Outcome of Sentinel Hospital-based and CDC-based ART Service Delivery: A Prospective Open Cohort of People Living with HIV in China

The primary objective of this study was to obtain insights into the outcomes of people living with HIV who accessed services through HIV/AIDS sentinel hospital-based and ART service delivery in China. Post-hoc analyses of an open cohort from an observational database of 22 qualified HIV/AIDS sentinel hospital-based and two CDC-based drug delivery facilities (DDFs) in Guangdong Province was completed. Linkage to care, mortality and survival rates were calculated according to WHO criteria. 12,966 individuals received ART from HIV/AIDS sentinel hospitals and 1,919 from DDFs, with linkage to care rates of 80.7% and 79.9%, respectively (P > 0.05). Retention rates were 94.1% and 84.0% in sentinel hospitals and DDFs, respectively (P < 0.01). Excess mortality was 1.4 deaths/100 person-years (95% CI: 1.1, 1.8) in DDFs compared to 0.4 deaths/100 person-years (95% CI: 0.3, 0.5) in hospitals (P < 0.01). A Cox-regression analysis revealed that mortality was much higher in patients receiving ART from the DDFs than sentinel hospitals, with an adjusted HR of 3.3 (95% CI: 2.3, 4.6). A crude HR of treatment termination in DDFs was 7.5 fold higher (95% CI: 6.3, 9.0) compared to sentinel hospitals. HIV/AIDS sentinel hospital had better retention, and substantially lower mortality compared to DDFs.

Results from the Survey of Antibiotic Resistance (SOAR) 2009-11 and 2013-14 in China

OBJECTIVES

To compare antibiotic susceptibility of community-acquired respiratory bacteria in China during 2009-11 and 2013-14.

METHODS

Susceptibility was determined by Etest(®) (bioMérieux) or disc diffusion according to CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints, except for azithromycin where Etest(®) breakpoints (in CO2 incubation) were used in place of standard CLSI breakpoints. Statistical significance of differences in susceptibility across time periods was evaluated using Fisher's exact test.

RESULTS

During 2009-11, 434 Streptococcus pneumoniae, 307 Haemophilus influenzae and 140 Moraxella catarrhalis were collected from eight centres and during 2013-14, 208 S. pneumoniae, 185 H. influenzae and 80 M. catarrhalis were collected from five centres. Penicillin-non-susceptible isolates remained stable at ∼66% over both time periods but susceptibility decreased significantly for amoxicillin/clavulanic acid (or amoxicillin) and cefaclor. For H. influenzae, the proportion of β-lactamase-positive isolates and β-lactamase-negative ampicillin-resistant strains (CLSI definition) was higher in 2013-14 (25.4% and 7.0%, respectively) than in 2009-11 (16.3% and 3.6%, respectively), with decreased ampicillin and cephalosporin susceptibility. By 2009-11 and 2013-14, only amoxicillin/clavulanic acid (amoxicillin), levofloxacin, penicillin (intravenously) and chloramphenicol inhibited >70% of S. pneumoniae. During 2013-14, M. catarrhalis showed increasing resistance, with cefaclor and levofloxacin susceptibility decreasing significantly. However, amoxicillin/clavulanic acid, cefuroxime and levofloxacin continued to inhibit >90% of isolates.

CONCLUSIONS

On the whole, antimicrobial susceptibility decreased in China between 2009-11 and 2013-14. In 2013-14, amoxicillin/clavulanic acid, levofloxacin and chloramphenicol were the most active antibacterial agents tested against community-acquired respiratory pathogens when assessed by CLSI, EUCAST or PK/PD breakpoints. Resistance to other antibacterials in China was generally high. Our data demonstrate the need to harmonize breakpoints for these pathogens.

Expression and characterization of a Talaromyces marneffei active phospholipase B expressed in a Pichia pastoris expression system

Phospholipase B is a virulence factor for several clinically important pathogenic fungi, including Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus, but its role in the thermally dimorphic fungus Talaromyces marneffei remains unclear. Here, we provide the first report of the expression of a novel phospholipase gene, designated TmPlb1, from T. marneffei in the eukaryotic expression system of Pichia pastoris GS115. Sensitive real-time quantitative reverse-transcription PCR (qRT-PCR) demonstrated that the expression of TmPlb1 increased 1.85-fold in the yeast phase compared with the mycelial phase. TmPlb1 contains an open reading frame (ORF) of 732 bp that encodes a protein of 243 amino acids. The conserved serine, aspartate and histidine catalytic triad and the G-X-S-X-G domain of TmPLB1 provide the structural basis for its molecular activity. The ORF of TmPlb1 was successfully cloned into a pPIC9K vector containing an α-mating factor secretion signal that allowed the secretory expression of TmPLB1 in P. pastoris. The heterologous protein expression began 12 h after methanol induction and peaked at 96 h. Through analysis with SDS-polyacrylamide gel electrophoresis (SDS-PAGE), western blotting and mass spectrometry, we confirmed that TmPLB1 was successfully expressed. Through Ni-affinity chromatography, TmPLB1 was highly purified, and its concentration reached 240.4 mg/L of culture medium. With specific substrates, the phospholipase A1 and phospholipase A2 activities of TmPLB1 were calculated to be 5.96 and 1.59 U/mg, respectively. The high purity and activity of the TmPLB1 obtained here lay a solid foundation for further investigation.

Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

INTRODUCTION

Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking.

METHODS

We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings.

RESULTS

Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025), children living with HIV (two studies, n=46), adolescents living with HIV (four studies, n=70) and pregnant women living with HIV (one study, n=79). Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay health workers and inadvertent disclosure of serostatus by participating in the intervention.

CONCLUSIONS

Our study evaluated adherence interventions based on qualitative data from PLHIV and health providers. The study underlines the importance of incorporating social and cultural factors into the design and implementation of interventions. Further qualitative research is needed to evaluate ART adherence interventions.

MAVS-dependent host species range and pathogenicity of human hepatitis A virus

Hepatotropic viruses are important causes of human disease, but the intrahepatic immune response to hepatitis viruses is poorly understood because of a lack of tractable small- animal models. We describe a murine model of hepatitis A virus (HAV) infection that recapitulates critical features of type A hepatitis in humans. We demonstrate that the capacity of HAV to evade MAVS-mediated type I interferon responses defines its host species range. HAV-induced liver injury was associated with interferon-independent intrinsic hepatocellular apoptosis and hepatic inflammation that unexpectedly resulted from MAVS and IRF3/7 signaling. This murine model thus reveals a previously undefined link between innate immune responses to virus infection and acute liver injury, providing a new paradigm for viral pathogenesis in the liver.

[Direct anterior approach versus posterolateral approach for total hip arthroplasty in the lateral decubitus position]

Objective: To compare the clinical efficacy of the direct anterior approach (DAA) and the posterolateral approach (PLA) for total hip arthroplasty (THA) in the lateral decubitus position. Methods: From July to December, 2014, 104 patients randomly divided into two equal groups of the DAA group and the PLA group underwent unilateral primary THA procedures.All procedures were performed by the same surgeon in the Department of Orthopaedics, the Affiliated Anhui Provincial Hospital of Anhui Medical University.General data, perioperative index, postoperative function and radiological evaluation were recorded and statistically analyzed. Results: The patients had an average follow-up of 14 (range, 10-16) months.No significant differences were detected with respect to the operation time, incision length, preoperative Hb concentration and transfusion rate between two groups (P> 0.05 for all comparisons). However, there were significant differences associated with the intraoperative bleeding, postoperative drainage and postoperative Hb concentration in the two groups(P<0.05 for all comparisons). The DAA group showed significant superior outcomes compared with the PLA group in the Harris hip scores [(83.6±7.1) vs (79.8±6.6), P<0.05], WOMAC[ (28.9±6.1) vs (36.1±6.9), P<0.001], and VAS pain scores[ (2.2±0.9) vs (2.9±1.1), P<0.05]at 1 month after surgery. No differences were seen between the study groups in the evaluation of radiography and the incidence of adverse event (P> 0.05 for all comparisons). Conclusions: Compared with the posterolateral approach, the present study shows the exciting results in patients underwent the DAA THA in the lateral decubitus position at early follow-up.The advantages of THA using the DAA include less operative trauma, alleviation of postoperative pain, and faster postoperative rehabilitation. It is a safe, reliable and effective surgery approach.

Plasma Mitochondrial DNA Levels as a Biomarker of Lipodystrophy Among HIV-infected Patients Treated with Highly Active Antiretroviral Therapy (HAART)

Lipodystrophy is a common complication in HIV-infected patients taking highly active antiretroviral therapy. Its early diagnosis is crucial for timely modification of antiretroviral therapy. We hypothesize that mitochondrial DNA in plasma may be a potential marker of LD in HIV-infected individuals. In this study, we compared plasma mitochondrial DNA levels in HIV-infected individuals and non-HIV-infected individuals to investigate its potential diagnostic value. Total plasma DNA was extracted from 67 HIV-infected patients at baseline and 12, 24 and 30 months after initiating antiretroviral therapy. Real-time quantitative PCR was used to determine the mitochondrial DNA levels in plasma. Lipodystrophy was defined by the physician-assessed presence of lipoatrophy or lipohypertrophy in one or more body regions. The mitochondrial DNA levels in plasma were significantly higher at baseline in HIV-infected individuals than in non-HIV-infected individuals (p<0.05). At month 30, 33 out of 67 patients (49.2%) showed at least one sign of lipodystrophy. The mean plasma mitochondrial DNA levels in lipodystrophy patients were significantly higher compared to those without lipodystrophy at month 24 (p<0.001). The receiver operating curve analysis demonstrated that using plasma mitochondrial DNA level (with cut-off value <5.09 log10 copies/ml) as a molecular marker allowed identification of patients with lipodystrophy with a sensitivity of 64.2% and a specificity of 73.0%. Our data suggest that mitochondrial DNA levels may help to guide therapy selection with regards to HIV lipodystrophy risk.

'I can coexist with HIV': a qualitative study of perceptions of HIV cure among people living with HIV in Guangzhou, China

Little is known about perceptions of HIV cure among people living with HIV (PLHIV), despite them being crucial stakeholders in ongoing HIV cure research. A qualitative research study was conducted in Guangzhou, China, to explore the perceptions of HIV cure among PLHIV in relation to their views on HIV treatment, stigma and social identity. We conducted in-depth interviews with 22 PLHIV from September 2014 to June 2015. Our qualitative data revealed three major themes: (1) Representations of HIV cure: PLHIV generally thought HIV cure was distant from them; (2) Possibility of HIV cure: ideas about the possibility of HIV cure ranged from optimism to scepticism and pessimism; and (3) Life without HIV cure: some participants had adjusted well to the chronic condition of HIV and ART adherence. Although some PLHIV looked forward to HIV being cured, most of the PLHIV in our study had little interest in it. On the contrary, many felt it is more important and realistic to have access to better ART medication and more education for the general public to decrease HIV stigma today rather than develop a cure for tomorrow.

Natural Polymorphisms Conferring Resistance to HCV Protease and Polymerase Inhibitors in Treatment-Naïve HIV/HCV Co-Infected Patients in China

BACKGROUND

The advent of direct-acting agents (DAAs) has improved treatment of HCV in HIV co-infection, but may be limited by primary drug resistance. This study reports the prevalence of natural polymorphisms conferring resistance to NS3/4A protease inhibitors and NS5B polymerase inhibitors in treatment-naïve HIV/HCV co-infected individuals in China.

METHODS

Population based NS3/4A sequencing was completed for 778 treatment-naïve HIV/HCV co-infected patients from twelve provinces. NS3 sequences were amplified by nested PCR using in-house primers for genotypes 1-6. NS5B sequencing was completed for genotyping in 350 sequences. Resistance-associated variants (RAVs) were identified in positions associated with HCV resistance.

RESULTS

Overall, 72.8% (566/778) of all HCV sequences had at least one RAV associated with HCV NS3/4A protease inhibitor resistance. Variants were found in 3.6% (7/193) of genotype 1, 100% (23/23) of genotype 2, 100% (237/237) of genotype 3 and 92% (299/325) of genotype 6 sequences. The Q80K variant was present in 98.4% of genotype 6a sequences. High-level RAVs were rare, occurring in only 0.8% of patients. 93% (64/69) patients with genotype 1b also carried the C316N variant associated with NS5B low-level resistance.

CONCLUSIONS

The low frequency of high-level RAVs associated with primary HCV DAA resistance among all genotypes in HIV/HCV co-infected patients is encouraging. Further phenotypic studies and clinical research are needed.

[Biomarker screening of rat pulmonary hypertension model by transcriptome sequencing]

OBJECTIVE

To screen relative gene and pathway of rat severe pulmonary hypertension by transcriptome sequencing.

METHOD

Pulmonary hypertension animal model of SD rats was established by left lung resection and hypodermic injection of monocrotaline.Monocrotaline was injected subcutaneously one week after left lung resection.Eight rats at 1, 3, 5 weeks after the injection of monocrotaline respectively were named group M1, group M2 and group M3.Eight normal rats were assigned into control group (group C). The right lung tissue was used for transcriptome sequencing to screen the differentially expressed genes.KEGG pathway analysis was performed to screen the pathways with enriched differentially expressed genes.

RESULT

The animal model was established successfully.The pulmonary artery pressure was as follows: group C (28.6±3.0) mmHg(1 mmHg=0.133 kPa), group M1 (38.9±3.3) mmHg, group M2 (50.8±3.9) mmHg, group M3 (51.5±3.5) mmHg.The pressure elevated in group M1 compared with group C (P=0.007). The pressure in M2 and M3 elevated compared with M1(P=0.002 and P<0.001 respectively). The pressure showed no significant difference between group M3 and group M2(P=1.000). The genes possibly associated with the formation of severe pulmonary hypertension were epithelial specific receptor tyrosine kinase(Tie2) and thrombospondin-1(TSP-1). Tie2 was down-regulated (q<0.005) in the early stage of pulmonary hypertension and up-regulated (q<0.005) in the late stage of pulmonary hypertension.TSP-1 was up-regulated (q<0.005) in the early stage of pulmonary hypertension and down-regulated (q<0.005) in the late stage of pulmonary hypertension.In the stage of severe pulmonary hypertension, the differentially expressed genes were enriched mainly in the pathways of phosphatidylinostitol 3-kinase, focal adhesion kinase and extracellular matrix receptor interaction.

CONCLUSION

The study provides transcriptome information of rat pulmonary hypertension model and normal rat.Possible mechanisms of pulmonary hypertension are found.These genes and pathways might be new precursor for the diagnosis and treatment of pulmonary hypertension.

Antibiotic prophylaxis for shunt surgery of children: a systematic review

OBJECTIVE

The object of this study was to evaluate the clinical effectiveness of antibiotic prophylaxis in children who underwent placement of intracranial ventricular shunts.

METHODS

In this paper, the authors report a systematic review and meta-analysis of infection rate for pediatric shunt implantation surgery. Randomized or non-randomized controlled trials for comparing the use of prophylactic antibiotics in intracranial ventricular shunt procedures with placebo or no antibiotics were included in the review.

RESULTS

Seven published reports of eligible studies involving 694 participants meet the inclusion criteria. Compared with the control group, antibiotic prophylaxis had made a significant difference in infection rate (RR = 0.59, 95% CI = 0.38, 0.90, P < 0.05).

CONCLUSION

Although current evidence demonstrates that antibiotic prophylaxis can lead to a significant reduction of the infection rate of shunt surgery, more evidence from advanced multi-center studies is needed to provide instruction for the use of prophylactic antibiotics.

Characteristic analysis of white matter lesions in migraine patients with MRI

OBJECTIVE

The aim of this study is to analyze the characteristics of white matter lesions in abnormal manifestations of magnetic resonance imaging (MRI) of patients with migraine, and its relationship with migraine.

PATIENTS AND METHODS

38 patients, diagnosed with migraine were continuously selected as the observation group, while during the same period, 30 healthy individuals were selected as the control group. The differences of the features of MRI of two groups, the ratios of white matter lesions manifestations and the severity were compared.

RESULTS

The manifestations of MRI in patients with migraine were mainly white matter lesions. The accuracy rate was 86.7%, and the sensibility was 92.3%. According to Wahlund white matter lesions classifications, patients with migraine were mainly Level II and Level III (84.2%). It can be acquired from relevant analyses that white matter lesions classifications and the degrees of migraine were positively correlated (p < 0.05). White matter lesions were mainly distributed in the frontal lobe (78.9%), limbic system (60.5%) and parietal lobe (28.9%).

CONCLUSIONS

The MRI of migraine, the manifestations of white matter lesions were relatively sensitive. The higher the classification was linked with the degree of migraine. They were mainly distributed in the frontal lobe, limbic system and parietal lobe.

Molecular tracing of white muscardine in Asian corn borer using inter-simple sequence repeat (ISSR) analysis

Beauveria bassiana is a soil fungus that parasitizes arthropod species, and is used to control the Asian corn borer in Northeast China. In this study, B. bassiana was investigated in Xiaoxian County and Baicheng City, and the results were compared with those of Gongzhuling City, where the fungus was not applied. Using the inter-simple sequence repeat (ISSR) molecular marker technique, 198 isolates were extracted from Asian corn borer and other insect cadavers, and soil and air, and two released strains were analyzed to trace the infection source. In Xiaoxian and Baicheng populations, artificially released B. bassiana subpopulations were more abundant than indigenous fungi, and the released strains were the main cause of disease in those areas. Artificial B. bassiana displayed positive effect on overwintering of Asian corn borers in corn straw stacks in Xiaoxian County. Indigenous populations in Gongzhuling City showed higher genetic variation. In summary, we identified a significant correlation between genetic distance and geographic distance (P < 0.01).

24 versus 48 Weeks of Peginterferon Plus Ribavirin in Hepatitis C Virus Genotype 6 Chronically Infected Patients with a Rapid Virological Response: A Non-Inferiority Randomized Controlled Trial

Objectives

The optimal treatment of hepatitis C virus (HCV) genotype 6 is unclear owing to its limited geographic distribution. Because of a high predictive value of rapid virological response (RVR) for sustained virological response (SVR), we conducted an open-label randomized controlled trial to compare 24- and 48-week peginterferon/ribavirin combination therapy for patients with HCV genotype 6 in Southern China who achieved an RVR.

Methods and Findings

Treatment-naive, non-cirrhotic patients with chronic hepatitis C genotype 6 were treated with pegylated interferon α-2a (180 μg/week) and ribavirin (800–1,200 mg, according to weight) for 4 weeks. Patients who achieved an RVR, which was defined as HCV RNA negativity at week 4 (<50 IU), were randomized to receive either an additional 20 or 44 weeks of treatment (24- and 48-week treatment groups, respectively). The primary outcome measure was SVR. From January 2011 to June 2014, 152(152/210, 72.4%) patients with HCV genotype 6a and RVR were randomized 1:1 to the 24- or 48-week treatment group. The SVR rates in the 24- and 48-week groups in the intention-to-treat analysis were 90.8% (69/76) and 88.2% (67/76), respectively; those in the per-protocol analysis were 95.7% (67/70) and 97.0% (64/66), respectively. More patients in the 48-week group had anemia (46.1% vs. 28.9%, P = 0.03), but other adverse events were comparable between the groups. The limitation of the present study was that only patients from Southern China were enrolled which may inhibit the extensive application of the findings.

Conclusion

Twenty-four weeks of peginterferon/ribavirin combination therapy was non-inferior to 48 weeks in patients with HCV genotype 6a in Southern China who achieved an RVR.

Trial Registration

ClinicalTrials.gov NCT01263860

Genotypic distribution and hepatic fibrosis among HIV/HCV co-infected individuals in Southern China: a retrospective cross-sectional study

Background

End-stage liver disease and hepatocellular carcinoma due to hepatitis C virus (HCV) co-infection are increasingly common causes of death among HIV-infected individuals. However, there are few clinical investigations of HIV/HCV co-infected individuals from low and middle-income nations. Here, we compare the epidemiology of HCV-infected and HIV/HCV co-infected individuals in Southern China and examine hepatic fibrosis scores in co-infected individuals.

Methods

We conducted a retrospective cross-sectional study of treatment-naïve HIV/HCV co-infected and HCV mono-infected subjects. Bivariate and multivariate models were used to examine the association between demographics and HCV genotype. Among co-infected individuals, we also studied the relationship between fibrosis scores derived from non-invasive studies and HCV genotype.

Results

Data were collected from 175 HCV-infected individuals, including 89 (51 %) HIV/HCV co-infected individuals. HIV/HCV co-infection was correlated with intravenous drug use (AOR 46.25, p < 0.001) and not completing high school (AOR 17.39, p < 0.001) in a multivariate model. HIV/HCV co-infected individuals were more likely to be infected with HCV genotype 6a (p < 0.0001) or 3a (p < 0.023), whereas increased fibrosis (FIB-4 score) was associated with HCV genotype 3a infection (β 2.18, p < 0.001).

Discussion

Our results suggest that intravenous drug use is driving HIV/HCV co-infection in Southern China. While additional studies are needed, HCV genotype 6a is more common and genotype 3a appears to be associated with more severe hepatic fibrosis in co-infected individuals.

Conclusions

Future HIV/HCV co-infection research in China should focus on at risk populations, HCV testing uptake, and genotype-specific treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-015-1135-1) contains supplementary material, which is available to authorized users.