HIV subtypes convey important epidemiological information and possibly influence the rate of disease progression. In this study, HIV disease progression in patients infected with CRF01_AE, CRF07_BC, and subtype B was compared in the largest HIV molecular epidemiology study ever done in China. A national data set of HIV pol sequences was assembled by pooling sequences from public databases and the Beijing HIV laboratory network. Logistic regression was used to assess factors associated with the risk of AIDS at diagnosis ([AIDSAD], defined as a CD4 count < 200 cells/µL) in patients with HIV subtype B, CRF01_AE, and CRF07_BC. Of the 20,663 sequences, 9,156 (44.3%) were CRF01_AE. CRF07_BC was responsible for 28.3% of infections, followed by B (13.9%). In multivariable analysis, the risk of AIDSAD differed significantly according to HIV subtype (OR for CRF07_BC vs. B: 0.46, 95% CI 0.39─0.53), age (OR for ≥ 65 years vs. < 18 years: 4.3 95% CI 1.81─11.8), and transmission risk groups (OR for men who have sex with men vs. heterosexuals: 0.67 95% CI 0.6─0.75). These findings suggest that HIV diversity in China is constantly evolving and gaining in complexity. CRF07_BC is less pathogenic than subtype B, while CRF01_AE is as pathogenic as B.
Beijing has seen a rising epidemic of HIV among students. However, little information was known about the molecular epidemiologic data among HIV-infected students. In this study, the diversity and the prevalence of transmitted drug resistance (TDR) in pol sequences derived from 237 HIV-infected students were analyzed. TDR mutations were found in five men who have sex with men (MSM) population among students. The overall prevalence of TDR in students was 2.1%, comprising 1.3% of protease inhibitors and 0.8% of non-nucleoside reverse transcriptase inhibitors. Our finding indicates a low-level prevalence of TDR mutations among students in Beijing.
Background: HIV subtypes convey important epidemiological information and possibly influence the rate of disease progression. Data on the effect of HIV strains CRF01_AE and CRF07_BC on disease progression are limited, and information on national HIV subtype distribution and trends needs to be updated. In this study, HIV disease progression in patients infected with CRF01_AE, CRF07_BC, and subtype B was compared in the largest HIV molecular epidemiology study ever done in China.Methods: A national data set of HIV pol sequences was assembled by pooling sequences from public databases and the Beijing HIV laboratory network (BHLN). The BHLN routinely maintains a nationally transmitted drug resistance cohort. Sequence data was linked to demographic and clinical data from the national HIV epidemiology database. Subtypes were assigned using the automated subtyping tool context-based modeling for expeditious typing (COMET), subtype prevalence was assessed using demographic characteristics, and trends in subtype were determined by sampling phase. Logistic regression was used to assess factors associated with the risk of AIDS at diagnosis ([AIDSAD], defined as a CD4 count <200 cells/µL) in patients with HIV subtype B, CRF01_AE, and CRF07_BC.Findings: Of the 20,663 sequences, 9,156 (44.3%) were CRF01_AE. CRF07_BC was responsible for 28.3% of infections, followed by subtype B (13.9%), unique recombinant forms (5.9%), CRF55_01B (2.2%), CRF08_BC (1.7%), and subtype C (1.3%). In multivariable analysis, the risk of AIDSAD differed significantly according to HIV subtype (OR for CRF07_BC vs. subtype B: 0.46, 95% CI 0.39─0.53), age (OR for ≥65 years vs. <18 years: 4.3 95% CI 1.81─11.8), and transmission risk groups (OR for man who have sex with man vs. heterosexual: 0.67 95% CI 0.6─0.75).Interpretation: These findings suggest that HIV diversity in China is constantly evolving and gaining complexity. CRF07_BC is less pathogenic than subtype B, while CRF01_AE is as pathogenic as subtype B.Funding: Beijing Natural Science Foundation, China Capital’S Funds For Health Improvement and Research.Declaration of Interest: We declare no competing interests.Ethical Approval: The research ethics committee at the Beijing Center for DiseasePrevention and Control approved this study.
Objectives: Fifteen years after the roll-out of antiretroviral treatment (ART) in China, there is limited information available on transmitted HIV drug resistance (TDR). This study aimed to characterize the epidemiology of TDR in China. Design: We conducted a prospective cross-sectional observational study. Methods: We analyzed the demographic, clinical, and virological data of individuals with newly diagnosed HIV infection using data from the Beijing HIV laboratory network collected between 2001 and 2017. We did population-based sequencing of the pol gene on plasma specimens and identified TDR mutations using the WHO list for surveillance of TDR mutations. Results: Data on TDR were available for 91% of the 10 115 individuals with newly diagnosed HIV infection tested, of whom 19.2% were from rural areas. The overall prevalence of TDR was 4.1% [95% confidence interval (CI): 3.7–4.5%], with a declining trend over the period 2001–2017. In the multivariable analysis, the risk of TDR differed significantly according to sex [odds ratio (OR) for women vs. men: 0.41, 95% CI: 0.22–0.69, P = 0.002]; infection type (OR for CRF07_BC vs. CRF01_AE: 0.24, 95% CI: 0.16–0.36, P < 0.001); and sampling period (OR for 2009–2012 vs. 2001–2008: 0.57, 95% CI: 0.41–0.79; P = 0.01), and was significantly higher among individuals from Hebei province than in those from Beijing (OR: 1.43, 95% CI: 1.05–1.96; P = 0.02). Conclusion: In China, the prevalence of TDR among individuals with newly diagnosed HIV infection is relatively low. Trends in TDR should be assessed in other countries with a high TDR burden.
Objectives: To understand the prevalence of HIV nucleic acid using internet-based dry blood spots HIV testing strategy in men who had sex with men (MSM) and to probe the factors associated with HIV infection. Methods: Using convenient sampling method, 1 375 MSM were recruited and their dry blood spots samples were collected before being mailed to the laboratories for HIV nucleic acid testing. Results were showed to these MSM on a specific website by inputting their codes to it. Non-conditional binary logistic regression method was used to identify the associated factors on HIV infection. Results: The overall proportions of HIV nucleic acid positives appeared as 9.7% (131/1 349) and HIV antibody positives as 8.3% (112/1 349). Fresh infections accounted for 14.5% (19/131) among the newly-identified HIV nucleic acid positives, and the interval was ranging from 6 to 120 days, between the laboratory testings and the closest date that experiencing high risk behavior. Risk factors that related to HIV infection would include: 30 to 39 years of age (comparing to those under the age of 30, OR=1.88, 95%CI: 1.07-3.29), ≥8 000 Yuan of monthly income (comparing to those without income, OR=0.42, 95%CI: 0.19-0.96), inconsistent condom use during anal sexual contacts in the last six months (compared with those who had not anal sex or used condoms consistently in anal sex in the past six months, OR=2.22, 95%CI: 1.45-3.40), ever use of Rush Poppers (compared with those who never used Rush Poppers, OR=2.33, 95%CI: 1.49-3.64), addictive drug abuse (compared with those who never abused addictive drugs, OR=5.43, 95%CI: 2.32-12.69), and not having regular sexual partners (compared with having regular sexual partners, OR=1.74, 95%CI: 1.13-2.68) etc.. Conclusions: Dry blood spots HIV nucleic acid testing could help to identify the fresh HIV infections at an early stage, so as to prevent further transmission in the MSM population, among which fresh HIV infections accounted for a fairly large proportion. It is necessary to set up programs in reducing the abuse of drugs or Rush Poppers, and to promote condom use and advocate on stable sexual partnership etc., among the MSM population.目的： 应用"互联网＋"干血斑HIV核酸检测策略了解MSM的HIV核酸阳性率及MSM感染HIV的影响因素。 方法： 采用方便抽样的方法招募1 375位MSM，采集干血斑样本并邮寄到实验室进行HIV核酸检测。调查对象凭检测条码到指定网站查询检测结果。采用非条件logistic回归分析MSM感染HIV的影响因素。 结果： MSM中新发现HIV感染者的HIV核酸阳性率为9.7%（131/1 349），HIV抗体阳性率为8.3%（112/1 349）。HIV早期感染者占新发现的HIV核酸阳性者的14.5%（19/131），检测核酸阳性距最后1次高危行为时间间隔为6～120 d。多因素logistic回归分析结果显示，MSM感染HIV的影响因素包括30～39岁（与<30岁者比较，OR＝1.88，95%CI：1.07～3.29）、月收入≥8 000元（与无收入者比较，OR＝0.42，95%CI：0.19～0.96）、最近6个月肛交行为中未坚持使用安全套（与最近6个月未发生肛交行为或肛交时坚持使用安全套者相比，OR＝2.22，95%CI：1.45～3.40）、使用过Rush Poppers（与未使用过Rush Poppers者相比，OR＝2.33，95%CI：1.49～3.64）、使用过毒品（与未使用过毒品者相比，OR＝5.43，95%CI：2.32～12.69）、没有固定性伴（与有固定性伴者相比，OR＝1.74，95%CI：1.13～2.68）。 结论： 北京市MSM的早期感染者占有较大比例，开展"互联网＋"干血斑HIV核酸检测能够在更短的时间内发现早期HIV感染者，有助于减少二代传播。有必要在MSM中开展禁毒、禁用Rush Poppers、推广使用安全套、倡导稳定性关系等措施。.
To propose a new mode of HIV test and surveillance among population of men who have sex with men (MSM): Internet-based Self-sampling at home plus Laboratory testing of HIV total nucleic acid (TNA) in dried blood spot (DBS) (ISL of DBS TNA). Feasibility of ISL of DBS TNA was studied. Characteristics of the new mode and that of conventional surveillance mode at HIV voluntary counseling and testing clinic (VCT) were compared.A non-governmental organization (NGO) published the recruitment information on the WeChat public account. MSM filled in the questionnaire online, applied for self-sampling service package, and mailed the self made DBS to professional laboratory. The laboratory performed HIV TNA test and submitted the test results to online platform. Participants queried test results online with their unique ID. Center for Disease Control and Prevention (CDC) followed up participants with positive nucleic acid results using IDs and contact information. Rates were compared by using the Chi-Square test or Fisher's exact test.Four hundred twenty-three questionnaires were completed. 423 self-sampling service packages were sent out and 340 DBSs were returned to professional laboratory within one month with qualified rate of sampling as high as 95.0% (323/340). Seven samples were found to be TNA positive. Comparing ISL of DBS TNA with sentinel surveillance, it was found that there was a significant difference in the composition ratio of the two modes of surveillance population (P < 0.05). HIV prevalence of ISL of DBS as 2.17% was significantly lower than sentinel site as 8.96% (χ2 = 14.953, P = 0.000 < 0.05).ISL of DBS TNA proposed is feasible and has a high self-sampling qualification rate, good confidentiality. It is an effective supplement to routine sentinel surveillance and has important promotion value.
HIV-1 CRF01_AE and CRF07_BC have been two mainly circulating HIV-1 strains in the men who have sex with men (MSM) population in Beijing for years. These two subtypes together were accounting for 78.1% of HIV-1 positive cases newly diagnosed in Beijing, 2016. In this study, we report a novel CRF01_AE/CRF07_BC second-generation unique recombinant form (URF) (named DT1427_NFLG) of HIV-1 identified in MSM population. The near full-length genome of DT1427_NFLG is about 8.8 kb with four CRF07_BC fragments inserted into the CRF01_AE backbone. In China, several novel second-generation URFs were reported in recent years and Beijing, as the capital of China, attracting a huge number of people all over the country to work and live, is confronted with the risk of the epidemic of recombinant HIV-1 strains. Therefore, it is necessary to take measures to monitor the emergency of novel recombinant of HIV-1.
Beijing is a national and international hub potentially containing a broad diversity of HIV variants. Previous studies on molecular epidemiology of HIV in Beijing pooled together samples from residents and non-residents. Pooling residents and non-residents has potentially introduced bias and undermined a good assessment and the intervention among the autochthonous population. Here, we aimed to define HIV subtype diversity and investigate the TDR in Beijing residents exclusively.We analyzed the demographic, clinical, and virological data collected between 2001 and 2016 from residents in Beijing. A population-based sequencing of the HIV pol gene was carried out using plasma specimens. Phylogenetic analysis was performed in order to classify sequences into their corresponding subtypes using an automated subtyping tool, the Context-Based Modeling for Expeditious Typing (COMET). Furthermore, the drug resistance mutations were determined using the World Health Organization list for surveillance of TDR mutations.Data on TDR were available for 92% of 2,315 individuals with HIV infection, of whom 7.1% were women. The bioinformatic analysis of HIV strains from this study revealed that a combined 17 subtypes were circulating in Beijing, China between 2001 and 2016. The most common ones were CRF01_AE, CRF07_BC, and subtype B in Beijing during this period. The overall prevalence of TDR was 4.5% (95% confidence intervals[CI]: 3.6%-5.4%), with a declining trend over the period of spanning 2001 through 2016. In-depth class-specific analysis revealed that the prevalence of TDR for the nucleoside reverse-transcriptase inhibitors (NRTIs) was 1.0% (95% CI: 0.6-1.5), 0.9% (95% CI:0.6-1.4) for non-NRTIs and 2.8% (95% CI:2.1-3.5) for protease inhibitors. The prevalence of TDR was lower in individuals infected with the CRF07_BC HIV strain than those infected with CRF01_AE.Our data showed that the HIV epidemic in Beijing displayed a high genetic heterogeneity and a low and declining prevalence of TDR. In sharp contrast to Europe and North America, the declining trend of TDR between 2001 through 2016 was noticed while there was a widespread distribution of antiretroviral treatment in Beijing, China.
Objective: To analyze the spatial clustering characteristics of HIV/AIDS among men who have sex with men (MSM) in Chongqing from January 2004 to December 2015 and understand the HIV/AIDS related behaviors among MSM by interview. Methods: Data related to MSM who were infected with HIV and whose present address were in Chongqing, were collected from Information System on the HIV/AIDS Prevention and Control. Information included the age when the information was inputted, address, occupation, education level, and marital status. The total number of MSM who were infected with HIV and reported was 6 604 in Chongqing. Those with unknown address were ruled out. The spatial autocorrelation analysis and the local spatial autocorrelation analysis were carried out by using ArcGIS 10.3. In addition, in November 2015 and May 2016, using a convenience sampling, we conducted one-on-one interviews among 23 MSM in the Chongqing Center for Disease Control and prevention.Receiving voluntary counseling and testing in the urban area of Chongqing and willing to participate in the interview by oral informed consent; male and self-described as MSM. The content of the interview included basic information, sexual orientation, sexual role, the main place of making friends, the main place of sexual behavior, a long-term experience in other provinces and drug abuse. Results: The HIV/AIDS reported number in Chongqing from 2004 to 2015 showed an uptrend, except in 2010. The age distribution of 6 604 cases of HIV positive patients was mainly concentrated in the 15-34 years old, about 68.5% (4 522 cases). There was a positive spatial autocorrelation in MSM, except 2005 (Moran's I=-0.046, P=0.823), form 2004 to 2015, Global Moran's I values were 0.308, 0.254, 0.335, 0.683, 0.673, 0.558, 0.620, 0.673, 0.685, 0.654 and 0.649, respectively; all P values were <0.01. The result of local spatial autocorrelation analysis showed that high-high accumulation area development in Chongqing city was divided into two stages in 2004-2015, which were Yuzhong, Jiangbei, and Shapingba district in 2004-2007 and the expanded Jiulongpo, Nan'an, and Yubei district in 2008-2015. Qualitative interviews results revealed that the age of the respondents was 20-44, and the mainly way of making friends were using mobile phone App and internet (17 participants). Most of the participants (11 participants) were making friends in the bar. The majority of respondents would ask the friends or themselves to use condoms when meeting with them the first time (19 participants), and 8 of respondents reported that they would not use condoms when their old friends refused to use condoms. Conclusion: The HIV infected MSM mainly aged between 15-34 years old and the spatial distribution of HIV/AIDS among MSM was clustered in economically developed main area in Chongqing. MSM began to make friends on the Internet, and could not adhere to using condom, which indicated that we should focus on internet intervention to find more efficacious interventions.目的： 分析重庆市2004年1月至2015年12月经男男性行为感染HIV者空间聚集性特点，并通过访谈方式进行男男性行为者（MSM）相关行为调查。 方法： 收集中国疾病预防控制中心"艾滋病综合防治信息管理系统"中2004—2015年报告的现住址为重庆市、自述传播途径为男性性行为传播的HIV感染者和艾滋病患者（HIV/AIDS）的信息，包括病例录入时的年龄、现住地址、职业、文化程度和婚姻状况等方面。剔除地址不详者后，共收集HIV/AIDS 6 604例。采用ArcGIS 10.3进行全局空间自相关分析和局部空间自相关分析。此外，于2015年11月和2016年5月，采用立意抽样法在重庆市疾病预防控制中心对23名MSM进行面对面访谈。纳入标准：在重庆市城区进行自愿咨询检测并通过口头知情同意愿意参加访谈者；男性并自述为MSM。访谈内容包括基本情况、性取向、性角色、主要交友活动场所、主要发生性行为场所、有无长期外出重庆市经历和药物滥用等。 结果： 2004—2015年期间，仅2010年报告例数比2009年有所下降，其余年份整体呈增长趋势；6 604例经男男性行为感染HIV者的年龄主要集中在15~34岁，约占68.5%（4 522例）。除2005年以外（Moran's I指数为-0.046，P值为0.823），2004—2015年全局空间自相关呈正相关关系（Moran's I分别为0.308、0.254、0.335、0.683、0.673、0.558、0.620、0.673、0.685、0.654和0.649，P值均<0.01）；局部空间自相关分析表明重庆市2004—2015年高-高型聚集区发展分为两个时间阶段，从2004—2007年仅有的渝中区、江北区、沙坪坝区扩充到2008—2015年的九龙坡区、南岸区和渝北区。23名访谈对象的年龄为20~44岁，其交友方式多为手机App、网络等联系方式，共17名；交友活动地点多集中在酒吧，共11名；大部分受访者与刚认识不久的人发生男男性行为时，会要求对方或自己采取保护措施，共19名。如是熟人，在对方不同意带安全套的情况下，部分受访者表示不会采取安全措施，共8名。 结论： 重庆市经男男性行为感染HIV者，年龄段多在15~34岁，空间上呈现聚集性分布，以经济发达的主城区为中心。MSM开始以网络交友为主，并且不能坚持使用安全套，提示需注重网络干预并探讨更深入的干预措施。.
Objective
The study aimed to get the prevalence of transmitted drug resistance mutations in newly diagnosed treatment-naive patients in beijing, 2016.
Methods
One-step RT PCR and Nested-PCR were used to amplify the pol gene. Through analysis of 712 pol sequences, the distribution of HIV subtype and the composition of HIV transmitted drug resistance mutations were obtained.
Results
The rate of HIV transmitted drug resistance mutations in Beijing is 4.2%. Among 712 patients, CRF01_AE was the predominant subtype, accounting for 49.3%, followed by CRF07_BC (28.8%) and subtype B (10.3%).
Conclusions
We observed a decline in the prevalence of TDR resistance among newly diagnosed treatment-naive patients. Compared with previous study in Beijing, our study reveals a low-level prevalence of TDR in Beijing.
Key words:
HIV-1; Newly diagnosed; Treatment-naive; Transmitted drug resistance mutations
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