In recognition of the morbidity and mortality associated with human immunodeficiency virus (HIV), the Joint United Nations Programme on HIV/acquired immunodeficiency syndrome (AIDS) (UNAIDS) aims to end the epidemic by setting and striving to achieve the ambitious 95-95-95 targets. However, Singapore is still not performing well in the first UNAIDS target. The National HIV Programme (NHIVP) developed this set of recommendations based on an adaptation of major international guidelines from the World Health Organization and the US Centers for Disease Control and Prevention. The goals of this recommendation are: (1) to increase the uptake of HIV testing; (2) to allow earlier detection and identification of individuals with unrecognised HIV infection; (3) to facilitate linkage to clinical services; and (4) reduce further transmission of HIV infection in Singapore.
Humans ; Singapore/epidemiology* ; HIV Infections/epidemiology* ; United States ; HIV Testing ; Mass Screening ; World Health Organization ; Practice Guidelines as Topic ; Centers for Disease Control and Prevention, U.S. ; National Health Programs

INTRODUCTION: Although pre-exposure prophylaxis (PrEP) has been available in Singapore since 2016, its uptake among gay, bisexual and other men-who-have-sex-with-men (GBMSM) is low. The iPARTY study was established to evaluate the acceptability and feasibility of PrEP and a PrEP teleconsultation service for young GBMSM aged 18 to 29 years. METHOD: A total of 53 young GBMSM were enrolled in the iPARTY study. They had a total of 5 in-person consultations and teleconsultations, at 12-week intervals. Laboratory tests and quarterly baseline surveys were performed to assess PrEP adherence, sexual behaviour, and incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). RESULTS: Thirty-five participants completed the entire 12-month follow-up. Most participants had positive experiences with PrEP teleconsultations. There was a statistically significant fall in participants' aggregate Patient Health Questionnaire-9 scores throughout the study. Self-reported PrEP adherence decreased over the course of the study, denoting improved mental health. Although self-reported condom use for anal intercourse and participants' risk perception of HIV decreased after PrEP adoption, there was no statisti-cally significant increase in STI incidence. CONCLUSION This pilot project has shown that PrEP services provide an opportunity for YMSM to access sexual health testing, treatment and counselling, and may even have tangible benefits on the mental health of this population. Teleconsultation is shown to be a suitable platform for the delivery of such services. Collaborative initiatives are crucial to further enhance the affordability and accessibility of PrEP in Singapore, and to improve patient adherence.
Adolescent ; Adult ; Humans ; Male ; Young Adult ; Anti-HIV Agents/administration & dosage* ; Feasibility Studies ; Health Risk Behaviors ; HIV Infections/psychology* ; Incidence ; Medication Adherence ; Mental Health/statistics & numerical data* ; Pilot Projects ; Pre-Exposure Prophylaxis/statistics & numerical data* ; Sexual and Gender Minorities/statistics & numerical data* ; Sexually Transmitted Diseases/prevention & control* ; Singapore/epidemiology* ; Telemedicine/statistics & numerical data* ; Homosexuality, Male/statistics & numerical data*

INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

OBJECTIVE: This study aimed to investigate the prevalence of HIV pretreatment drug resistance (PDR) and the transmission clusters associated with PDR-related mutations in newly diagnosed, treatment-naive patients between 2020 and 2023 in Dehong prefecture, Yunnan province, China. METHODS: Demographic information and plasma samples were collected from study participants. PDR was assessed using the Stanford HIV Drug Resistance Database. The Tamura-Nei 93 model within HIV-TRACE was employed to compute pairwise matches with a genetic distance of 0.015 substitutions per site. RESULTS: Among 948 treatment-naive individuals with eligible sequences, 36 HIV subtypes were identified, with unique recombinant forms (URFs) being the most prevalent (18.8%, 178/948). The overall prevalence of PDR was 12.4% (118/948), and resistance to non-nucleotide reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) was 10.7%, 1.3%, and 1.6%, respectively. A total of 91 clusters were identified, among which eight showed evidence of PDR strain transmission. The largest PDR-associated cluster consisted of six CRF01_AE drug-resistant strains carrying K103N and V179T mutations; five of these individuals had initial CD4+ cell counts < 200 cells/μL. CONCLUSION The distribution of HIV subtypes in Dehong is diverse and complex. PDR was moderately prevalent (12.4%) between 2020 and 2023. Evidence of transmission of CRF01_AE strains carrying K103N and V179T mutations was found. Routine surveillance of PDR and the strengthening of control measures are essential to limit the spread of drug-resistance HIV strains.
Humans ; HIV Infections/virology* ; China/epidemiology* ; Drug Resistance, Viral ; Male ; Adult ; Female ; Middle Aged ; HIV-1/genetics* ; Anti-HIV Agents/therapeutic use* ; Myanmar/epidemiology* ; Young Adult ; Prevalence ; Adolescent ; Mutation

Objective To clarify the mechanism that HIV infection mediates mitochondrial damage of CD4⁺ T lymphocytes (CD4⁺ T cells) through mitogen-activated protein kinase (MAPK) pathway. Methods From October 1st, 2022 to March 31st, 2023, 47 HIV-infected people who received antiretroviral therapy (ART) for 4 years were recruited, including 22 immune non-responders (INR) and 25 responders (IR); and 26 sex and age-matched control participants (HC) who were negative for HCV, HBV, and HIV infections. The immune parameters were analyzed by flow cytometry. Finally, peripheral blood mononuclear cells (PBMCs) from HC or HIV patients were treated with MAPK pathway inhibitor SB203580, and the changes of mitochondrial function of CD4⁺ T cells were observed. Results Compared with HC group, the proportion of CD4⁺ T cells in PBMCs in INR group and IR group was significantly lower, and the proportion of CD4⁺ T cells in PBMCs in INR group was significantly lower than that in IR group. In addition, the proportion of naive (CD45RA⁺CD27⁺)T cells in PBMCs in INR group was significantly lower than that in HC group and IR group. Compared with HC group and IR group, the proportions of CD4⁺PD-1⁺, CD4⁺Av⁺ and CD4⁺MO⁺ in PBMCs in INR group and the proportions of CD45RA⁺CD27⁺PD-1⁺, CD45RA⁺CD27⁺Av⁺, CD45RA⁺CD27⁺MO⁺ in CD4⁺ T cell subsets increased significant. Compared with HC-con group, the basal respiration, maximal respiration and adenosine triphosphate(ATP) production of CD4⁺ T cells in HIV-con group decreased significantly, and JC-1 (green/red) in CD4⁺ T cells increased significantly. Compared with HIV-con group, the basal respiration, maximal respiration, ATP production and respiratory potential of CD4⁺ T cells in HIV-SB203580 group increased significantly, and the JC-1 (green/red) in CD4⁺ T cells decreased significantly. Conclusion Abnormal activation of the MAPK signaling pathway is observed in HIV patients receiving ART treatment, especially in CD4⁺ T cells of INR patients, which may lead to impaired mitochondrial function and abnormal CD4⁺ T cell homeostasis.
Humans ; HIV Infections/immunology* ; Male ; Mitochondria/drug effects* ; Female ; CD4-Positive T-Lymphocytes/metabolism* ; Adult ; Middle Aged ; MAP Kinase Signaling System/drug effects* ; Pyridines/pharmacology* ; Imidazoles/pharmacology* ; Leukocytes, Mononuclear/immunology*

OBJECTIVES: The prevalence of human immunodeficiency virus (HIV) associated neurocognitive disorders (HAND) in people living with HIV/acquired immunodeficiency syndrome (PLWHA) worldwide is as high as 42.6%. This study aims to investigate the neurocognitive function status and its influencing factors in PLWHA, providing evidence for early identification and intervention of neurocognitive impairment in this population. METHODS: PLWHA aged 18 and above who received outpatient or inpatient care at the First Hospital of Changsha between June and August 2019 were included. Sociodemographic and HIV-related information were collected. Neurocognitive function was assessed using the Brief Neurocognitive Screen (BNCS), which includes the Digit Symbol Test (DST) and Trail Making Test A and B (TMT-A and TMT-B). Impaired neurocognitive function was defined as abnormal scores in at least one dimension (DST score <30, TMT-A time >60 seconds, TMT-B time >90 seconds). RESULTS: A total of 375 PLWHA were included, of whom 212 (56.5%) exhibited neurocognitive impairment. Higher impairment rates were observed among females, individuals aged ≥50 years, those with primary education or below, and those who were married/cohabiting (all P<0.05). Heterosexual transmission accounted for the majority of infections (233 cases, 62.1%), with a significantly higher rate of neurocognitive impairment (69.1%) compared to homosexual transmission and unknown routes (P<0.001). Higher WHO clinical stages were associated with increased impairment rates (P<0.001). PLWHA with a nadir CD4⁺ T cell count <200 cells/mm³ or an infection duration ≥5 years had significantly higher impairment rates than those with higher CD4⁺ T cell count or shorter infection durations (both P<0.05). Logistic regression analysis showed that patients with a nadir CD4⁺ T cell count <200 cells/mm³ had a significantly higher risk of neurocognitive impairment (OR=2.461, 95% CI 1.116 to 5.427). Compared to WHO stage I, the risk increased progressively in stage II (OR=6.005, 95% CI 2.906 to 12.407), stage III (OR=6.989, 95% CI 2.502 to 19.523), and stage IV (OR=22.059, 95% CI 7.289 to 66.760; all P<0.05). CONCLUSIONS Potential risk factors for neurocognitive impairment in PLWHA include low nadir CD4⁺ T cell counts and advanced WHO clinical stages. The lower the CD4⁺ T cell count and the higher the clinical stage, the greater the risk of neurocognitive dysfunction.
Humans ; Female ; Male ; Middle Aged ; HIV Infections/psychology* ; Adult ; Acquired Immunodeficiency Syndrome/psychology* ; Neuropsychological Tests ; Cognitive Dysfunction/epidemiology* ; Neurocognitive Disorders/epidemiology* ; CD4 Lymphocyte Count ; Risk Factors ; Aged

OBJECTIVE: Antiretroviral drugs covered by medical insurance have been gradually used by people living with human immunodeficiency virus (PLWH) in recent years in China. This study aimed to analyze their willingness to pay (WTP) for antiretroviral drugs. METHODS: A mixed-methods study design involving a cross-sectional survey and in-depth interviews was conducted. A cross-sectional survey was performed to collect data on the general characteristics, economic status, antiretroviral therapy (ART) status, and WTP of PLWH in 18 Chinese cities from August 2022 to February 2023. Multivariate logistic regression was used to analyze the factors associated with WTP. Representatives of PLWH were interviewed via in-depth interviews, and the data were thematically analyzed. RESULTS: Among the 941 PLWH, 271 (28.80%) were willing to pay for antiretroviral drugs covered by medical insurance. For basic medical insurance for urban and rural residents, PLWH with the following characteristics were more willing to pay: an educational level of senior high school or technical secondary school, having an undergraduate degree or higher, frequently working away from their hometowns, and homosexual transmission. Off-farm workers and recipients of government medical aid were more unwilling to pay. For basic medical insurance for urban employees, PLWH with the following characteristics were more willing to pay: frequently working away from their hometowns; homosexual transmission; personal annual income ≥ 100,000 CNY; and adverse events of antiretroviral drugs. The main reasons for PLWH's WTP for antiretroviral drugs covered by medical insurance were that the drugs had fewer adverse events and were easier to administer. The main reasons for PLWH's unwillingness to pay were financial difficulties and privacy concerns. CONCLUSION Nearly one-third of PLWH are willing to pay for antiretroviral drugs covered by medical insurance. In the future, PLWH with a high WTP can be guided to use these drugs.
Humans ; HIV Infections/economics* ; China ; Male ; Female ; Adult ; Cross-Sectional Studies ; Middle Aged ; Anti-Retroviral Agents/economics* ; Cities ; Insurance, Health/economics* ; Young Adult

Humans ; Cost-Benefit Analysis ; HIV Infections/drug therapy* ; Cost-Effectiveness Analysis ; Decision Trees

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are one of the global public health issues concerning health of human beings. Dyslipidemia is one of the major risk factors for cardiovascular events, while elevation of plasma cholesterol levels is associated with the onset of over 50% coronary heart disease. The incidence risks of cardiovascular diseases are higher in HIV/AIDS patients than those in normal populations. In addition to conventional risk factors, viral duplication and suboptimal treatments increase risks of atherosclerotic coronary vascular disease (ASCVD) in HIV/AIDS patients. Thus, a deep knowledge of lipid metabolism and dysregulation profiles, an efficient control of conventional ASCVD risk factors, as well as strengthened measures to lipid management, are of significance to improve long-term prognosis and life quality for HIV/AIDS patients. However, up to date, there is no particular consensus on lipid management for HIV/ADIS populations under long-term antiretroviral therapies (ART). Hereby, based on current status quo of ART in China and frontier achievements of fundamental researches and clinical trials, we invited domestic experts in fields of infectious diseases and cardiovascular diseases to compose this expert consensus on the integrated management of lipid in HIV/AIDS patients in China.
Humans ; Acquired Immunodeficiency Syndrome ; Cardiovascular Diseases/prevention & control* ; Consensus ; HIV Infections ; Lipids/blood* ; China

OBJECTIVE: The mode of human immunodeficiency virus (HIV) transmission via injection drug use (IDU) still exists, and the recent shift in IDU-related transmission of HIV infection is largely unknown. The purpose of this study was to analyze the spatiotemporal sources and dynamics of HIV-1 transmission through IDU in Guangxi. METHODS: We performed a molecular epidemiological investigation of infections across Guangxi from 2009 to 2019. Phylogenetic and Bayesian time-geographic analyses of HIV-1 sequences were performed to confirm the characteristics of transmission between IDUs in combination with epidemiological data. RESULTS: Among the 535 subjects, CRF08_BC (57.4%), CRF01_AE (28.4%), and CRF07_BC (10.7%) were the top 3 HIV strains; 72.6% of infections were linked to other provinces in the transmission network; 93.6% of sequence-transmitted strains were locally endemic, with the rest coming from other provinces, predominantly Guangdong and Yunnan; 92.1% of the HIV transmission among people who inject drugs tended to be transmitted between HIV-positive IDUs. CONCLUSION HIV recombinants were high diversity, and circulating local strains were the transmission sources among IDUs in Guangxi. However, there were still cases of IDUs linked to other provinces. Coverage of traditional prevention strategies should be expanded, and inter-provincial collaboration between Guangxi, Yunnan, and Guangdong provinces should be strengthened.
Humans ; HIV-1/genetics* ; HIV Infections ; Drug Users ; Phylogeny ; Bayes Theorem ; China/epidemiology* ; Genotype