Epidemiology and Clinical Outcomes of HIV Infection in South-Central China: A Retrospective Study From 2003 to 2018

Prevalence, Risk Factors, and Clinical Outcomes with Advanced HIV Disease Among People with Newly Diagnosed HIV During the "Treat-All" Era: A Retrospective Cohort Study From Xi'an City, China

Purpose

China launched "treat-all" in 2016 to make all HIV-positive people eligible for ART regardless of disease stage. Widespread treatment may not eliminate advanced HIV. This study investigated the prevalence, characteristics, risk factors, and clinical outcomes of advanced HIV disease (AHD) in newly diagnosed HIV-positive individuals in China during the "treat-all" period.

Patients and methods

We performed a retrospective cohort study on newly diagnosed adult ART-naive people with HIV (PWH) in Xi'an from 2016 to 2022. The prevalence of AHD and six-month mortality/loss to follow-up (LTFU) were investigated. Risk variables for AHD and predictors of mortality or LTFU in the cohort were investigated using multivariate logistic and Cox regression, respectively.

Results

Of the PWH, 47.5% (2999/6318) had AHD at HIV diagnosis. At enrollment, being ≥50 years (aOR: 1.75, 95% CI: 1.44-2.12, P < 0.001; ≥50 vs 18-29), 30-49 years (aOR: 1.43, 95% CI: 1.24-1.65, P < 0.001; 30-49 vs 18-29), opportunity infections (aOR: 7.43, 95% CI: 5.96-9.35, P < 0.001), severe anemia (aOR: 3.56, 95% CI: 1.81-7.70, P = 0.001) and liver disease (aOR: 3.09, 95% CI: 1.48-7.05, P = 0.004) were independently associated with AHD. Within 6 months of enrollment, 95.6% and 58.3% of those who died or were LTFU had AHD. AHD (aHR: 14.30, 95% CI: 4.42-46.30, P < 0.001), ≥50 years (aHR: 5.39, 95% CI: 2.10-13.82, P < 0.001; ≥50 years vs 18-29 years), those with opportunistic infections (aHR: 2.59, 95% CI: 1.54-4.34, P < 0.001), and severe anemia (aHR: 9.89, 95% CI: 5.19-18.87, P < 0.001) were independent predictors of six-month mortality.

Conclusion

Under the "treat-all" policy, Xi'an had a high prevalence of AHD upon HIV diagnosis. AHD predicted 6-month mortality. Urgent implementation of targeted strategies is necessary to minimize AHD.

Association between respiratory pathogens and severe clinical outcomes in people living with HIV-1 and pulmonary infections: A 180-day longitudinal cohort study

BACKGROUND

Many respiratory pathogens have been identified in people living with HIV-1 and pulmonary infection, but their impact on clinical outcomes remains largely unclear.

METHODS

Metagenomic sequencing and traditional laboratory diagnostics were applied to identify bacterial, viral, and fungal respiratory pathogens. Clinical outcomes were assessed by (i) mortality or ICU transfer during hospitalization, and (ii) 30-day re-hospitalization and 180-day mortality after hospital discharge.

RESULTS

Microbiological analyses of bacterial, viral and fungal pathogens in 237 in-patients with HIV-1 and pulmonary infections revealed Pneumocystis jirovecii (58 %) as the most prevalent respiratory pathogen, followed by Cytomegalovirus (39 %), Mycobacterium tuberculosis (22 %), Talaromyces marneffei (17 %), and Epstein-Barr virus (16 %). Fifty-six patients (24 %) were coinfected with bacterial, viral and fungal pathogens, referred to as bacterial+fungal+viral coinfections. Risk factors for bacterial+fungal+viral coinfections (RR=8.41, 95 %CI: 4.2-14.3), severe pneumonia (RR=13.6, 95 %CI: 8.14-19.3), and elevated C-reactive protein levels (RR=6.42, 95 %CI: 1.58-10.13) were significantly associated with mortality or ICU transfer during hospitalization. After hospital discharge, 38 patients (16 %) were rehospitalized within 30 days. Antiretroviral therapy reduced the risk of 30-day rehospitalization (HR=0.21, p = 0.01). During the 180-day follow-up, 13 patients (5.5 %) died. Survival analyses identified severe pneumonia and age ≥ 60 years as risk factors for 180-day mortality.

CONCLUSIONS

Multiple pulmonary coinfections are associated with severe outcomes in in-patients with HIV-1 infection. Effective management of both HIV-1 and pulmonary infections is crucial to reduce hospitalization rates and mortality risk.

Non-linear association between CD4+ T-cell counts and mortality risk in people living with HIV: evidence from a 10-year cohort study

Background

The study aimed to investigate the dose-response association between CD4+ T-cell counts and mortality risk in people living with HIV (PLHIV).

Methods

Data on PLHIV who had a high prevalence of acquired immunodeficiency syndrome (AIDS) were retrospectively collected from the routine treatment database in Henan Province, China, covering the period from October 2003 to October 2021. We randomly selected 1,000 PLHIV from age groups 30, 40, 50, and 60 years who met the inclusion criteria as study participants. The Kaplan-Meier analysis, the Cox proportional hazards regression model, and the restricted cubic spline (RCS) model were employed to analyze the association between CD4+ T-cell counts and mortality risk in PLHIV.

Results

A total of 4,000 participants were enrolled in the study, with a follow-up period of 28,158 person-years. During this period, there were 941 (23.5%) deaths, resulting in a mortality rate of 3.34 per 100 person-years. The mean duration of follow-up was 6.77 ± 3.45 years, and the cumulative survival rate was 76.5%. The Cox proportional hazards regression model revealed that as the CD4+ T-cell count increased, the hazard ratio (HR) decreased. The results of the RCS model demonstrated a non-linear association between CD4+ T-cell counts and mortality risk in PLHIV, with cutoff values for each age group being 382, 332, 334, and 215 cells/μL. The non-linear curve indicated that the HR decreased as the CD4+ T-cell counts increased. However, once the CD4+ T-cell counts reached their respective cutoff values, the curve showing the reduction in mortality risk began to flatten.

Conclusion

There was a non-linear association between CD4+ T-cell counts and mortality risk in PLHIV. Although the cutoff values vary across age groups, they consistently remain close to 350 cells/μL. Therefore, considering a threshold of CD4+ T-cell count <350 cells/μL across various age groups is crucial as a strategic approach to mitigate mortality rates among PLHIV.

Pretreatment drug resistance among people living with HIV from 2018 to 2022 in Guangzhou, China

The presence of pretreatment drug resistance (PDR) is posing an increasing threat to HIV control. Here we investigated drug resistance mutations (DRMs) and PDR among 6831 HIV-infected individuals from 2018 to 2022 in Guangzhou, China. DRMs were detected among 24.5% of the patients. The overall prevalence of PDR was 7.4%, with resistance rate to nucleotide reverse transcriptase inhibitor (NRTI) being 1.3%, nonnucleoside reverse transcriptase inhibitor (NNRTI) 4.8%, and protease inhibitor (PI) 1.4%. Abacavir (0.8%) resistance was the most common in NRTI, followed by resistance to emtricitabine (0.6%), lamivudine (0.6%), and tenofovir disoproxil fumarate (0.3%). In NNRTI, nevirapine (3.7%) resistance was the most common, followed by efavirenz (3.5%) and rilpivirine (3.4%). Among PI, resistance to tipranavir (0.8%), nelfinavir (0.6%), fosamprenavir (0.2%) and lopinavir (0.1%) was most frequent. Annual prevalence of PDR showed an increase trend from 2018 to 2022, although not significant. In the multivariable logistic regression model, hepatitis B surface antigen positivity, circulating recombinant form (CRF) 55_01B, CRF08_BC, CRF59_01B, and subtype B were demonstrated as associated risk factors for PDR. The overall prevalence of PDR in Guangzhou was moderate, with relatively severe NNRTI resistance. Therefore, it remains crucial to continue monitoring PDR among newly diagnosed HIV-infected individuals.

The profile of HIV-1 drug resistance in Shanghai, China: a retrospective study from 2017 to 2021

BACKGROUND

HIV-1 drug resistance is a huge challenge in the era of ART.

OBJECTIVES

To investigate the prevalence and characteristics of acquired HIV-1 drug resistance (ADR) in Shanghai, China.

METHODS

An epidemiological study was performed among people living with human immunodeficiency virus (PLWH) receiving ART in Shanghai from January 2017 to December 2021. A total of 8669 PLWH were tested for drug resistance by genotypic resistance testing. Drug resistance mutations (DRMs) were identified using the Stanford University HIV Drug Resistance Database program.

RESULTS

Ten HIV-1 subtypes/circulating recombinant forms (CRFs) were identified, mainly including CRF01_AE (46.8%), CRF07_BC (35.7%), B (6.4%), CRF55_01B (2.8%) and CRF08_BC (2.4%). The prevalence of ADR was 48% (389/811). Three NRTI-associated mutations (M184V/I/L, S68G/N/R and K65R/N) and four NNRTI-associated mutations (V179D/E/T/L, K103N/R/S/T, V106M/I/A and G190A/S/T/C/D/E/Q) were the most common DRMs. These DRMs caused high-level resistance to lamivudine, emtricitabine, efavirenz and nevirapine. The DRM profiles appeared to be significantly different among different subtypes.

CONCLUSIONS

We revealed HIV-1 subtype characteristics and the DRM profile in Shanghai, which provide crucial guidance for clinical treatment and management of PLWH.