The lopinavir/ritonavir (LPV/r) -based second-line antiretroviral therapy (ART) has been used for treating HIV/AIDS patients in China for more than 10 years, but post-therapy immunological non-response (INR) in these patients has been rarely studied.
To explore the prevalence and influencing factors of post-therapy INR in HIV/AIDS patients switching from first- to second-line ART.
Data (including general information and three-year follow-up information after switching to second-line ART) were collected from the Database of TCM Treatment for AIDS and AIDS Prevention and Control Information System, involving 3 016 HIV/AIDS patients (baseline CD4+ T cell count<200 cells/μl) who switched to second-line ART during January 2009 to December 2015. The prevalence of INR was estimated using the follow-up information. Multivariate Logistic regression analysis was performed to investigate the influencing factors of INR.
The prevalence of INR in the patients after switching to second-line ART during the first, second and third years of follow-up was 42.34% (774/1 828) , 32.31% (608/1 882) , and 24.11% (421/1 746) , respectively. The results of multivariate Logistic regression analysis showed that gender〔female: OR=0.60, 95%CI (0.49, 0.73) 〕 and the baseline CD4+ T cells count〔<50 cells/μl: OR=3.42, 95%CI (2.51, 4.69) ; 50-100 cells/μl: OR=3.26, 95%CI (2.50, 4.27) ; 101-150 cells/μl: OR=1.51, 95%CI (1.19, 1.92) 〕were associated with the prevalence of INR in the first year of follow-up (P<0.05) ; gender〔female: OR=0.70, 95%CI (0.57, 0.86) 〕, age〔40-50 year: OR=1.37, 95%CI (1.05, 1.80) ; >50 year : OR=1.81, 95%CI (1.36, 2.42) 〕, route of infection〔blood: OR=1.40, 95%CI (1.06, 1.85) 〕, duration of HIV positive〔3-6 years: OR=1.48, 95%CI (1.02, 2.13) 〕, duration of HAART therapy before switch to second-line ART〔3-5 year: OR=0.66, 95%CI (0.48, 0.90) ; >5 year: OR=0.71, 95%CI (0.53, 0.95) 〕and baseline CD4+ T cells count〔<50 cells/μl: OR=2.54, 95%CI (1.84, 3.49) ; 50-100 cells/μl: OR=2.49, 95%CI (1.90, 3.27) ; 101-150 cells/μl: OR=1.59, 95%CI (1.23, 2.05) 〕were associated with the prevalence of INR in the second year of follow-up (P<0.05) ; age〔>50 year: OR=1.8, 95%CI (1.31, 2.49) 〕, route of infection〔blood: OR=1.45, 95%CI (1.07, 2.00) 〕, baseline CD4+ T cell count〔<50 cells/μl: OR=2.07, 95%CI (1.52, 2.82) ; 50-100 cells/μl: OR=2.14, 95%CI (1.57, 2.92) ; 101-150 cells/μl: OR=1.49, 95%CI (1.12, 1.98) 〕 were associated with the prevalence of INR in the third year of follow-up (P<0.05) .
The prevalence of INR in the HIV/AIDS patients after switching to second-line ART during the first, second and third years of follow-up was 42.34%, 32.31%, and 24.11%, respectively. Gender, age, baseline CD4+ T cell counts, infected with HIV via contaminated blood or blood products were the influencing factors of immunological non-response. In addition, immune status is suggested to be specially focused in male patients , aged over 50 years and those the baseline CD4+ T cells count <150 cells/μl.
Tuberculosis is the leading cause of death in patients living with HIV/AIDS, and HIV infection is also a major risk factor for latent tuberculosis infection (LTBI) developing to tuberculosis. So screening and treatment of LTBI is an important measure to prevent the incidence of tuberculosis to reduce the mortality rate in this population.
To examine the prevalence of LTBI and associated factors, and to identify the high-risk individuals among HIV/AIDS patients in Yinchuan urban areas, Ningxia Hui Autonomous Region, providing a scientific basis for the preventive treatment of tuberculosis in this population.
A total of 546 HIV/AIDS patients who were treated in designated institutions for HIV/AIDS management in the urban area of Yinchuan, Ningxia Hui Autonomous Region from March to August 2021 were selected. By use of an on-site survey in combination with reviewing management files, general information (including demographic characteristics such as sex, age, ethnic group, education level, marital status, annual household income per capita, occupation, BMI, smoking and drinking) and clinical information (chronic disease prevalence, closely contacting with tuberculosis patients, time since the HIV/AIDS diagnosis, duration of antiviral treatment, other co-infections, recent CD4+ T cell count) were collected. LTBI was screened by the tuberculin skin test (TST) . The general information was compared between those with LTBI (n=133) and those without (n=413) . Multivariate Logistic regression analysis was used to explore the influencing factors of LTBI in HIV/AIDS patients. R software was used to establish a restricted cubic spline model to fit the dose-effect relationship between CD4+ T cell count and the risk of LTBI.
The prevalence of LTBI detected by TST was 24.4%. Married 〔OR=0.544, 95%CI (0.321, 0.922) , P<0.05〕was associated with decreased risk of LTBI in HIV/AIDS, while smoking〔OR=1.919, 95%CI (1.213, 3.037) , P<0.05〕, and closely contacting with tuberculosis patients 〔OR=11.100, 95%CI (2.889, 42.648) , P<0.05〕were associated with increased risk of LTBI in HIV/AIDS. The fitting results of the restricted cubic spline model showed that the CD4+ T cell count and LTBI risk had an approximate "n" -shaped nonlinear relationship (non-linear test χ2=29.080, P<0.001) .
To reduce the incidence of LTBI in people living with HIV/AIDS, more attention and timely preventive treatment should be given to those unmarried, smokers, and close contacts of tuberculosis patients. In addition, multiple methods are recommended for screening for LTBI in those with low CD4+ T cell count.
Chinese men who have sex with men (MSM) have a higher prevalence of depression than the general population. Long-term depression symptoms could increase the risk of having physical harm, self-harm and suicide. Therefore, depression issues among MSM need to be solved urgently.
To explore the latent classes of depression, and the influence of HIV-related knowledge and anticipated stigma on depression among MSM.
Usingthe General Information Questionnaire, HIV Knowledge Questionnaire, Anticipated HIV Stigma Scale and 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) , an online questionnaire survey was conducted from December 2020 to March 2021 via the same-sex social network of Blued7.5. A total of 1396 MSM with HIVinfection or unclear status of HIVinfection were sampled by use of convenience sampling to attend the survey. The latent classes of depressive symptoms were analyzed by latent class analysis. Multinomial Logistic regression analysis was used to explore the correlation of the latent class of depression with HIV-related knowledge or anticipated HIV stigma.
Finally, 1 394 cases (99.9%.) who returned responsive questionnaires were included. The 10 items of CES-D-10 were taken as observed indicators, and exploratory latent class analysis was employed to identify the latent classes of depression based on model from 1 to 5 classes. The 4-class model was finally selected, and the probabilities of each class were 40.1% (no obvious depression) , 21.6% (possible risk of depression) , 28.0% (possible mild depression) , and 10.3% (possible moderate to severe depression) . The accuracy of the classification was assessed by test for homogeneity according to the cut-off value of CES-D-10 (0=no depression, 1=depression) and the results of latent class analysis (0= no obvious depression and possible risk of depression, 1= possible mild depression and possible moderate to severe depression) , and the result showed that Kappa=0.735 (P<0.001) . Multinomial Logistic regression analysis indicated that a high level of HIV-related knowledge (OR=0.926, P=0.001) , undergraduate attainment or above (OR=0.642, P=0.003) were related to possible risk of depression. The anticipated HIV stigma (OR=1.594, P<0.001) and being married (OR=0.593, P=0.026) were related to possible mild depression. A high level of HIV-related knowledge (OR=0.935, P=0.026) , anticipated HIV stigma (OR=2.239, P<0.001) and no long-term employment (OR=1.518, P=0.045) were related to possible moderate to severe depression.
The depression in MSM population presented obvious category characteristics, which may be a new idea for tailoring interventions to depression in MSM. Relevant authorities may cooperate with social media to deliver interventions incorporated with HIV-related knowledge and anticipated HIV stigma to prevent and control the development of depression in MSM.
