Characteristics of Migration Among HIV-Positive MSM - Guangxi Zhuang Autonomous Region, China, 2005-2021

Mortality and immunological indicators of men who have sex with men living with HIV on antiretroviral therapy: a 10-year retrospective cohort study in Southern China

BACKGROUND

The proportion of people living with HIV (PLHIV) in Guangxi who are men who have sex with men (MSM) increased rapidly to nearly 10% in 2023; notably, over 95% of this particular population is currently receiving antiretroviral therapy (ART). This study aimed to describe the survival of MSM PLHIV, depict the characteristics and trends of changes in CD4+ T cell counts, CD4+/CD8+ T cell ratio, and viral load, and explore immunological indicators that may be related to mortality during different stages of treatment.

METHODS

Immunological indicators of MSM PLHIV receiving ART were extracted and categorized into baseline, mid-treatment, and last values. These were then incorporated into the Cox models in the form of repeated measurements to evaluate the associations (Adjusted-hazard ratios, aHRs) and 95% confidence intervals (95% CIs) of these immunological indicators with mortality at different stages.

RESULTS

A total of 5,642 patients who met the criteria were enrolled in the study, and 160 died, representing a mortality of 2.8%. The first, median, and last values of the CD4+ count and the CD4+/CD8+ ratio in surviving patients were significantly greater than the corresponding values in nonsurviving patients (P < 0.001). Except for the first viral load (P = 0.379), the median and last viral loads of the former were significantly lower than those of the latter (P < 0.001). In Cox model, with 2,144 cases, immunological indicators of increased mortality risk included a baseline CD4+ count below 200 cells/µL (aHR: 4.58, 95% CI: 2.28-9.19), a median (aHR: 8.46, 95% CI: 3.05-23.46), and a final (aHR: 4.43, 95% CI: 1.06-18.45) ratio below 0.7 and a median (aHR: 9.47, 95% CI: 4.02-22.35) and final (aHR: 14.46, 95% CI: 4.50-46.50) viral load 100,000 copies/mL and above.

CONCLUSIONS

Mortality among MSM PLHIV on ART in Guangxi is relatively low, and both high viral loads and low CD4+/CD8+ T cell ratios during treatment and at recent follow-up are strongly predictive of a serious prognosis and should be closely monitored.

Characteristics and Predictors of Interprovincial Migration Following HIV Diagnosis Among Men Who Have Sex with Men - China, 2016-2022

What is already known about this topic?

Men who have sex with men (MSM) are highly vulnerable to human immunodeficiency virus (HIV) infection and demonstrate significant mobility patterns. Understanding post-diagnosis migration patterns among HIV-positive MSM is crucial for targeted case management, yet comprehensive data from China remains limited.

What is added by this report?

Among 204,394 HIV-positive MSM, 20,117 (9.8%) migrated after diagnosis, with primary movement from economically developed regions like Guangdong Province and Shanghai Municipality to less developed provincial-level administrative divisions such as Sichuan Province and Anhui Province. Key predictors of migration included age under 50 years, unmarried status, lower educational attainment, employment as commercial staff or student status, and diagnosis before 2020.

What are the implications for public health practice?

Enhanced healthcare resources, strengthened case management systems, and targeted HIV-related services are essential to ensure consistent treatment access and improved health outcomes for migrant HIV-positive MSM.

Distinct Rates and Transmission Patterns of Major HIV-1 Subtypes among Men who Have Sex with Men in Guangxi, China

The diversity and transmission patterns of major HIV-1 subtypes among MSM population in Guangxi remains unknown. Understanding the characteristics is crucial for effective intervention strategies. Between 2016 and 2021, we recruited individuals newly diagnosed with HIV-1 from MSM population in Guangxi. HIV-1 pol region was amplified and sequenced, and constructed molecular network, assessed clustering rate, cluster growth rate, spatial clustering, and calculating the basic reproductive number (R0) based on sequences data. We identified 16 prevalent HIV-1 subtypes among Guangxi MSM, with CRF07_BC (53.1%), CRF01_AE (26.23%), and CRF55_01B (12.96%) predominating. In the network, 618 individuals (66.17%) formed 59 clusters. Factors contributing to clustering included age < 30 years (AOR = 1.35), unmarried status (AOR = 1.67), CRF07_BC subtype (AOR = 3.21), and high viral load (AOR = 1.43). CRF07_BC had a higher likelihood of forming larger clusters and having higher degree than CRF01_AE and CRF55_01B. Notably, CRF07_BC has higher cluster growth rate and higher basic reproductive number than CRF01_AE and CRF55_01B. Our findings underscore CRF07_BC as a prominent driver of HIV-1 spread among Guangxi's MSM population, highlighting the viability of targeted interventions directed at specific subtypes and super clusters to control HIV-1 transmission within this population.