1.Interpretation of Expert Consensus on the Management of Low-Level Viremia in People Living with HIV ( 2025 Edition)
Chinese Journal of Clinical Infectious Diseases 2025;18(2):92-95
People living with HIV(PLWH)experiencing low-level viremia(LLV)face increased risks of virologic failure,abnormal immune activation,HIV drug resistance mutations,AIDS-related and non-AIDS-related comorbidities,and mortality. Currently,standardized management guidelines specifically addressing LLV in the context of HIV care are lacking in China. To address this gap,the AIDS Committee,Chinese Society of Tropical Disease and Parasitology,Infectious Diseases Professional Committee of Zhejiang Society for Mathematical Medicine,and Committee of AIDS Diagnosis and Treatment Quality Control Management,Zhejiang Provincial STD/AIDS Prevention Association jointly formulated the Expert Consensus on the Management ofLow- Level Viremia in People Living withHIV(2025 Edition). This consensus synthesizes domestic clinical practices,international guidelines,recent research advancements,and expert recommendations. This article provides a critical interpretation of the key recommendations outlined in the consensus.
2.The role of diagnostic whole body scan in decision-making of 131I treatment for differentiated thyroid cancer
Xiaotong JIANG ; Jinchuan LIU ; Yingqiang ZHANG ; Tong WANG ; Ning GUO ; Yuqing SUN ; Cong SHI ; Bing YAN ; Yansong LIN
China Oncology 2025;35(1):77-84
Background and purpose:As one of the first-line treatment methods for differentiated thyroid cancer(DTC),131I treatment is an important therapeutic approach for most patients with medium-high recurrence risk DTC after total or near-total thyroidectomy.Risk stratification and real-time dynamic assessment before 131I treatment after surgery are important steps in deciding on 131I treatment,enabling individualized treatment.This retrospective study aimed to explore the role of diagnostic whole body scan(DxWBS)in the decision-making of treatment for DTC after surgery and before 131I therapy.Methods:DTC patients who underwent pre-ablation evaluation were included.Patients were divided into low,medium and high sTg groups based on their pre-131I treatment stimulated thyroglobulin(sTg)levels(<1 ng/mL,1 ng/mL≤sTg<10 ng/mL,sTg≥10 ng/mL).The concordance rates of DxWBS and post treatment whole body scan(RxWBS)in each patient of the whole cohort were compared.The lesion detection rate between DxWBS and RxWBS in different sTg level groups was also explored.The"thyroid stunning effect"by DxWBS was evaluated by RxWBS.Through these analyses,the role of DxWBS in 131I treatment decision-making and its predicting treatment objectives were assessed.This study was approved by the Ethics Committee of Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences(ethics number:JS-2151).Results:A total of 91 patients were included.The low,medium and high sTg groups accounted for 15.4%(14/91),34.1%(31/91)and 50.5%(46/91)of the patients,respectively.Comparison of DxWBS and RxWBS results in the same patients in each sTg group showed no evidence of a stunning effect on 131I treatment.The overall concordance rate between DxWBS and RxWBS was 89.0%(81/91);In different sTg level groups was 100.0%(14/14),90.3%(28/31),84.8%(39/46)respectively.Taking sTg levels into consideration,DxWBS accurately predicted the need for total thyroidectomy,with a 100%(20/20)agreement with RxWBS.Among the 71 patients who received adjuvant therapy and/or remnant ablation due to suspected elevated Tg or high recurrence risk stratification or the iodine-avid metastatic lesions identified by DxWBS,87.5%(63/71)showed only residual thyroid tissue by DxWBS;Through the purpose verification by RxWBS and single photon emission computed tomography(SPECT)/CT,only 12.7%(9/71)of cases were verified as adjuvant or tumoricidal treatment due to iodine-avid cervical lymph node and/or lung metastasis identified by RxWBS,87.3%(62/71)were residual thyroid ablation.In the medium and high sTg group,the overall detection rate of functional cervical lymph node metastasis by DxWBS and RxWBS was 5.5%(5/91).For the detection of functional lung metastases,the overall detection rate of DxWBS was slightly lower than that of RxWBS(3.3%vs 5.5%).This indicates that DxWBS can be used to accurately pre-judge the purposes of 131I treatment,particularly for thyroid ablation and adjuvant therapy.Conclusion:DxWBS did not induce"thyroid stunning"effect.Integrating DxWBS as a theranostic tool into the real-time decision-making and evaluation system of 131I treatment,as well as with sTg and other biochemical indicators,may help to bridge the limitations of static evaluations based on pathology and clinical data,and provides a clear understanding and more precise objectives of 131I treatment.
3.Interpretation of Expert Consensus on the Management of Low-Level Viremia in People Living with HIV ( 2025 Edition)
Chinese Journal of Clinical Infectious Diseases 2025;18(2):92-95
People living with HIV(PLWH)experiencing low-level viremia(LLV)face increased risks of virologic failure,abnormal immune activation,HIV drug resistance mutations,AIDS-related and non-AIDS-related comorbidities,and mortality. Currently,standardized management guidelines specifically addressing LLV in the context of HIV care are lacking in China. To address this gap,the AIDS Committee,Chinese Society of Tropical Disease and Parasitology,Infectious Diseases Professional Committee of Zhejiang Society for Mathematical Medicine,and Committee of AIDS Diagnosis and Treatment Quality Control Management,Zhejiang Provincial STD/AIDS Prevention Association jointly formulated the Expert Consensus on the Management ofLow- Level Viremia in People Living withHIV(2025 Edition). This consensus synthesizes domestic clinical practices,international guidelines,recent research advancements,and expert recommendations. This article provides a critical interpretation of the key recommendations outlined in the consensus.
4.The role of diagnostic whole body scan in decision-making of 131I treatment for differentiated thyroid cancer
Xiaotong JIANG ; Jinchuan LIU ; Yingqiang ZHANG ; Tong WANG ; Ning GUO ; Yuqing SUN ; Cong SHI ; Bing YAN ; Yansong LIN
China Oncology 2025;35(1):77-84
Background and purpose:As one of the first-line treatment methods for differentiated thyroid cancer(DTC),131I treatment is an important therapeutic approach for most patients with medium-high recurrence risk DTC after total or near-total thyroidectomy.Risk stratification and real-time dynamic assessment before 131I treatment after surgery are important steps in deciding on 131I treatment,enabling individualized treatment.This retrospective study aimed to explore the role of diagnostic whole body scan(DxWBS)in the decision-making of treatment for DTC after surgery and before 131I therapy.Methods:DTC patients who underwent pre-ablation evaluation were included.Patients were divided into low,medium and high sTg groups based on their pre-131I treatment stimulated thyroglobulin(sTg)levels(<1 ng/mL,1 ng/mL≤sTg<10 ng/mL,sTg≥10 ng/mL).The concordance rates of DxWBS and post treatment whole body scan(RxWBS)in each patient of the whole cohort were compared.The lesion detection rate between DxWBS and RxWBS in different sTg level groups was also explored.The"thyroid stunning effect"by DxWBS was evaluated by RxWBS.Through these analyses,the role of DxWBS in 131I treatment decision-making and its predicting treatment objectives were assessed.This study was approved by the Ethics Committee of Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences(ethics number:JS-2151).Results:A total of 91 patients were included.The low,medium and high sTg groups accounted for 15.4%(14/91),34.1%(31/91)and 50.5%(46/91)of the patients,respectively.Comparison of DxWBS and RxWBS results in the same patients in each sTg group showed no evidence of a stunning effect on 131I treatment.The overall concordance rate between DxWBS and RxWBS was 89.0%(81/91);In different sTg level groups was 100.0%(14/14),90.3%(28/31),84.8%(39/46)respectively.Taking sTg levels into consideration,DxWBS accurately predicted the need for total thyroidectomy,with a 100%(20/20)agreement with RxWBS.Among the 71 patients who received adjuvant therapy and/or remnant ablation due to suspected elevated Tg or high recurrence risk stratification or the iodine-avid metastatic lesions identified by DxWBS,87.5%(63/71)showed only residual thyroid tissue by DxWBS;Through the purpose verification by RxWBS and single photon emission computed tomography(SPECT)/CT,only 12.7%(9/71)of cases were verified as adjuvant or tumoricidal treatment due to iodine-avid cervical lymph node and/or lung metastasis identified by RxWBS,87.3%(62/71)were residual thyroid ablation.In the medium and high sTg group,the overall detection rate of functional cervical lymph node metastasis by DxWBS and RxWBS was 5.5%(5/91).For the detection of functional lung metastases,the overall detection rate of DxWBS was slightly lower than that of RxWBS(3.3%vs 5.5%).This indicates that DxWBS can be used to accurately pre-judge the purposes of 131I treatment,particularly for thyroid ablation and adjuvant therapy.Conclusion:DxWBS did not induce"thyroid stunning"effect.Integrating DxWBS as a theranostic tool into the real-time decision-making and evaluation system of 131I treatment,as well as with sTg and other biochemical indicators,may help to bridge the limitations of static evaluations based on pathology and clinical data,and provides a clear understanding and more precise objectives of 131I treatment.
5.Balancing standardized management and individualized implementation of antiretroviral therapy during pregnancy: an interpretation of the Expert Consensus on Antiretroviral Therapy for Women Living with HIV during Pregnancy ( 2025 version)
Zongxing YANG ; Zhongdong ZHANG ; Jinchuan SHI
Chinese Journal of Clinical Infectious Diseases 2025;18(4):280-284,304
The management of antiretroviral therapy(ART)in pregnant women living with HIV presents considerable challenges,necessitating a comprehensive approach that integrates virological suppression,drug safety,physiological changes during pregnancy,co-infections,and maternal-infant outcomes. To address these issues,the AIDS Committee of the Chinese Society of Tropical Disease and Parasitology,the Perinatal Infection Professional Committee of the Zhejiang Maternal and Child Health Association,and the Committee of AIDS Diagnosis and Treatment Quality Control Management of the Zhejiang Provincial STD/AIDS Prevention Association jointly developed the Expert Consensus on Antiretroviral Therapy for Women Living with HIV During Pregnancy(2025 version). This consensus synthesizes international guidelines,the latest evidence-based research,and clinical expertise tailored to the management of HIV-infected pregnant women in China. It systematically outlines key aspects of ART management across various clinical scenarios during pregnancy,including treatment initiation or re-initiation,dynamic monitoring,regimen optimization,continuum of perinatal care,and management of co-infections,thereby establishing a clinically applicable decision-making framework. This article interprets the core recommendations and clinical applications of the consensus to assist healthcare providers in optimizing care for this population.
6.Balancing standardized management and individualized implementation of antiretroviral therapy during pregnancy: an interpretation of the Expert Consensus on Antiretroviral Therapy for Women Living with HIV during Pregnancy ( 2025 version)
Zongxing YANG ; Zhongdong ZHANG ; Jinchuan SHI
Chinese Journal of Clinical Infectious Diseases 2025;18(4):280-284,304
The management of antiretroviral therapy(ART)in pregnant women living with HIV presents considerable challenges,necessitating a comprehensive approach that integrates virological suppression,drug safety,physiological changes during pregnancy,co-infections,and maternal-infant outcomes. To address these issues,the AIDS Committee of the Chinese Society of Tropical Disease and Parasitology,the Perinatal Infection Professional Committee of the Zhejiang Maternal and Child Health Association,and the Committee of AIDS Diagnosis and Treatment Quality Control Management of the Zhejiang Provincial STD/AIDS Prevention Association jointly developed the Expert Consensus on Antiretroviral Therapy for Women Living with HIV During Pregnancy(2025 version). This consensus synthesizes international guidelines,the latest evidence-based research,and clinical expertise tailored to the management of HIV-infected pregnant women in China. It systematically outlines key aspects of ART management across various clinical scenarios during pregnancy,including treatment initiation or re-initiation,dynamic monitoring,regimen optimization,continuum of perinatal care,and management of co-infections,thereby establishing a clinically applicable decision-making framework. This article interprets the core recommendations and clinical applications of the consensus to assist healthcare providers in optimizing care for this population.
7.Mental health disparities in people living with human immunodeficiency virus: A cross-sectional study on physician-patient concordance and treatment regimens
Jinchuan SHI ; Zhongdong ZHANG ; Junyan ZHANG ; Yishu ZHANG ; Jiating QIU ; Fang LIU ; Daoyuan SONG ; Yanfang MA ; Lianmei ZHONG ; Hongxing WANG ; Xiaolei LIU
Chinese Medical Journal 2024;137(18):2223-2232
Background::Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown.Methods::A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen’s kappa test was used to assess the agreement between physicians and PLWH.Results::The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% ( P <0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis ( P <0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR] = 0.71, 95% CI: 0.59-0.87, P = 0.003) and a lower prevalence of anxiety issues (OR = 0.63, 95% CI: 0.52-0.76, P <0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR = 0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR = 0.81, 95% CI: 0.67-0.99). Conclusion::Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.
8.Application value of heparin binding protein,NLR,LMR,and PLR in immune function reconstruction evaluation in HIV/AIDS patients
Lingyan HE ; Jinchuan SHI ; Jianghao CHENG ; Mingli ZHU
China Modern Doctor 2024;62(32):52-55
Objective To explore the application value of heparin binding protein(HBP),neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR),and platelet to lymphocyte ratio(PLR)in the evaluation of immune function reconstruction in human immunodeficiency virus(HIV)infected individuals/acquired immunodeficiency syndrome(AIDS)patients.Methods Collect 138 HIV/AIDS patients from the Outpatient Department of Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from January 1,to June 30,2023.According to CD4+T lymphocyte counts after antiretroviral treatment,categorize patients into groups with good immune function reconstruction(n=108)and poor immune function reconstruction(n=30).Compare the levels of HBP,NLR,LMR,and PLR between two groups,receiver operating characteristic(ROC)curve was used to evaluate the application value of HBP,NLR,LMR,and PLR in the reconstruction of patient immune function.Results The NLR and PLR of group with good immune function reconstruction was significantly higher than that of group with poor immune function reconstruction(P<0.05).The LMR of group with good immune function reconstruction were significantly lower than those of group with poor immune function reconstruction(P<0.05).The HBP between two groups was no significant differences(P>0.05).LMR had the best efficacy in evaluating whether immune function reconstruction was good in HIV/AIDS patients area under the curve(AUC)=0.803,PLR was the second(AUC)=0.796,NLR was poor(AUC)=0.728.Conclusion NLR,LMR,and PLR are closely related to the immune function of HIV/AIDS patients and can be used as detection indicators to evaluate whether the immune function reconstruction of HIV/AIDS patients is good.
9.Expert consensus on the clinical application of long-acting cabotegravir and rilpivirine
Lijun SUN ; Hongxia WEI ; Haibo DING ; Ping MA ; Hui WANG ; Lijing WANG ; Chunmei WANG ; Min WANG ; Qian WANG ; Hai LONG ; Jinchuan SHI ; Wei LYU ; Biao ZHU ; Jun LIU ; An LIU ; Lianguo RUAN ; Zaicun LI ; Linghua LI ; Huiqin LI ; Shenghua HE ; Meiyin ZOU ; Yuxia SONG ; Renfang ZHANG ; Jian ZHANG ; Xinping YANG ; Yahong CHEN ; Yaokai CHEN ; Hongxin ZHAO ; Qingxia ZHAO ; Zhongsi HONG ; Feng QIAN ; Guangyong XU ; Huihuang HUANG ; Wei CAO ; Jianhua YU ; Juan JIN ; Lin CAI ; Fujie ZHANG
Chinese Journal of Clinical Infectious Diseases 2024;17(6):431-439
The long-acting cabotegravir and rilpivirine injection regimen(CAB+RPV regimen)is the first approved long-acting antiretroviral therapy(ART)for HIV in China,administered once every two months. This regimen provides an innovative alternative to daily oral ART,benefiting virologically suppressed patients. Several large clinical-studies have shown that the CAB+RPV regimen achieves comparable virologic suppression and safety to daily oral regimens,while significantly enhancing patient satisfaction. Based on international and domestic HIV/AIDs guidelines and clinical evidence,this consensus offers expert recommendations on patient selection,clinical management,and key communication strategies for healthcare providers to support the effective use of this regimen,aiming to improve quality of life for people living with HIV and accumulate domestic clinical experience with this advanced treatment approach.
10.Expert consensus on the clinical application of long-acting cabotegravir and rilpivirine
Lijun SUN ; Hongxia WEI ; Haibo DING ; Ping MA ; Hui WANG ; Lijing WANG ; Chunmei WANG ; Min WANG ; Qian WANG ; Hai LONG ; Jinchuan SHI ; Wei LYU ; Biao ZHU ; Jun LIU ; An LIU ; Lianguo RUAN ; Zaicun LI ; Linghua LI ; Huiqin LI ; Shenghua HE ; Meiyin ZOU ; Yuxia SONG ; Renfang ZHANG ; Jian ZHANG ; Xinping YANG ; Yahong CHEN ; Yaokai CHEN ; Hongxin ZHAO ; Qingxia ZHAO ; Zhongsi HONG ; Feng QIAN ; Guangyong XU ; Huihuang HUANG ; Wei CAO ; Jianhua YU ; Juan JIN ; Lin CAI ; Fujie ZHANG
Chinese Journal of Clinical Infectious Diseases 2024;17(6):431-439
The long-acting cabotegravir and rilpivirine injection regimen(CAB+RPV regimen)is the first approved long-acting antiretroviral therapy(ART)for HIV in China,administered once every two months. This regimen provides an innovative alternative to daily oral ART,benefiting virologically suppressed patients. Several large clinical-studies have shown that the CAB+RPV regimen achieves comparable virologic suppression and safety to daily oral regimens,while significantly enhancing patient satisfaction. Based on international and domestic HIV/AIDs guidelines and clinical evidence,this consensus offers expert recommendations on patient selection,clinical management,and key communication strategies for healthcare providers to support the effective use of this regimen,aiming to improve quality of life for people living with HIV and accumulate domestic clinical experience with this advanced treatment approach.

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