART respectively (aHR=1.47, 95%CI: 1.40-1.54; aHR=2.50, 95%CI: 2.22-2.81); other marital status vs. being married or under cohabitation (aHR=1.29, 95%CI: 1.21-1.36); baseline CD₄⁺T cells counts (CD₄)<50, 50-199 and 200-349 cells/μl respectively vs. baseline CD₄≥350 cells/μl (aHR=4.50, 95%CI: 4.14- 4.89; aHR=2.49, 95%CI: 2.31-2.69; aHR=1.44, 95%CI: 1.33-1.56); number of opportunistic infections at baseline were one case, 2-3 cases and 4-5 cases respectively vs. non opportunistic infections cases at baseline (aHR=1.17, 95%CI: 1.06-1.29; aHR=1.47, 95%CI: 1.35-1.59; aHR=1.74, 95%CI: 1.60-1.89); taking TMP-SMZ vs. not taking TMP-SMZ (aHR=0.69, 95%CI: 0.65- 0.73). Conclusions The 16-year accumulate survival rate was 61.5% among FPD living with HIV/AIDS after initiation of ART, during 2002 to 2017 in Henan province. The risk factors for FPD death case would include: being males, aged 45 and older years at the initiation of ART, baseline CD₄<350 cells/μl and the number of baseline opportunistic infections cases ≥1. The protective factors on FPD death appeared as: being married or cohabited as wel as on TMP-SMZ.

Objective To evaluate the effectiveness of the intervention on preventing mother to child transmission of HIV and identify the influencing factors.Methods The data regarding the pregnant women and their infants were collected,including demographic characteristics,pregnancy and delivery,access to antiviral therapy,HIV infection status at age 18 months and survival of infants between 2002 and 2013 through follow-up,Multivariate logistic regression model were used to identify the influencing factors.Results By the end of 2013,a total of 8 621 554 pregnant women received HIV test,among them 2 264 were infected with HIV.The positive rate of HIV is 0.03％.The HIV positive rate decreased year by year (x2=4.871,P=0.027).A total of 1 530 infants were born from 2002 to 2013,among them 1 384 survived and 92 died at age of 18 months,and 54 were lost for follow up.Sixty infants were tested to be HIV-positive,1 324 infants were tested to be HIV-negative.The mother to child transmission rate was 4.34％,the corrective mother to child transmission rate was 6.33％.Receiving HIV prevention service in early pregnancy (OR=0.26,95％ CI:0.09-0.77),standardized antiviral therapy OR=0.42,95％CI:0.21-0.82),artificial feeding (OR=0.06,95％CI:0.02-0.21) might be the mam protective factors,episiotomy on delivery (OR=3.91,95％ CI:1.74-8.80) might be the risk factors.Conclusion The HIV tested positive rate remained to be low and decreased year by year in pregnant women in Henan,but the mother to child HIV transmission rate was high.It is necessary to improve the prevention of mother to child HIV transmission.

Objective To investigate the status of survival and related risk factors among HIV-exposed children in Henan province from 2002 to 2014.Methods A follow-up program was set up when infants as 1,3,6,9,12,18 month olds.Data regarding the HIV-exposed children and their mothers were collected,including service of PMTCT,antiviral therapy,incidence of infectious disease and survival status of infants.Univariate and multivariate logistic regression models were used to explore the risk factors.Results A total number of 1 705 HIV-infected infants were reported from 2002 to 2014.Among them,1 536 infants (90.09％) were still alive when they were at one and a half years old,with another 58 (3.40％) lost to follow up and 111 (6.51％) infants were dead.The cumulative mortality rates in HIV-exposed children,newborn,and HIV-exposed infants were 67.39‰,23.07‰,and 57.01‰,respectively.No statistical significance was found on the decreasing tendency of mortality in different years.The leading cause of death was noticed as pneumonia,with a proportion of 32.43％,followed by suspected AIDS.Early diagnosis had not been made in infants.Low-birth weight (OR=4.97,95％CI:3.12-7.92) seemed to be a risk factor.Early detection in pregnancy (OR=0.46,95％ CI:0.26-0.80) and HARRT provided to children (OR=0.25,95％ CI:0.15-0.42) were recognized as protective factors.Conclusions The mortality of HIV-exposed children were high,which called for the development of programs on early infant diagnosis and HARRT.Measures should be taken to prevent pneumonia and other infectious diseases,together with nutrition support and monitor program on growth.

OBJECTIVETo investigate the progression and drug resistance of long-term non-progressors during three follow-up in Henan province.

METHODSIn May 2009, 26 cases of long-term non-progressors were recruited who infected HIV more than 10 years with blood collection and supply routes, did not receive anti-retroviral therapy, CD4(+)T lymphocyte count ≥350/μl and did not show typical symptoms of AIDS from Weishi, Shangcai, and Linying of Henan Province. Continuous follow-up were conducted three times since 2009 every two years with cohort analysis, the epidemiological information of infection routes, infection time and blood were collected, and 78 parts of 10 ml EDTA anticoagulated whole blood were collected. The changes of CD4 (+) T lymphocytes, viral load, and virus gene variety were characterized from 2009 to 2014. In-house methods were used to explore primary drug resistance of long-term non-progressors. Nonparametric Kruskal-Wallis test were used to compare CD4(+) T lymphocyte count and viral load changes during different follow-up times.

RESULTSThe average age and infection time of 26 cases were (48.51 ± 6.75) years, (13.42 ± 4.26) years, respectively. Three follow-up times, CD4(+) T lymphocyte count P50 (P25-P75) was 573.5 (487.4-789.8), 499.8 (403.5-635.7), and 418.8 (297.6-537.8)/μl (H=63.99,P<0.001), respectively. And natural logarithm of viral load P50 (P25-P75) were 3.93 (3.43-4.55), 4.29 (3.78-4.75), 4.50 (4.01-4.81) (H=3.19,P=0.355), respectively. Subtype and phylogenetic analysis of HIV showed that prevalent cases were B subtype, accounting for 88.5% (23/26), and three cases showed restructuring changes. Two cases appeared highly resistant of 18 infected patients whose viral load >1 000 copies/ml.

CONCLUSIONThe CD4(+)T lymphocyte had a declining trend, virus subtype recombinant changes in a few cases, and primary drug resistance was found of long-term non-progressors in Henan province.

Adult ; CD4 Lymphocyte Count ; China ; Cohort Studies ; Disease Progression ; HIV ; classification ; drug effects ; HIV Infections ; epidemiology ; HIV Long-Term Survivors ; Humans ; Middle Aged ; Phylogeny ; Viral Load

Objective To understand the factors associated with high risk behaviors among people newly diagnosed to be infected with HIV through heterosexual contact before and after diagnoses in some areas in Henan province,and evaluate the risk of secondary transmission.Methods A face to face interview was conducted among people infected with HIV through heterosexual contact by using self-designed questionnaires during January-May in 2015.Results Among 361 HIV infected persons,the proportions of those with commercial heterosexual behaviors or sex with irregular sex partners decreased from 77.3％(279/361) and 28.5％(103/361) before diagnosis to 13.6％ (49/361) and 2.5％(9/361) after diagnosis,the difference was significant (x2=16.66,P＜0.001;x2=4.80,P=0.03).The subjects surveyed always had more commercial heterosexual behaviors in Henan,Guangdong and Zhejiang provinces before and after diagnosis.After HIV infection confirmation,the condom use rates were 51.0％(25/49) for commercial heterosexual behaviors,88.5％ (184/208) for sex with regular partners and 88.9％(8/9) for sex with irregular partners,respectively.Multivariate logistic regression analysis indicated that risk behaviors associated with HIV transmission included commercial sexual behaviors,previous HIV detection and age of 35 years or older.Conclusions Extra-marital heterosexual behavior has posed serious challenge to the prevention and control of HIV spread.It is necessary to inform the HIV test results,improve the intervention and promote condom use in people with history of commercial sex and people aged ≥35 years.

Objective To investigate the quality of life and its related factors among HIV/AIDS patients from HIV serodiscordant couples in Zhoukou city of Henan province.Methods During January to May in 2015, by the convenience sample, World Health Organization Quality of Life Questionnaire for Brief Version (WHOQOL?BREF) (Chinese version) and a self?edited questionnaire were used to investigate 1 251 HIV/AIDS patients who were confirmed with HIV positive by local CDC, registered in“HIV serodiscordant family”and agreed to participate in a face?to?face interview with above 18 year?old based on the local CDC , township hospitals and village clinics of 9 counties and 1 district of Zhoukou city, excluding the HIV/AIDS patients who were in divorce, death by one side, unknowing about his HIV status, with mental illness and disturbance of consciousness, incorrectly understanding the content of the questionnaire, and reluctant to participate in this study. The scores of quality of life of physical, psychological, social relations, and environmental domain were calculated. The related factors of the scores of different domains were analyzed by Multiple Two Classification Unconditioned Logistic Regression. Results The scores of investigation objects in the physical, psychological, social relations, and environmental domain were 12.00± 2.02, 12.07 ± 2.07, 11.87 ± 1.99, and 11.09 ± 1.84, respectively. The multiple Unconditioned Logistic Regression analysis indicated that age <40 years, on ART and no other sickness in last two weeks were beneficial factors associated with physical domain with OR (95%CI): 0.61 (0.35-1.06), 0.52 (0.30-0.90), and 1.66 (1.09-2.52), respectively. The possibility of no poverty and no other sickness in last two weeks increased to 0.15(0.09-0.26) and 1.57(1.06-2.33) times of those who was in poverty and with other sickness in last two weeks in physical domain. The possibility of participants who were below 40 years old and with children increased to 0.58 (0.34-0.98) and 0.37 (0.23-0.57) times of who were above 40 years old and without children in psychological domain. The factors of with AIDS related symptoms, no children and with other sickness in last two week were found to be significantly associated with environmental domain with OR (95%CI):0.65 (0.48-0.88), 0.66 (0.51-0.85), and 0.65 (0.51-0.84), respectively . Conclusion The scores of every domain of quality of life in HIV serodiscordant couples of Zhoukou city were good. Age, whether having AIDS related symptoms, whether to accept ART , children, status of poverty, and whether suffering from other diseases in last two weeks were the main factors associated with the quality of life .

Objective To investigate the quality of life and its related factors among HIV/AIDS patients from HIV serodiscordant couples in Zhoukou city of Henan province.Methods During January to May in 2015, by the convenience sample, World Health Organization Quality of Life Questionnaire for Brief Version (WHOQOL?BREF) (Chinese version) and a self?edited questionnaire were used to investigate 1 251 HIV/AIDS patients who were confirmed with HIV positive by local CDC, registered in“HIV serodiscordant family”and agreed to participate in a face?to?face interview with above 18 year?old based on the local CDC , township hospitals and village clinics of 9 counties and 1 district of Zhoukou city, excluding the HIV/AIDS patients who were in divorce, death by one side, unknowing about his HIV status, with mental illness and disturbance of consciousness, incorrectly understanding the content of the questionnaire, and reluctant to participate in this study. The scores of quality of life of physical, psychological, social relations, and environmental domain were calculated. The related factors of the scores of different domains were analyzed by Multiple Two Classification Unconditioned Logistic Regression. Results The scores of investigation objects in the physical, psychological, social relations, and environmental domain were 12.00± 2.02, 12.07 ± 2.07, 11.87 ± 1.99, and 11.09 ± 1.84, respectively. The multiple Unconditioned Logistic Regression analysis indicated that age <40 years, on ART and no other sickness in last two weeks were beneficial factors associated with physical domain with OR (95%CI): 0.61 (0.35-1.06), 0.52 (0.30-0.90), and 1.66 (1.09-2.52), respectively. The possibility of no poverty and no other sickness in last two weeks increased to 0.15(0.09-0.26) and 1.57(1.06-2.33) times of those who was in poverty and with other sickness in last two weeks in physical domain. The possibility of participants who were below 40 years old and with children increased to 0.58 (0.34-0.98) and 0.37 (0.23-0.57) times of who were above 40 years old and without children in psychological domain. The factors of with AIDS related symptoms, no children and with other sickness in last two week were found to be significantly associated with environmental domain with OR (95%CI):0.65 (0.48-0.88), 0.66 (0.51-0.85), and 0.65 (0.51-0.84), respectively . Conclusion The scores of every domain of quality of life in HIV serodiscordant couples of Zhoukou city were good. Age, whether having AIDS related symptoms, whether to accept ART , children, status of poverty, and whether suffering from other diseases in last two weeks were the main factors associated with the quality of life .

OBJECTIVETo study the condition of HIV-1 drug resistance mutation among failures of first-line antiretroviral therapy in Henan province.

METHODThe sub platform of China's legal infectious disease monitoring information reporting system-HIV/AIDS integrated prevention and control data information management system was used to collect the information of patients experiencing first-line antiretroviral treatment failure (virus load ≥ 1 000 copies/ml) more than one year among nine cities of Henan in 2011. A total of 40 cases with no information and 212 cases with incomplete drug resistance results were deleted, and 1 922 cases were included in this study and genotype resistance testing was carried out. Non-conditional logistic regression analysis was used to analyse the influencing factors of drug resistance mutation.

RESULTSA total of 1 922 cases were included in the analysis. 1 039 cases were males, 833 cases were females, the age was (45.7 ± 12.1) years, 82.73% (1 590) were married, and 87.93% (1 690) were transmitted by blood. 64.20% (1 234) patients acquired drug resistance. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI) resistance mutations were found in 62.59% (1 203), 49.74% (956) and 0.94% (18) of subjects, respectively. 42.09% (809) of patients harbored NRTI and NNRTI resistance mutations synchronously. ≥ 1TAM was the most commonly emerged NRTI resistance mutation (41.94% (806)), the prevalences of TAM-1 and TAM-2 were 8.48% (163) and 4.24% (81), respectively. K65R/N and Q151M complex existed in 23 and 4 patients, respectively. K103N/S was the most commonly emerged NNRTI resistance mutation (34.32% (659)). Non-conditional logistic regression analysis showed that, factors associated with high drug resistance were the following: transmitted by mother to child (OR = 9.05, 95% CI: 1.14-72.12), clinical stage was IV (OR = 1.70, 95% CI: 1.09-2.66) and 5-year-treated (OR = 1.59, 95% CI: 1.03-2.47). Factors associated with low drug resistance were the following: 1-year-treated (OR = 0.19, 95% CI: 0.13-0.27).

CONCLUSIONComplex patterns of HIV-1 drug resistance mutations were identified among individuals experiencing failure of first-line antiretroviral therapy in Henan province. Factors associated with high drug resistance were lived in Luohe, Shangqiu, Nanyang, Xinyang, transmitted by mother to child, clinical stage was IV, and 5-year-treated.

Adult ; China ; Drug Resistance, Viral ; genetics ; Female ; Genotype ; HIV Infections ; drug therapy ; HIV-1 ; drug effects ; genetics ; Humans ; Infectious Disease Transmission, Vertical ; Male ; Middle Aged ; Prevalence ; Protease Inhibitors ; therapeutic use ; Reverse Transcriptase Inhibitors ; therapeutic use