Objective:To identify the association between CD4 +T lymphocyte (CD4) counts and physical frailty among HIV-infected people aged 65 years and older, and evaluate whether this association will be modified by the indicators of body composition. Methods:From May to October 2022, 485 elderly HIV-infected patients receiving antiretroviral therapy (ART) were recruited from 7 antiviral treatment sites in Jiangjin District Center for Disease Control and Prevention, Chongqing. The data of basic characteristics (age and gender), living habits (smoking and drinking) and disease history (metabolic diseases, cardiovascular and cerebrovascular diseases, respiratory disease and malignant tumors) were collected through the face-to-face investigation with self-made questionnaires. Fried Frailty Scale was used to evaluate the status of physical frailty. Physical fitness (walking speed, grip strength, height, and weight) and body composition (skeletal muscle mass, body fat mass, and basal metabolic rate) were measured. The antiretroviral treatment data were obtained from the China AIDS Integrated Prevention and Treatment Data information management system. The prevalence of physical frailty was calculated among the HIV-infected patients. The potential effects of CD4 counts on physical frailty were explored by using multivariate logistic regression. Subgroup analyses were repeated in the logistic regression with muscle mass, body fat mass, and other indicators of body composition as subgroup variables to determine whether the association might be modified by body composition.Results:The age of 485 patients were (72±5) years old, of which 48.2% (234 cases) were>70 years old and 70.9% (344 cases) were male, and all of whom had initiated the ART treatment. The prevalence of physical frailty among these patients was 7.4% (36/485). Multivariate logistic regression showed that after adjusting for age, sex, smoking, drinking, body composition index, ART duration, viral load and the number of comorbidities, increased CD4 cell level was associated with decreased prevalent risk of physical frailty among elderly HIV-infected patients. For every increase of 5.0×10 7 CD4 cells/L, the prevalent risk of physical frailty decreased by 12% [ OR (95% CI): 0.88 (0.76-1.01)]. Compared with the low CD4 cell level group, the risk of physical frailty in those with normal CD4 cell level decreased by 69% [ OR (95% CI): 0.31 (0.10-0.92)]. Subgroup analysis of body composition indicators showed that the protective effect of normal CD4 cell level on physical frailty was more pronounced in the high skeletal muscle mass and high basal metabolic rate group ( Pinteraction<0.05). Conclusion:The prevalence of physical frailty among elderly HIV-infected patients is relatively lower in Chongqing, and the CD4 cell level, skeletal muscle mass and basal metabolic rate are related to physical frailty.

Objective:To identify the association between CD4 +T lymphocyte (CD4) counts and physical frailty among HIV-infected people aged 65 years and older, and evaluate whether this association will be modified by the indicators of body composition. Methods:From May to October 2022, 485 elderly HIV-infected patients receiving antiretroviral therapy (ART) were recruited from 7 antiviral treatment sites in Jiangjin District Center for Disease Control and Prevention, Chongqing. The data of basic characteristics (age and gender), living habits (smoking and drinking) and disease history (metabolic diseases, cardiovascular and cerebrovascular diseases, respiratory disease and malignant tumors) were collected through the face-to-face investigation with self-made questionnaires. Fried Frailty Scale was used to evaluate the status of physical frailty. Physical fitness (walking speed, grip strength, height, and weight) and body composition (skeletal muscle mass, body fat mass, and basal metabolic rate) were measured. The antiretroviral treatment data were obtained from the China AIDS Integrated Prevention and Treatment Data information management system. The prevalence of physical frailty was calculated among the HIV-infected patients. The potential effects of CD4 counts on physical frailty were explored by using multivariate logistic regression. Subgroup analyses were repeated in the logistic regression with muscle mass, body fat mass, and other indicators of body composition as subgroup variables to determine whether the association might be modified by body composition.Results:The age of 485 patients were (72±5) years old, of which 48.2% (234 cases) were>70 years old and 70.9% (344 cases) were male, and all of whom had initiated the ART treatment. The prevalence of physical frailty among these patients was 7.4% (36/485). Multivariate logistic regression showed that after adjusting for age, sex, smoking, drinking, body composition index, ART duration, viral load and the number of comorbidities, increased CD4 cell level was associated with decreased prevalent risk of physical frailty among elderly HIV-infected patients. For every increase of 5.0×10 7 CD4 cells/L, the prevalent risk of physical frailty decreased by 12% [ OR (95% CI): 0.88 (0.76-1.01)]. Compared with the low CD4 cell level group, the risk of physical frailty in those with normal CD4 cell level decreased by 69% [ OR (95% CI): 0.31 (0.10-0.92)]. Subgroup analysis of body composition indicators showed that the protective effect of normal CD4 cell level on physical frailty was more pronounced in the high skeletal muscle mass and high basal metabolic rate group ( Pinteraction<0.05). Conclusion:The prevalence of physical frailty among elderly HIV-infected patients is relatively lower in Chongqing, and the CD4 cell level, skeletal muscle mass and basal metabolic rate are related to physical frailty.

Objective: To assess risk of HIV infection and its risk factors among men who have sex with men (MSM) in Beijing, China. Methods: We conducted a cross-sectional online survey in October, 2017. Inclusion criteria of participants were: aged 18 year or more; resided in Beijing; conducted homosexual activities in past six months; self-reported HIV status as negative or unclear. Demographic information, HIV test history, social media use, and high-risk sexual behaviors were collected by a self-reporting questionnaire, and a HIV risk assessment tool was used to assess HIV risk of MSM, 5 388 particpants were finally enrolled in the study. Logistic regression model was used to analyze factors associated with risk of HIV infection. Results: Of the total 5 388 participants, most were 18-29 years old (64.35%), and the proportion of medium and high HIV risk score was 40.36%. The odds of medium and high HIV risk score among MSM who logged onto the app 1-20 times per week and>20 times per week were higher comparing with those who logged onto the app<1 time per week (OR=1.22, 95%CI: 1.02-1.46; OR=1.69, 95%CI: 1.38-2.06, respectively); MSM who completed college or higher education had lower probability of medium and high HIV infection risk, comparing with those who only had high school education level (OR=1.25, 95%CI:1.09-1.43) or junior or below education level (OR: 1.27, 95%CI: 1.05-1.53); MSM who did not conduct HIV test in past year had lower risk of medium and high HIV infection risk comparing with MSM who conducted HIV test in past year (OR=0.87, 95%CI: 0.77-0.99), and those who reported their HIV infection status unclear had higher probability of medium and high HIV infection risk than MSM who reported their HIV infection status negative (OR: 1.63, 95%CI: 1.44-1.86). Conclusion The proportion of MSM who were in medium and high HIV infection risk score was high in Beijing. Lower level of education, high frequency of social media use, conducted HIV test in past year, and unclear of their own HIV infection status were associated with medium and high level of HIV infection risk.

Objective To assess the current status of HIV test during the past year and related factors in men who have sex with men (MSM) in college students in China.Methods Based on a MSM website,a cross-sectional study was conducted in 500 MSM in college students aged 18-25 years,who were selected based on the estimated HIV detection rate of 50％ in this population,by means of mobile phone questionnaire survey.x2 test and non-conditional multivariate logistic regression analysis were conducted to identify the factors related with HIV test,respectively.Results The mean age of MSM in college students was 20.99 (± 0.04) years and the HIV test rate during the past year was 47.1％ (652/1 384).Multivariate logistic regression analysis indicated that active factors associated with HIV test included awareness of HIV test (OR=6.37,95％CI:3.592-11.300),willing to receive regular HIV testing (OR=2.64,95％CI:1.191-2.631) well-knowing or not knowing of the HIV infection statues of their regular sex partners (OR=3.58,95％ CI:2.138-5.996),(OR=2.25,95％ CI:1.479-3.422),respectively.The negative factors associated with HIV test included believing their regular sex partners not being infected with HIV (OR=0.65,95％CI:0.445-0.938),having only one regular sex partner during the past year (OR=0.37,95％CI:0.232-0.589).Conclusion The survey indicated that the HIV test rate in MSM in college students during the past year was low.The MSM in college students are usually sexual active,but less of them received HIV test due to the trust between them and less number of sexual partners.Close attention should be paid to the AIDS intervention in this population.

Objective To analyze the effect of missing data in population based viral load (PVL) survey in HIV infected men who have sex with men (MSM) sampled in 16 cities in China.Methods The database of 3 virus load sampling survey conducted consecutively in HIV infected MSM population in 16 large cities (Beijing,Shanghai,Nanjing,Hangzhou,Wuhan,Chongqing,Kunming,Xi' an,Guangzhou,Shenzhen,Narning,Urumuqi,Harbin,Changchun,Chengdu and Tianjin) during 2013-2015 was used.SPSS 17.0 software was used to describe distribution of the missing data and analyze associated factors.Results A total of 12 150 HIV infected MSM were randomly selected for the surveys,in whom,9 141 (75.2％) received virus load tests,while 3 009 (24.8％) received no virus load tests,whose virus load data missed.The virus load data missing rates in MSM with or without access to antiretroviral therapy (ART) were 11.5％ (765/6 675) and 39.4％ (2 060/5 223) respectively,and the virus load data missing rates were 21.9％ (1 866/8 523) and 28.4％ (959/3 374),respectively,in local residents and non-local residents (migrants).Conclusions The analysis indicated that the data missing occurred in the virus load survey in HIV infected MSM population.ART status and census registering status were the main influencing factors.Data missing could influence the accurate evaluation of community viral load (CVL) and population viral load (PVL) levels in HIV infected MSM in China.

Objective To understand the distribution of population viral load (PVL) data in HIV infected men who have sex with men (MSM), fit distribution function and explore the appropriate estimating parameter of PVL. Methods The detection limit of viral load (VL) was ≤ 50 copies/ml. Box-Cox transformation and normal distribution tests were used to describe the general distribution characteristics of the original and transformed data of PVL, then the stable distribution function was fitted with test of goodness of fit. Results The original PVL data fitted a skewed distribution with the variation coefficient of 622.24%, and had a multimodal distribution after Box-Cox transformation with optimal parameter (λ) of-0.11. The distribution of PVL data over the detection limit was skewed and heavy tailed when transformed by Box-Cox with optimal λ=0. By fitting the distribution function of the transformed data over the detection limit, it matched the stable distribution (SD) function (α=1.70, β=-1.00, γ=0.78, δ=4.03). Conclusions The original PVL data had some censored data below the detection limit, and the data over the detection limit had abnormal distribution with large degree of variation. When proportion of the censored data was large, it was inappropriate to use half-value of detection limit to replace the censored ones. The log-transformed data over the detection limit fitted the SD. The median (M) and inter-quartile ranger (IQR) of log-transformed data can be used to describe the centralized tendency and dispersion tendency of the data over the detection limit.

Objective To compare results of different methods in organizing HIV viral load (VL) data with missing values mechanism. Methods We used software SPSS 17.0 to simulate complete and missing data with different missing value mechanism from HIV viral loading data collected from MSM in 16 cities in China in 2013. Maximum Likelihood Methods Using the Expectation and Maximization Algorithm (EM), regressive method, mean imputation, delete method, and Markov Chain Monte Carlo (MCMC) were used to supplement missing data respectively. The results of different methods were compared according to distribution characteristics, accuracy and precision. Results HIV VL data could not be transferred into a normal distribution. All the methods showed good results in iterating data which is Missing Completely at Random Mechanism (MCAR). For the other types of missing data, regressive and MCMC methods were used to keep the main characteristic of the original data. The means of iterating database with different methods were all close to the original one. The EM, regressive method, mean imputation, and delete method under-estimate VL while MCMC overestimates it. Conclusion MCMC can be used as the main imputation method for HIV virus loading missing data. The iterated data can be used as a reference for mean HIV VL estimation among the investigated population.

Objective To compare the community viral load (CVL) among MSM in 15 cities in China using standardized national reference sources.Methods The study analyzed the existing database of National Major Science and Technology Project of China.The database was established with serial random survey of MSM HIV CVL among MSM in 15 cities from 2013 to 2015.VL tests were conducted in 15 laboratories with different equipment and methods,including RT-PCR,nucleic acid sequence based amplification (NASBA),branched DNA testing (bDNA) and Abbott M2000 RealTime system (M2000).Based on proficiency test for 15 laboratories conducted by National HIV Reference Laboratory,VL test values detected with EasyQ,bDNA and M2000 were converted and standardized into resultant values of TaqMan 2.0.Software SPSS 17.0 was used to produce descriptive statistics for the dataset.Results From 2014 to 2015,the 15 testing sites were found to use a number of different viral load detection techniques.In 2014,the community viral load values were (2.38 ±1.47) and (2.99 ± 1.31) in 15 testing sites,while in 2015 these values were found to be (2.07± 1.34) and (2.72± 1.19).The measurement of community VL was done using standard benchmarks of ≤200 copies/ml,≤400 copies/ml and ≤1 000 copies/ml,that were used for reference for now.Conclusion It is necessary to use standard detection method to improve the comparability of annual results.Using a standardized rate of ≤400 copies/ml or ≤ 1 000 copies/ml for successful control of VL was found with high stability for the result comparison among different areas.

OBJECTIVETo analyze factors associated with antiretroviral therapy (ART) initiation and its timeliness among HIV sero-discordant couples in high HIV prevalence regions in China.

METHODSData from the national HIV epidemiology and treatment databases by Dec 31, 2013 were used to collect HIV serodiscordant couples' baseline and follow-up informations in 40 counties which had reported 200 HIV cases cumulatively from Yunnan, Guangxi, Sichuan, Henan, and Xinjiang. Positive couples were divided into ART group and Non-ART group based on their ART initiation status. Sero-discordant couples that were reported between January 1, 2012 and October 31, 2013 and initiated ART treatment by 2013, were classified into two categories: 'having initiated ART within two months of receiving their HIV diagnosis', and not accessing timely treatment as 'having not initiated ART within two months of receiving their HIV diagnosis'. Multivariate logistic regressions were used to analyze potential factors associated with ART initiation and serodiscordant couples' timeliness to treatment. Odds ratios (95% confidence internal) were used to measure the associations.

RESULTSA total of 10 213 HIV-positive individuals were included in this study, among whom 73.9% (7 550/10 213) were males and 26.1% (2 663/10 213) were females, 66.4% (6 780/10 213) had initiated ART and 33.6% (3 433/10 213) had not. There were 1 733 serodiscordant couples who were reported during January 1, 2012 to October 31, 2013 had initiated ART. Among those 64.9% (1 125/1 733) had successfully initiated ART within two months of receiving their HIV diagnosis and 35.1% (608/1 733) had not. Multivariate logistic regression analysis showed that those being male were 0.81(0.71-0.92) less likely to initiate ART, as compared with those being female. Those being Yi ethnicity were 0.29(0.25-0.35) less likely to initiate ART, as compared with those being Han ethnicity. Those being Uygur ethnicity were 1.57 (1.28-1.93) times more likely to initiate ART, as compared with those being Han ethnicity. Those engaging the other jobs were 0.85(0.75-0.96) less likely to initiate ART, as compared with those being peasant. Those being diagnosed in medical institutions were 0.61 (0.53-0.71) less likely to initiate ART, as compared with those being diagnosed in VCT. Those having CD4⁺ T cells of 250-349, 350-550 and > 550 were 0.75 (0.64-0.89), 0.17 (0.14-0.19), 0.10 (0.08-0.11) less likely to initiate ART, respectively, as compared with those having CD4⁺ T cells of < 250. Those having duration of follow-up of 13-36 months and ≥ 37 months were 0.55(0.48-0.63) and 0.32 (0.28-0.37) less likely to initiate ART respectively, as compared with those having duration of follow-up of ≤ 12 months. Multivariate logistic regression analysis showed that those being Yi and Uygur ethnicity were 0.63 (0.44-0.91) and 0.40(0.29-0.56) less likely to initiate ART timely respectively, as compared with those being Han ethnicity. Those being infected through injecting drug use were 0.64 (0.47-0.86) less likely to initiate ART timely, as compared with those being infected through heterosexual intercourse. Those being diagnosed in other institutions were 0.58(0.43-0.78) less likely to initiate ART timely, as compared with those being diagnosed in VCT. Those having CD4⁺T cells of 250-349, 350-550 and > 550 were 0.75(0.56-1.00), 0.44(0.34-0.58), and 0.31(0.22-0.45) less likely to initiate ART timely respectively, as compared with those having CD4⁺ T cells of < 250.

CONCLUSIONBeing males, being Yi ethnicity, engaging other jobs, being diagnosed in medical institutions, having high CD4⁺ T cells and having long duration of follow-up were risk factors for initiating ART among serodiscordant couples.Being Yi and Uygur ethnicity, being infected through injecting drug use, and having CD4⁺ T cells were risk factors for initiating ART timely among serodiscordant couples.

Anti-Retroviral Agents ; Asian Continental Ancestry Group ; CD4 Lymphocyte Count ; China ; Disease Transmission, Infectious ; Family Characteristics ; Female ; HIV Infections ; Humans ; Logistic Models ; Male ; Occupations ; Prevalence ; Risk Factors ; Street Drugs ; Time-to-Treatment

Objective To analyze factors associated with antiretroviral therapy (ART) initiation and its timeliness among HIV sero?discordant couples in high HIV prevalence regions in China. Methods Data from the national HIV epidemiology and treatment databases by Dec 31, 2013 were used to collect HIV serodiscordant couples' baseline and follow?up informations in 40 counties which had reported 200 HIV cases cumulatively from Yunnan, Guangxi, Sichuan, Henan,and Xinjiang. Positive couples were divided into ART group and Non?ART group based on their ART initiation status. Sero?discordant couples that were reported between January 1, 2012 and October 31, 2013 and initiated ART treatment by 2013, were classified into two categories:‘having initiated ART within two months of receiving their HIV diagnosis', and not accessing timely treatment as‘having not initiated ART within two months of receiving their HIV diagnosis'. Multivariate logistic regressions were used to analyze potential factors associated with ART initiation and serodiscordant couples' timeliness to treatment. Odds ratios (95% confidence internal) were used to measure the associations. Results A total of 10 213 HIV?positive individuals were included in this study, among whom 73.9%(7 550/10 213) were males and 26.1%(2 663/10 213) were females, 66.4%(6 780/10 213) had initiated ART and 33.6%(3 433/10 213) had not. There were 1 733 serodiscordant couples who were reported during January 1, 2012 to October 31, 2013 had initiated ART. Among those 64.9%(1 125/1 733) had successfully initiated ART within two months of receiving their HIV diagnosis and 35.1%(608/1 733) had not. Multivariate logistic regression analysis showed that those being male were 0.81(0.71-0.92) less likely to initiate ART, as compared with those being female. Those being Yi ethnicity were 0.29(0.25-0.35) less likely to initiate ART, as compared with those being Han ethnicity. Those being Uygur ethnicity were 1.57(1.28-1.93) times more likely to initiate ART, as compared with those being Han ethnicity. Those engaging the other jobs were 0.85(0.75-0.96) less likely to initiate ART, as compared with those being peasant. Those being diagnosed in medical institutions were 0.61(0.53-0.71) less likely to initiate ART, as compared with those being diagnosed in VCT. Those having CD4+T cells of 250-349 , 350-550 and>550 were 0.75(0.64-0.89), 0.17(0.14-0.19), 0.10(0.08-0.11) less likely to initiate ART,respectively, as compared with those having CD4+T cells of<250. Those having duration of follow?up of 13-36 months and≥37 months were 0.55(0.48-0.63) and 0.32(0.28-0.37) less likely to initiate ART respectively, as compared with those having duration of follow?up of≤12 months. Multivariate logistic regression analysis showed that those being Yi and Uygur ethnicity were 0.63(0.44-0.91) and 0.40(0.29-0.56) less likely to initiate ART timely respectively, as compared with those being Han ethnicity. Those being infected through injecting drug use were 0.64(0.47-0.86) less likely to initiate ART timely, as compared with those being infected through heterosexual intercourse. Those being diagnosed in other institutions were 0.58(0.43-0.78) less likely to initiate ART timely, as compared with those being diagnosed in VCT. Those having CD4+T cells of 250-349 , 350-550 and>550 were 0.75(0.56-1.00), 0.44(0.34-0.58), and 0.31(0.22-0.45) less likely to initiate ART timely respectively, as compared with those having CD4+T cells of<250. Conclusion Being males,being Yi ethnicity,engaging other jobs,being diagnosed in medical institutions,having high CD+4 T cells and having long duration of follow-up were risk factors for initiating ART among serodiscordant couples.Being Yi and Uygur ethnicity,being infected through injecting drug use,and having CD+4 T cells were risk factors for initiating ART timely among serodiscordant couples.