HIV/AIDS epidemic and the development of comprehensive surveillance system in China with challenges

AIDS is the most severe infectious disease that has appeared in the second half of the 20th century.Since the United States Center of Disease Control ＆ Prevention （US CDC） reported the first case of HIV carrier in the men who had sex with men （MSM）population in 1981, HIV/AIDS had spread globally. By the end of December 2008, UNAIDS and WHO estimated that there were 3340 million （3110-3580 million）infected with HIV/AIDS worldwide.1 While the HIV/AIDS epidemic in Asia began later than the epidemic in Europe, America and Africa, experts predict that countries in Asia, especially in three countries, China,India and Indonesia, which have a population of more than 100 million, will have the world＇s largest number of HIV/AIDS in the near future.     

Impact of HIV/sexually transmitted infection testing on risky sexual behaviors among men who have sex with men in Langfang, China

Background Men who have sex with men (MSM) in China remain at high risk for HIV infection,the proportion of reported HIV/AIDS cases that occurred among MSM rose greatly from 2005 to 2011.HIV testing an...     

An HIV/AIDS intervention programme with Buddhist aid in Yunnan Province

Background The prevalence of HIV/AIDS in Chinese ethnic minorities is an important component of China＇s AIDS issues. In this study, we launched an intervention programme in Yunnan Province of China, where the Dai people live, to carry out the community-based HIV/AIDS health education and behavioral interventions on ordinary Dai farmers. The Dai people believe in Theravada Buddhism. Methods Four rural communities were randomly divided into two groups. In one group （Buddhist group）, HIV/AIDS health education and behavioral intervention were carried out by monks. The other group （women group） was instructed by women volunteers. The intervention continued for one year and the data were collected before and after the intervention project. Results In the Buddhist group, the villagers＇ AIDS related knowledge score was boosted from 3.11 to 3.65 （P 〈0.001）, and some indices of the villagers＇ behavior using condoms improved after the intervention. But this improvement was poorer than that in the women group. In the Buddhist group, the villager＇s attitude score towards the people living with HIV and AIDS （PLWHA） also increased significantly from 1.51 to 2.16 （P〈0.001）. Conclusion The results suggested that the Buddhist organization has limited success in promoting the use of condoms but plays an important role in eliminating HIV/AIDS related discrimination.     

HIV microbicides: innovation and challenge

According to Joint United Nations Program on HIV/AIDS （UNAIDS） report in 2009, the estimated number of people living with HIV-1 is 33.4 million, and half of the infected adults （aged 15-49 years） are women, who acqluired HIV-1 mainly through heterosexual exposure. In China, HIV-1 transmission through sexual contact has also increased rapidly, and has reached over 70% in overall cases; heterosexual transmission accounted for 40% and men who had sex with man （MSM） for 32.0%.     

Synthetic Characteristics Associated with HIV Diagnosis through Voluntary HIV Testing among HIV-positive People with Non-marital and Non-commercial Heterosexual Transmission in China

The Joint United Nations program on HIV/AIDS reported that 53% of new infections globally in 2017 were beyond key populations and their sexual partners.In this report, although only 16% in Asia and the Pacific were people living with HIV (PLHIV) who did not report any HIV-risk behaviors (mainly including injective drug use, men who have sex with men, sexual workers, and their dients), increasing diag no sed cases who reported their own transmission as non-marital and non-commercial heterosexual con tact (non-M&C sex, defi ned as those heterosexuals who have unpaid sex with any other sexual partners whom they have never married) in China have indicated that the HIV epidemic is spreading to the general population by the bridge of key populations.     

Impact evaluation of HIV/AIDS education in rural Henan province of China

Nowadays, there is a trend of HIV prevalence transmitting from high-risk group to average-risk group in China. Rural China is the weak link of HIV prevention, and rural areas of Henan province which is one of the most high-risk regions in China have more than 60% of the AIDS patients in the province. Thus, improving the HIV awareness and implementing health education become the top-priority of HIV/AIDS control and prevention. A multistage sampling was designed to draw 1129 people living with HIV/AIDS （PLWHAs） and 1168 non-PLWHAs in 4 prevalence counties of Henan province. A health promoting and social-psychological support model was constructed to improve the health knowledge of participants. Chi-square tests and unconditional logistic regression were performed to determine the intervention effect and influencing factors. All groups had misunderstandings towards the basic medical knowledge and the AIDS transmission mode. Before the intervention, 59.3% of the HIV/AIDS patients and 74.6% of the healthy people had negative attitudes towards the disease. There was statistically significant difference in the improvement of knowledge, attitude and action with regards to HIV prevention before and after intervention （P〈0.05）. PLWHAs who were males （OR=l.731） and had higher education level （OR=1.910） were found to have better HIV/AIDS health knowledge, whereas older PLWHAs （OR=0.961） were less likely to have better HIV/AIDS health knowledge. However, the intervention effect was associated with the expertise of doctors and supervisors, the content and methods of education, and participants＇ education level. It was concluded that health education of HIV/AIDS which positively influences the awareness and attitude of HIV prevention is popular in rural areas, therefore, a systematic and long-term program of HIV control and prevention is urgently needed in rural areas.     

Full-length clone and characterization of a human immunodeficiency virus type 1 subtype B’ isolated from Hubei Province, China

There are two types of Human Immunodeficiency Virus （HIV）： HIV-1 and HIV-2. HIV-1 dominates epidemics in many different parts of the world, and HIV-2 is principally responsible for the epidemic in westem Africa. In China, Zeng et al have reported the first individual infected with HIV-1 in 1985. And in the 1990s, there was a severe epidemic involving the HIV-1 B＇ strain among people who sold blood and plasma in Henan, Hubei and adjacent provinces. To further study in HIV/AIDS vaccines and HIV-1 drug resistance for people in these regions, we need to construct an infectious HIV-1 B＇ molecular clone which is representative of the virus in these areas. To this end, we have isolated a HIV-1 B＇ virus from a child who was infected with HIV-1 from his mother in Hubei province, and have constructed a full-length clone from this genome.     

HIV/AIDS epidemiology and prevention in China

Objective To review HIV/AIDS epidemic history, current situation and prevention policy in China.
Data sources Information included in this article was identified by searching PUBMED （1997-2006） online resources using the key terms ＂HIV/AIDS＂, ＂epidemic＂, ＂prevention＂, and ＂China＂.
Study selection Original milestone articles and critical reviews written by major pioneer investigators of the field were selected.
Results The key issues related to the HIV/AIDS epidemic situation in China and Chinese government prevention policy were summarized. HIV/AIDS epidemic groups and trends for HIV transmission were discussed.
Conclusion In January 2006, 650 000 people were estimated to be living with HIV in China. The overall HIV/AIDS epidemic is at a low level （0.05%） and concentrated in several at risk populations. However, the data show that new cases of HIV infection are growing every year and spreading from at risk populations to the general population. Premier WEN Jia-bao announced the ＂Four frees and one care＂ policy and the Chinese government has developed a series of programs with strong policy measures to stop the spread of HIV/AIDS in China.     

AIDS- Related Knowledge, Attitudes and Behavior Survey among the ＂Migrant＂ Population in China

Objective To realize AIDS related knowledge, attitude and behavior among floating people in China and discuss its influencial factors, and to provide the evidence for how to prevent AIDS in floating population. Methods The data were collected from the ＂Sex and Reproductive Health Baseline Survey among Floating People in China＂ conducted in March 2004. The standard questionnaires were used to interview altogether 4 900 floating people from 6 provinces. Results Nearly 95.4 % of them had heard about AIDS, but only 0.5% can judge all the transmitted ways and no-transmitted ways correctly, 45.9 % believed that we need to isolate the HIV positive people. Only 65.7% knew that using condom can preventive HIV infection, 43. 7% showed their understanding about the man who has long time no sexual life has sex with a sexual worker. About 13.6% floating people chose condom as FP method and among them only 34. 6% used condom every time. Conclusion Chinese floating people are lack of AIDS knowledge. Most of them do not practise Safe Sex Activity. We need to give more intervention to the floating population.     

Knowledge Level about HIV/AIDS among Reproductive Men in Five Counties in China

To understand the HIV/IDS knowledge level and its influential factors among reproductive men in China so as to provide scientific evidence for preventive measures. Methods Cross-sectional survey, system random sample and constructed questionnaire were used in this study. There were 1 285 male subjects who had filled in anon）,mous questionnaires. Results There were significant differences on the HIV/IDS knowledge level in different counties and different demographic characteristic people. Major inJluential factors inchtded area, urban/rural, marriage, educational level, age, consultation about HIV/AIDS. Conclusion It is necessary to strengthen the training of HIV/AIDS knowledge among reproductive men.     

An antiretroviral regimen containing 6 months of stavudine followed by long-term zidovudine for first-line HIV therapy is optimal in resource-limited settings: a prospective, multicenter study in China

Background An zidovudine （AZT）-substitution regimen containing 24-week stavudine （d4T） followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associated with d4T in resourcelimited settings.However,evidence is scarce.This study aims to assess the efficacy and safety of AZT-substitution regimen,aiming to find a regimen with better efficacy,less adverse events,and more affordability in resource-limited settings.Methods This prospective,multicenter study enrolled 499 （190 on d4T regimen,172 on AZT regimen,and 137 on AZT-substitution regimen） HIV-1-infected subjects who initiated combined antiretroviral therapy and attended follow-up visits over 96 weeks from 2009 to 2011.Lamivudine （3TC） and either nevirapine （NVP） or efavirenz （EFV） were the other two drugs in the antiretroviral regimens.Virologic and immunologic responses and adverse events were monitored at baseline and at weeks 4,12,24,36,48,60,72,84,and 96.Results In terms of hematological adverse effects,AZT-substitution group had similar safety profiles to d4T group and was superior to AZT group.In comparison with AZT-substitution group,AZT group was associated with higher risk of developing anemia （adjusted hazard ratio （aHR）for anemia ≥ grade Ⅱ,8.44,95％ CI 1.81-39.46） and neutropenia （aHR for neutropenia ≥ grade Ⅱ,1.86,95％ CI 1.19-2.93）.The prevalence of lipodystrophy in d4T group was 19.5％,while that in AZT-substitution group was zero.As to antiretroviral efficacy,these three groups showed no differences.Conclusion AZT-substitution regimen provides a relatively safe and effective first-line antiretroviral strategy in resource-limited settings.     

Experimental and clinical research of HIV-1 resistance in three AIDS patients who had experienced multiple regimens

Highly active antiretroviral therapy （HAART） for HIV/AIDS has efficiently controlled the progression of the disease, extended life expectancy and decreased HIV/AIDS related morbidity and mortality since the advent of HIV protease inhibitors in 1996.1 Recent emergence of HIV resistance has severely affected the efficacy of antiretroviral therapy. The prevalence of HIV resistance has been increasing from the usage of AZT. Studies in US indicated that the prevalence was approximately 50% in patients who had experienced antiretroviral therapy.2 Antiviral regimens based on resistance tests could efficiently decrease viral load, increase CD4 cell counts and significantly improve the efficacy of antiretroviral therapy.3 There are two methods commonly used to test HIV resistance at present： one is genotypic resistance assay which predict HIV resistance based on resistance mutations in the viral genome; the other is a phenotypic resistance assay which directly evaluates HIV resistance through analyzing drug sensitivity in vitro.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

The role of central nervous system on hypoglycemia and the feasibility of the brain theory in traditional Chinese medicine on treatment of diabetes mellitus

The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine （TCM） has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.     

人类免疫缺陷病毒原发感染的实验室检测

人类免疫缺陷病毒(human immunodeficiency virus,HIV)的原发感染期(primary infection)指从病毒进入人体到抗体产生后的3～12个月,根据其临床表现及机体免疫应答的出现又可进一步分为急性感染期(acute infection)和之后的新近感染期(re-cent infecti...     

Modulating Effects of Chlorogenic Acid on Lipids and Glucose Metabolism and Expression of Hepatic Peroxisome Proliferator-activated Receptor-α in Golden Hamsters Fed on High Fat Diet

Objective To examine the effects of chlorogenic acid （CGA） on lipid and glucose metabolism under a high dietary fat burden and to explore the possible role of peroxisome proliferator-activated receptor-α （PPAR-α） in these effects. Methods Twenty male golden hamsters were randomly divided into CGA treatment group （n=10, given peritoneal injection of CGA solution prepared with PBS, 80 mg CGA/kg body weight daily）, and control group （n=10, given PBS i.p. at the average volume of the treatment group）. Animals in both groups were given 15% high fat diet. Eight weeks after treatment with CGA, the level of biochemical parameters in fasting serum and tissues and the expression of hepatic mRNA and protein PPAR-α were determined. Results Eight weeks after treatment with CGA, the levels of fasting serum triglyceride （TG）, free fatty acid （FFA）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, glucose （FSG）, and insulin （FSI） were significantly lower in the GGA treatment group than in the control group. CGA also led to higher activity of hepatic lipase （HL） lower contents of TG and FFA in liver, and lower activity of lipoprotein lipase （LPL） in skeletal muscle. Furthermore, CGA significantly elevated significantly elevated the expression level of mRNA and protein expression in hepatic PPAR-α. Conclusion CGA can modify lipids and glucose metabolism, which may be attributed to PPAR-α facilitated lipid clearance in liver and improved insulin sensitivity.     

Efficacy of Different Iron Controlling Fortificants in Wheat Flour in Iron Deficiency

Objective To observe the different impacts of electrolytic iron, FeSO4, and NaFeEDTA on body iron store of anemic school students. Methods Four hundreds anemic students at the age of 11-18 years were divided into four groups. Of which, three consumed different iron fortificants from wheat flour as food vehicle for six months and one consumed non-fortified flour （control）. The fortification level of electrolytic iron, FeSO4, and NaFeEDTA was 60 mg Fe/kg, 30 mg Fe/kg, and 20 mg Fe/kg, respectively. Blood samples were collected at 0, 2, 4, and 6 months and hemoglobin （Hb）, serum ferritin （SF）, and transferrin receptor （TfR） were measured. Results The hemoglobin levels in three intervention groups increased, the increments of Hb in the NaFeEDTA group were significantly higher than that in the other groups. SF and TfR levels increased in the tested groups and body iron store in the NaFeEDTA group was higher than that in the other groups. These parameters did not show any significant changes in the control group. Conclusion NaFeEDTA and FeSO4 tortified wheat flour has positive impacts on iron status in anemic students and NaFeEDTA is more effective than FeSO4, while electrolytic iron is less effective in improving iron store in anemic students.     

Diagnosis and treatment of epistaxis caused by non-traumatic pseudoaneurysms of carotid artery

Epistaxis remains one of the most common otolaryngology emergencies. Severe epistaxis may be caused by internal carotid artery （ICA） pseudoaneurysm or cavernous fistula, which is clinically rare but life threatening if it is not diagnosed and treated timely. Most ICA pseudoaneurysms are mainly caused by trauma with few other causes. From January 1998 to December 2005, a total of 8 cases with non-traumatic carotid artery pseudoaneurysm were correctly diagnosed through digital subtraction angiography （DSA） in Ganzhou People＇s Hospital. The patients had suffered from serious nose bleeding repeatedly and had been resistant to routine treatments.