Alcohol use and subsequent sex among HIV-infected patients in an ethnic minority area of Yunnan Province, China

Objective

To examine alcohol use and subsequent HIV risky behaviors among a sample of predominately ethnic minority people living with HIV/AIDS (PLWHA) in a rural community in Yunnan Province, China.

Method

A cross-sectional study with a face-to-face questionnaire interview was conducted among eligible participants.

Results

In total, 455 (94.4%) out of 482 eligible HIV patients participated in the study. Of them, 82.6% were ethnic minorities; 15.4% were never married; 96.5% were sexually experienced; 55.4% had used drugs, 67% were receiving antiretroviral therapy (ART). Over 65% were ever drinkers; of whom 61.5% were current drinkers. Among current drinkers, 32.4% drank daily and 41.2% were hazardous drinkers. Chinese white wine was the preferred choice. Higher level of alcohol use among drinkers in the preceding month was positively associated with being males (OR = 2.76, 95%CI: 1.03–7.43), ethnic minorities (OR _Jingpo = 2.21, 95%CI: 1.06–4.59; OR _{other minorities} = 3.20, 95%CI: 1.34–7.62), higher education (OR_1–6 = 1.98, 95%CI: 0.99–3.96; OR_≥7 = 2.35, 95%CI: 1.09–5.06) and being ART-naive (OR = 2.69, 95%CI: 1.67–4.32). About 39% of ever drinkers reported having engaged in sex after drinking since HIV diagnosis. Those who were younger than 46 years (OR_16–25 = 7.77, 95%CI: 1.22–49.60, OR_26–35 = 2.79, 95%CI: 1.06–7.35, OR_36–45 = 2.96, 95%CI: 1.57–7.58), hazardous drinkers (OR = 1.99, 95%CI: 1.00–3.97) and drug users (OR = 3.01, 95%CI: 1.19–7.58) were more likely to have had sex after drinking. Approximately 56% of drug users had used drugs after drinking.

Conclusions

High prevalence of alcohol use and subsequent risky behaviors including sexual engagement and drug use among HIV patients in rural Yunnan require tremendous and integrated efforts for prevention and control of alcohol and drug abuse and HIV spreading.

Prevalence and correlates of HIV discordance and concordance among Chinese-Burmese mixed couples in the Dehong prefecture of Yunnan province, China

BACKGROUND

Many people from Burma have migrated to Dehong prefecture and married local residents during the past decades; however, little is known about HIV risk-taking behaviours and HIV prevalence among these mixed couples. We investigated factors correlated with HIV discordance and concordance within Chinese?Burmese mixed couples in Dehong prefecture, Yunnan province, China.

METHODS

A cross-sectional study with face-to-face questionnaire interviews and HIV blood testing was conducted.

RESULTS

Of 5742 couples, 1.6% couples were HIV-infected concordant, 2.2% were HIV serodiscordant with an HIV-infected male spouse and 0.9% were HIV serodiscordant with an HIV-infected female spouse. HIV discordance with an HIV-infected male spouse was significantly associated with characteristics of the male spouse, including being aged =30 years, non-Han ethnic minority, a marital relationship of <3 years, commercial sex and injection drug use by the male spouse. HIV discordance with an HIV-infected female spouse was significantly associated with an education level of primary school (v. illiterate); a marital status of being in their second marriage, widowed or divorced; a history of sexually transmissible infection diagnosis of the female spouse; noncommercial extramarital sex by the female spouse or by both spouses; and injection drug use by the male spouse. A marital relationship of =3 years was the only significant independent correlate of HIV-infected seroconcordance.

CONCLUSIONS

The study findings underscore the importance of premarital HIV counselling and testing for this population, and the need for targeted interventions among HIV serodiscordant mixed couples to reduce secondary transmission as early as possible when the relationship begins.

Genetic diversity and drug resistance among newly diagnosed and antiretroviral treatment-naive HIV-infected individuals in western Yunnan: a hot area of viral recombination in China

Background

The emergence of an HIV-1 epidemic in China was first recognized in Dehong, western Yunnan. Due to its geographic location, Dehong contributed greatly in bridging HIV-1 epidemics in Southeast Asia and China through drug trafficking and injection drug use; and also extensively to the HIV genetic diversity in Yunnan and China. We attempt to monitor HIV-1 in this area by studying the HIV-1 genetic distribution and transmitted drug resistance (TDR) in various at-risk populations.

Methods

Blood samples from a total of 320 newly HIV-1 diagnosed individuals, who were antiretroviral therapy (ART)-naive, were collected from January 2009 to December 2010 in 2 counties in Dehong. HIV-1 subtypes and pol gene drug resistance (DR) mutations were genotyped.

Results

Among 299 pol sequences successfully genotyped (93.4%), subtype C accounted for 43.1% (n=129), unique recombinant forms (URFs) for 18.4% (n=55), CRF01_AE for 17.7% (n=54), B for 10.7% (n=32), CRF08_BC for 8.4% (n=25) and CRF07_BC for 1.7% (n=5). Subtype distribution in patients infected by different transmission routes varied. In contract to the previous finding of CRF01_AE predominance in 2002-2006, subtype C predominated in both injecting drug users (IDUs) and heterosexually transmitted populations in this study. Furthermore, we found a high level of BC, CRF01_AE/C and CRF01_AE/B/C recombinants suggesting the presence of active viral recombination in the area. TDR associated mutations were identified in 4.3% (n=13) individuals. A total of 1.3% of DR were related to protease inhibitors (PIs), including I85IV, M46I and L90M; 0.3% to nucleoside reverse transcriptase inhibitors (NRTIs), including M184I; and 2.7% to non-nucleoside reverse transcriptase inhibitors (NNRTIs), including K103N/S, Y181C, K101E and G190A.

Conclusion

Our work revealed diverse HIV-1 subtype distributions and intersubtype recombinations. We also identified a low but significant TDR mutation rate among ART-naive patients. These findings enhance our understanding of HIV-1 evolution and are valuable for the development and implementation of a comprehensive public health approach to HIV-1 DR prevention and treatment in the region.

Prevalence and correlates of alcohol use and subsequent sexual activity among adult males in a rural community of ethnic minorities in Yunnan Province, China

This community-based cross-sectional study examined alcohol use and HIV risks among a sample of predominantly ethnic males in Yunnan Province, China. Information about alcohol use, sexual behavior, sex after drinking, and HIV infection was collected using face-to-face interviews and blood testing. Out of 497 potential male participants, 382 males agreed to participate in this study. Of these males, 70% were ethnic minorities, 74.1% were currently married, 95.5% were sexually experienced, 27.5% had used drugs, and 6% were HIV-infected. Over 81% were current drinkers and 55.7% started drinking before the age of 18. Among current drinkers, 44.5% drank daily and 31.9% had drunk heavily in the past 30 days. Baijiu (a Chinese liquor distilled from sorghum with an ethanol content of at least 40%) was the preferred drink of choice. Excessive alcohol use was associated with being an ethnic Jingpo (OR = 1.96), being a smoker (OR = 2.09) and having multiple lifetime sex partners (OR = 1.55). Over 21% reported having ever engaged in sex after drinking. Those who were aged 26 to 35 (OR = 3.80), started drinking before age 18 (OR = 2.14), who were heavy drinkers (OR = 1.99), or who had ever used drugs (OR = 2.00) were more likely to have ever engaged in sex after drinking. Health education programs for alcohol abuse and unwanted outcomes, particularly the risk of HIV, are urgently needed for ethnic males in Yunnan.

[The application of National AIDS spending assessment in a county of Dehong prefecture, Yunnan province, China]

OBJECTIVE

To calculate the actual expenditures in a county of Dehong prefecture, Yunnan province, China by using the method of National AIDS Spending Assessment (NASA) in 2010.

METHODS

Data were collected through NASA data collection form based on adapted NASA classification in the county of Dehong prefecture from October to December, 2011, and complemented by semi-structured interview with 16 well trained programmatic and financial representatives in 8 spending units. Data were entered in Resource Tracking Software (RTS) V 2009.3.0, and SPSS 13.0 was used for data processing and analysis.

RESULTS

The NASA estimations showed that the county spent a total of ¥16 235 954 on HIV/AIDS in 2010. Public funds constituted 96.3% of the total expenditure (¥15 630 937), followed by Global Fund which accounted for 3.0% (¥484 585) and private sources which accounted for 0.7% (¥120 432). Findings based on NASA categories showed that AIDS spendings were mainly on 4 areas, and expenditure on Care & Treatment was ¥12 401 382 (76.4% of total expenditure), followed by Prevention which accounted for 14.3% (¥2 325 707), Program Management & Administration which accounted for 7.8% (¥1 268 523) and human resources which accounted for 1.5% (¥240 342). The most beneficial population group was People Living with HIV (PLHIV), accounting for 84.7% of total expenditure. (¥13 753 428), followed by 4.8% for high risk population, including female sex workers and their partners (¥297 333), injection drug users and their partners (¥293 143), men having sex with men and their partners (¥185 136) and 1.5% (¥241 429) for the general population.

CONCLUSION

The local funds for HIV/AIDS in this county was insufficient. The local government should increase corresponding funds based on central government funding. Care and treatment was the first spending priority in the county and the investment of prevention services needs to be increased. Prevention and treatment and care should be combined to ensure the effectiveness of comprehensive prevention and treatment of AIDS.

Dual-frequency High Intensity Focused Ultrasound (HIFU) Accelerating Therapy

By cutting a spherical focused transducer into two coaxial and confocal transducer elements, a confocal complex transducer used in dual-frequency HIFU system was obtained. The lesion induced by dual-frequency HIFU in freshly excised porcine livers were obviously larger than that induced by conventional single-frequency HIFU at the same exposure conditions. The experiment results have also shown that injecting ultrasound contrast agents to the tissue or selecting appropriate difference frequency could further improve the lesioning effect. The dual-frequency HIFU would bring a new approach to accelerate ablating large tumor with HIFU and also provide a new method to miniaturize the conventional HIFU apparatus.

[Study on the mortality and risk factors among HIV-infected individuals during 1989 - 2011 in Dehong prefecture, Yunnan province]

OBJECTIVE

To examine the mortality and risk factors among HIV-infected patients during 1989 - 2011 in Dehong prefecture, Yunnan province.

METHODS

All HIV-infected patients reported during 1989 - 2011 in Dehong prefecture who held local residency were included in the study. Mortality rates and cumulative survival rates were calculated. Multiple regression analysis under Cox proportional hazard model was conducted to examine the risk factors for deaths.

RESULTS

A total of 13 006 HIV-infected patients were included in this study including 73.2% males, 79.1% peasants and 48.7% married at the time of reporting. 64.5% of the patients were ethnic minorities, and 68.7% were illiterate or having received only primary school education. All the patients were followed-up for a total of 55 962.30 person-years with 4648 patients died, with overall mortality rate as 8.31/100 person-years. The mortality rate had been increasing from 1990 to 2004 but decreasing since 2005. The average survival time since the identification of HIV infection was 9.48 years overall, and was 16.65 years for those having received antiretroviral treatment (ART) and 7.67 years for those without ART. Data from multiple regression analysis indicated that ART and socio-demographic characteristics such as age, gender, ethnicity, occupation, marital status, education background etc. were significantly associated with death among HIV-infected patients.

CONCLUSION

The comprehensive AIDS campaigns including ART had significantly reduced the deaths among HIV-infected patients in Dehong prefecture. More efforts on the scaling up program of ART as well as the enhanced management and follow-up program tailored for HIV-infected patients with different socio-demographic characteristics were needed to further reduce the deaths in the area.

[Distribution of HIV-1 subtypes among different populations in Dehong prefecture, Yunnan province, in 2011]

OBJECTIVE

To investigate the distribution of HIV-1 subtypes in Dehong prefecture, Yunnan province, in 2011.

METHODS

300 HIV-1 positive plasma samples were collected from Jan. 2011 to May 2011 in Dehong prefecture. HIV-1 gag genes and env genes were amplified by nested-polymerase chain reaction (PCR) from viral RNA. After sequencing, the HIV-1 subtypes were determined by phylogenetic analysis.

RESULTS

Based on the phylogenetic trees of gag gene and env gene fragments, a total of 222 samples were genotyped. Subtype C was the predominant strain in Dehong (43.2%, 96/222), followed by unique recombinant forms (URFs, 27.0%, 60/222), CRF01_AE (21.2%, 47/222), CRF08_BC (5.0%, 11/222), B' (2.3%, 5/222) and CRF07_BC (1.4%, 3/222). Subtype C strains were predominant in both heterosexually transmitted population and intravenous drug users (IDUs), but different subtype distribution patterns were found in these two populations. All 6 genotypes including subtype C (40.7%, 70/172), CRF01_AE (25.0%, 43/172), and URFs (25.0%, 43/172) found in this area among heterosexually transmitted population, which showed the diversity of genotypes in this population. Except subtype B' and CRF07_BC, the other 3 subtypes and URFs were detected among IDUs, mainly including subtype C (54.8%, 23/42) and URFs (38.1%, 16/42), which showed the concentration trend of genotypes distribution among IDUs. The proportion of URFs increased significantly in this area, including the new BC recombinants (41.7%, 25/60) and CRF01_AE relative URFs (58.3%, 35/60). However, the distributions of these two URFs among heterosexually transmitted population and IDUs showed no statistical significance.

CONCLUSION

The distribution of HIV-1 strains prevailing in Dehong prefecture was diversity, including 5 subtypes and a variety of URFs, of which subtype C was the predominant strain. The distribution patterns of subtype were different among different populations.

Plasma Hepatitis C Virus Viral Load Among Hepatitis C Virus Mono-Infected and HCV/HIV Co-Infected Individuals in Yunnan Province,China

BACKGROUND

Hepatitis C virus (HCV)/human immunodeficiency virus (HIV) co-infection has become a serious public health problem especially in high risk groups such as injection drug users in China. However, the impact of HIV infection and antiretroviral therapy (ART) on HCV viral load which is usually regarded as a predictor of liver disease progress had not been well studied in this country.

OBJECTIVES

To explore correlations of HIV co-infection and ART with plasma HCV load among HCV-infected patients in an ethnic minority area in Yunnan Province, China.

PATIENTS AND METHODS

HCV/HIV co-infected patients and HCV mono-infected controls were examined and compared for plasma HCV RNA and related risk factors.

RESULTS

A total of 145 HCV/HIV co-infected patients and 25 HCV mono-infected controls were studied. The majority of the participants were male, belonged to an ethnic minority and were younger than 45 years old. HCV viral suppression rate with undetectable plasma HCV viral load was 28.3% in the HCV/HIV co-infected patients, 36% among HCV mono-infected controls and 29.4% overall. ART-prescribed HCV/HIV co-infected patients had significantly higher HCV viral loads (IQR: (3.80-6.44)*log(10) copies ml-1) than those naïve to ART (IQR: (undetectable-6.41)*log(10) copies ml-1) and HCV mono-infected patients (IQR: (undetectable-5.44)*log(10) copies ml-1). Men, from the Dai minority and those with more than six years education, were also shown to have a higher plasma HCV viral load,according to multiple logistic regression analysis.

CONCLUSIONS

ART potentially increases the plasma HCV viral load among HCV/HIV coinfected patients in an ethnic minority area in China. Future large scale prospective cohort studies are needed to address the controversy associated between HIV co-infection and the natural history of HCV.

[Association between amino acid mutations in Gag protein and human leukocyte antigen class I alleles in human immunodeficiency virus-1 B' infected Han Chinese people]

OBJECTIVE

To explore the human leukocyte antigen (HLA)-associated mutations in Gag protein of B' clade (human immunodeficiency virus-1) HIV-1 infected Han Chinese people and evaluate the impact of HLA associated Gag mutations on the disease progression of HIV infection.

METHODS

A total of 95 B' clade HIV-1 infected Han Chinese cases were recruited. The gag sequences were amplified from viral RNA and sequenced directly. HLA-I genotypes were detected with the assay of polymerase chain reaction-sequence specific primer (PCR-SSP). HLA-associated mutations were identified and the relationships between HLA-associated mutations and CD4+ T cell counts or plasma viral loads analyzed.

RESULTS

Forty-seven kinds of mutations at 28 sites (15, 18, 26, 30, 34, 46, 62, 67, 81, 84, 90, 102, 118, 121, 122, 125, 146, 147, 173, 176, 252, 357, 374, 376, 437, 470, 471, 478) of Gag protein were significantly associated with particular HLA class I allelotypes (P < 0.05). Among which, 9 sites (26, 30, 81, 84, 125, 146, 147, 357, 437) were located within 13 known cytotoxic T-lymphocyte (CTL) epitopes or flanking regions. The number of HLA-associated mutations was significantly associated with both CD4 T cell counts (r = -0.318, P = 0.002) and viral loads (r = 0.360, P = 0.003).

CONCLUSION

HLA-associated mutations may have a significant impact on HIV disease progression in B' clade HIV-1 infected Han Chinese population.

Modulation of ascorbic acid-induced DNA cleavage by polyamide: cleavage manner, kinetics and mechanism

Manipulation of DNA presents a great interest in biotechnology and therapeutics. The molecules that damage DNA selectively offer new prospects for controlled manipulation of DNA. The conjugations of DNA-code reading molecules such as polyamides to reagents that induce DNA damages provide an approach to reach this goal. In this work, a new compound which contained polyamide and ascorbic acid conjugated by flexible linker (polyamide-Vc), was successfully synthesized, characterized, and evaluated as DNA cleavage agent, compared with that by using ascorbic acid molecule. The kinetics data showed that polyamide-Vc successfully promoted the cleavage of plasmid DNA, with k(max) of 0.314 h(-1) and K(d) of 0.105 mM. The evaluation of DNA linearization elicited that the activity of cleaving double-strand in the supercoiled pUC18 plasmid DNA by polyamide-Vc was enhanced remarkably, achieving n1/n2 ratio of 13.9 at 1.2 mM for 1 h. The introduction of polyamide to Vc could also partially weaken the inhibition of hydrogen radical to double-strand cleavage process because of its good binding activity to DNA. We anticipate that this work could provide a method for improving the efficiency of double-strand cleavage, especially to oxidative cleavage agents.

The situation of sanitary systems in rural areas in the Miyun catchment, China

The Miyun Reservoir provides most of Beijing's drinking water. Despite its importance, the Miyun reservoir suffers from decreasing water quality caused by uncontrolled wastewater discharges, inadequate land use and over fertilization, which increase the pressure on soil and water resources. The major pollutants are nitrogen and phosphorus which emanate to some extent from untreated sewage. So far there is little data about the existing wastewater quantity and quality in rural settlements in northern China. This study was conducted in typical villages situated along upstream rivers in the catchment of the Miyun Reservoir. The main objective was to determine the current situation and efficiency of the wastewater treatment system in rural settlements.

Economic evaluation of methadone maintenance treatment in HIV/AIDS control among injecting drug users in Dehong, China

The purpose of this study was to analyze the cost and cost-effectiveness of methadone maintenance treatment (MMT) program in Dehong prefecture, Yunnan province, China. The cost-effectiveness analysis used process data retrospectively collected from the MMT clinics in Dehong Prefecture, Yunnan Province, from July 2005 to December 2007, a 30-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using incidence rate from cohort studies and retrospective studies. Program costs were collected retrospectively following standard methods using an ingredients methodology. The cost for each participant treated in MMT clinics was about $9.1-16.7 per month and the intervention averted 8.4-87.2 HIV infections with a cost-effectiveness of US$ 2509.3-4609.3 per HIV infection averted. This research demonstrates that MMT is a cost-effective intervention for reducing HIV transmission among injecting drug users, but the coverage of MMT intervention should be matched with the designed volume of MMT clinics to make the best use of resources.

[Study on incidence of HIV infection among heroin addicts receiving methadone maintenance treatment in Dehong prefecture, Yunnan province]

OBJECTIVE

To determine the incidence and risk factors of HIV infection among heroin addicts receiving methadone maintenance treatment (MMT) in Dehong prefecture, Yunnan province.

METHODS

All heroin addicts who were HIV negative at the initiation of MMT in June 2005 and through June 2011, in Dehong prefecture were included in the cohort analysis. HIV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.

RESULTS

A total of 3154 MMT clinic attendants were qualified for this cohort study. By June 2011, 1023 (32.4%) of them had never received any follow-up HIV testing so were thus referred as loss to follow-up. The other 2131 (67.6%) members had received at least one follow-up HIV testing and were observed for a total of 4615.86 person-years. During the period, 22 new HIV infections or seroconverters were identified, making the overall HIV incidence as 0.48/100 person-years. The HIV incidence was higher among those who were unemployed, never married, self-reported being injecting drug users (IDUs) and HCV positive at entry into the MMT program. None of those who were always negative on follow-up-urine-testing of morphine was discovered as HIV newly infected during the follow-up period. Data from multiple regression analysis under Cox proportional hazard model indicated that after controlling for confounding variables, non-IDUs at the entry point for the MMT program, were less likely to be HIV newly-infected or seroconverted than IDUs (HR = 0.29, 95%CI: 0.11 - 0.76).

CONCLUSION

MMT program in Dehong prefecture was demonstrated to be fairly effective in reducing HIV transmission through drug use. Those HIV negative attendants at the MMT clinic who were IDUs or keep using drugs during the treatment, were at higher risk of HIV seroconvertion. More efforts were needed to improve the follow-up and HIV testing programs for the MMT clinic attendants.

[Survey on contact tracing of newly reported HIV infections in 2009 in Dehong prefecture, Yunnan province]

OBJECTIVE

To explore a new method for finding more HIV/AIDS.

METHODS

In September 2009, newly reported HIV-infected individuals from May to August, 2009 in Dehong prefecture were asked to participate in a survey which requested demographic characteristics, history of high-risk behaviors and contact information of individuals with whom they had high risky contacts. People with risky contacts with HIV-infected cases (index cases) were also approached to participate in this survey and HIV testing was provided.

RESULTS

A total of 342 HIV-infected individuals were newly reported and served as index cases from May to August, 2009. Among them, 47.1% (161/342) were transmitted by regular sexual partners. Through three-round surveys, 218 contacts were traced and among them, 84.9% (185/218) were traced by regular heterosexual partners. HIV positive rate of the tested was 34.7% (60/173) in the first-round tracing and 12.5% (1/8) in the second one. Among the 560 individuals (index cases and their high-risk contacts), the proportions of having regular heterosexual partners, non-regular and non-commercial sexual partners, commercial sexual heterosexual partners and men having sex men were 87.9% (492/560), 18.9% (106/560), 22.3% (125/560) and 0.3% (1/318), respectively, while the proportion of having never used condoms when having sex with the above four types sexual partners were 73.8% (363/492), 72.6% (77/106), 63.2% (79/125) and 0.0% (0/1), respectively.

CONCLUSION

As an epidemiological method for HIV/AIDS finding, contact tracing identified a large number of HIV infectors who were traced by newly reported HIV-infected individuals.

[Analysis of quality of life and its influencing factors of heroin dependent patients with methadone maintenance therapy in Dehong prefecture, Yunnan province]

OBJECTIVE

To investigate the quality of life of heroin dependent patients with methadone maintenance therapy and its influencing factors.

METHODS

Totally 462 heroin dependent patients who were receiving methadone maintenance therapy in Mangshi, Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture, Yunnan province were randomly selected using proportional stratified sampling and interviewed with the WHO Quality of Life-BREF (QOL-BREF) in order to understand their quality of life in the fields of physical, psychological, social relationships, and environmental function during 4 weeks ago before interviewing, and the influencing factors of the quality of life.

RESULTS

Among the 462 patients, 451 patients (97.6%) were male and 11 (2.4%) were female. Their average age was (37.80 ± 9.13) years old; 145 patients (31.39%) unmarried, 270 patients (58.44%) were married; 35.93% (166/462) of patients had primary school education, 37.23% (172/462) of patients had senior high school education. The patients had a score of 54.11 ± 6.74 for total quality of life and well being and a score of 14.31 ± 2.23, 13.28 ± 1.79, 13.90 ± 2.52, 12.63 ± 1.77 for physical, psychological, social relationships and environmental function, respectively. The quality of life for physical, psychological, social relationships and environmental function of the group of patients which ages between 30 to 40, unmarried, high middle school and above education, length of drug addiction more than 10 years before receiving treatment, treatment duration less than 6 months, incoming from temporary job were with lower score for total quality of life and well being. The quality of life for physical, psychological was lower for those aged between 16 and 30 when becoming first time drug user, which scores were 14.29 ± 2.25 and 13.22 ± 1.84, respectively. The quality of life for physical, psychological, social relationships of the group of patients which injecting drug only or injecting drug with other manners before receiving treatment were lower, which scores were 13.92 ± 2.25, 13.08 ± 1.67, 13.25 ± 2.60 for injecting drug only and 13.67 ± 2.52, 13.43 ± 1.71, 13.80 ± 2.56 for injecting drug with other manners.

CONCLUSION

Attending and keeping methadone maintenance therapy could improve the quality of life of heroin dependent patients. Age, marriage status, education, time of drug use, treatment duration may be the influential factors.

Experimental study on the atlanto-axial joint and related structures with regional anatomy and medical imaging

OBJECTIVE

To evaluate the anatomy and medical imaging characteristics in a study observing the atlanto-axial joint (AAJ) and related structures.

METHODS

Eight cadaveric specimens of the AAJ segment were studied with both anatomical and imaging methods. The vertebral arteries of the AAJ segment (VA-A), the first and second cervical nerves (CN1, CN2) and synovial fold (SF) of the AAJ were observed and measured.

RESULT

After extending from the vertebral canal, the CN1 goes between the posterior arch of the atlas and VA-A, and the CN2 passes between the posterior arch of the atlas and axis, and is posterior to VA-A. Among the eight cases, six were found in the SF in the central anterior AAJ and five in lateral. The vertebral arteries of the AAJ segment go along the AAJ with four curves, of which the second and fourth are away from the bone structure of the AAJ. The distance from CN1, CN2 to VA-A and that from the second, fourth curve of VA-A to AAJ is 0.0-2.2 mm, 0.0-3.6 mm and 0.0-4.8 mm, 2.0-7.9 mm respectively. There is no significant difference between the measurements made anatomically and those by the imaging method (p > 0.05).

CONCLUSION

The anatomical method has advantages in observing the CN and SF, while the imaging method shows clearly and directly the VA-A and AAJ. Both are mutually complementary with consistent measurements. The combined use of the two provides a new way to study the complicated anatomy in this region.

Nitric oxide-releasing nanoparticle combination therapy to overcome drug resistance in platinum-resistant breast cancers

278

Background: The most successful cancer chemotherapy regimens usually involve the administration of multiple cytotoxic agents simultaneously. Because different chemotherapies may have different mechanisms of action; it is difficult for cancer cells to become resistant to combination therapy. Recent investigations have discovered that nitric oxide (NO) may be involved in the reversal of cisplatin (CDDP) resistance in chemotherapy. Therefore, we sought to develop a combination regimen involving a NO-releasing prodrug (NO1) and cisplatin for the treatment of breast cancer.

Methods: The prodrug NO1 was synthesized to be localized in tumor cells and to release nitric oxide over 10 hours. The antiproliferative activity of NO1 was determined in human breast cancer cell line, MDA-MB-468LN. To evaluate the effectiveness of the CDDP/NO combination regimen, platinum-resistant MDA-MB-468LN cells were treated with either cisplatin alone ([CDDP]=0.01, 0.02 or 0.03 mM) or the CDDP/NO combination ([CDDP]=0.01, 0.02 or 0.03 mM; [NO1]=0.02 mM). The cell viability was determined 48 hours post-treatment using a live/dead trypan blue exclusion assay.

Results: The toxicity to breast cancer cells was higher than JS-K, a systemic NO agent currently in preclinical development. (NO1: IC50=26µM; JS-K: IC50=42 µM). In addition, NO1 had a long sustained release of nitric oxide, approximately one fold longer than JS-K (NO1: t1/2=6 h; JS-K: t1/2=3 h). The combination treatments resulted in 6.6-, 6.9- and 7.5-fold increase in cell death compared to cisplatin treatment alone at cisplatin concentrations of 0.01, 0.02 and 0.03 mM, respectively. A subsequent study in a murine xenograft of head and neck cancer found NO-1 conjugated to nanoparticles increased survival a mean of 10 weeks compared to controls (p<0.0001).

Conclusions: Nitric oxide prodrug NO-1 and nanoparticles of it have high anticancer activity in vivo and they can reverse platinum resistance in vitro. Ongoing studies are examining the safety and efficacy of CDDP/NO combination therapy in mouse xenografts of human breast cancer.

[Studies on the determinants and changes related to the natural CD4(+) T cell counts among antiretroviral treatment-naive HIV/AIDS patients in Dehong prefecture, Yunnan province]

OBJECTIVE

To explore the determinants and changes of CD4(+) T cell counts among antiretroviral treatment-naive HIV/AIDS patients in Dehong prefecture, Yunnan province.

METHODS

A retrospective cohort analysis was conducted on HIV-infected local residents, being reported during 1989 through May 2010, in Dehong prefecture. The patients had received at least two CD4(+) T cell counting tests before receiving the antiretroviral treatment (ART). Difference between the first and the last CD4(+) T cell counts was calculated and described. Logistic regression analysis was conducted to examine the determinants of significant depletion of CD4(+) T cell counts among them.

RESULTS

A total of 4487 HIV/AIDS patients were included in the study. The change of CD4(+) T cell counts between the first and the last CD4(+) T cell count tests had a median of -2.0 cells/µl in month (IQR: -8.2 - 3.6) and was significantly associated with socio-demographic characteristics, HIV transmission mode, the first or baseline CD4(+) T cell counts and the time interval between the first and the last CD4(+) T cell counting tests etc. About 60.0% (2693/4487) of the HIV/AIDS patients had deletions of CD4(+) T cell counts, and 31.2% (1400/4487) had significant (≥ 30%) deletions of CD4(+) T cell counts. Results from the multiple logistic regression analysis indicated that age, ethnicity, marital status, HIV transmission mode, the first CD4(+) T cell counts and the interval between the first and the last CD4(+) T cell counting tests were significantly associated with the significant depletion of CD4(+) T cell counts.

CONCLUSION

The changing rate of CD4(+) T cell count among ART-naive local HIV-infected patients in Dehong prefecture, Yunnan province was relatively slow. However, substantial proportion of them showed significant decreases of CD4(+) T cell counts, which was determined by many factors. More efforts were needed to systematically and consistently follow-up those HIV-infected patients and measure their CD4(+) T cell counts in China, in order to instantaneously monitor the disease progression, and the initiation of ART, if necessary.