The impact of social factors on human immunodeficiency virus and hepatitis C virus co-infection in a minority region of Si-chuan, the People's Republic of China: a population-based survey and testing study

The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis

A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.

The changing modes of human immunodeficiency virus transmission and spatial variations among women in a minority prefecture in southwest China: An exploratory study

Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.

Population prevalence of myopia, glasses wear and free glasses acceptance among minority versus Han schoolchildren in China

Aim

To measure myopia, glasses wear and free glasses acceptance among minority and Han children in China.

Methods

Visual acuity testing and questionnaires assessing ethnicity, study time, and parental and teacher factors were administered to a population-based sample of 9–12 year old minority and Han children in Yunnan and Guangdong, and their teachers and parents. Refraction was performed on children with uncorrected visual acuity (VA) < = 6/12 in either eye, and acceptance of free glasses assessed.

Main outcome measures

Baseline myopia (uncorrected visual acuity < = 6/12 in > = 1 eye and spherical equivalent refractive power < = -0.5D in both eyes); baseline glasses wear; free glasses acceptance.

Results

Among 10,037 children (mean age 10.6 years, 52.3% boys), 800 (8.0%) were myopic, 4.04% among Yunnan Minority children (OR 0.47, 95%CI 0.33, 0.67, P<0.001), 6.48% in Yunnan Han (OR 0.65, 95%CI 0.45, 0.93, P = 0.019), 9.87% in Guangdong Han (Reference). Differences remained significant after adjusting for study time and parental glasses wear. Difference in baseline glasses ownership (Yunnan Minority 4.95%, Yunnan Han 6.15%, Guangdong Han 15.3%) was not significant after adjustment for VA. Yunnan minority children (71.0%) were more likely than Yunnan Han (59.6%) or Guangdong Han (36.8%) to accept free glasses. The difference was significant after adjustment only compared to Guangdong Han (OR 3.34, 95% CI 1.62, 6.90, P = 0.001).

Conclusion

Myopia is more common among Han children and in wealthier Guangdong. Baseline differences in glasses wear could be explained by student, teacher and parental factors. Yunnan Minority children were more likely to accept free glasses.

Prevalence of hepatitis C virus infection and its correlates in a rural area of southwestern China: a community-based cross-sectional study

OBJECTIVES

Hepatitis C virus (HCV) infection is a major public health problem in southwestern China. Our aim of the study was to assess the prevalence of HCV infection and its correlates in the Yi population of this region.

METHODS

A community-based survey was conducted to investigate sociodemographic characteristics and other associated factors for HCV infection in a rural area of southwestern China. Blood samples were collected and tested for antibodies to HCV. Anti-HCV positive samples were further assessed for HCV RNA.

RESULTS

A total of 2558 participants aged ≥14 years were included in our analysis. Of them, 2.8% (95% CI 2.2% to 3.5%) were positive for HCV antibody. Multiple logistic regression analysis revealed that sex (male vs female: adjusted OR (aOR)=3.30, 95% CI 1.80 to 6.07), marital status (unmarried vs married: aOR=0.27, 95% CI 0.09 to 0.80), ever using injection drug (aOR=28.65, 95% CI 15.9 to 51.64) and ever having blood transfusion (aOR=7.64, 95% CI 1.94 to 30.16) were significantly associated with HCV infection (indicated by positive HCV antibody). Stratified analysis by HIV infection found that in HIV-negative individuals, sex (male vs female: aOR=3.84, 95% CI 1.88 to 7.85), ever using injection drug (aOR=22.15, 95% CI 8.45 to 58.04), having multiple sexual partners (aOR=2.57, 95% CI 1.26 to 5.23), and ever having blood transfusion (aOR=16.54, 95% CI 4.44 to 61.58) were significantly associated with HCV infection and in HIV-positive individuals, ever using injection drug (aOR=8.96, 95% CI 3.16 to 25.38) was associated with HCV infection.

CONCLUSION

The data suggested a higher risk of HCV infection in this area when compared with the rest of China and some unique associated factors. Rapid scale-up of targeted interventions are needed to prevent further transmission and consequent morbidities.

Trends and factors in human immunodeficiency virus and/or hepatitis C virus testing and infection among injection drug users newly entering methadone maintenance treatment in Guangdong Province, China 2006-2013: a consecutive cross sectional study

OBJECTIVES

To assess trends and related factors in HIV and/or hepatitis C virus (HCV) antibody testing and infection among injection drug users (IDUs) newly entering methadone maintenance treatment (MMT) in Guangdong Province, China.

METHOD

Consecutive cross sectional surveys were conducted in 14 MMT clinics from July 2006 to December 2013 in Guangdong Province, China. IDUs were excluded if they were re-enrolled or referred from other MMT clinics. Trend tests were used to examine HIV and/or HCV testing and infection, sociodemographic characteristics, drug use related behaviours and the past 3 month sexual behaviours on enrolment. Multivariate logistic regression was used to identify correlates of HIV and/or HCV testing and infection.

RESULTS

7539 IDUs with an average age of 35.6±6.2 years were newly enrolled with a history of injection for an average of 11.8±4.9 years. The average frequency of injection before enrolment had been increasing. HIV, HCV and HIV/HCV dual testing increased from 2006 to 2013 (p_trend<0.001). However, all three types of infections remained stable (p_trend>0.05) until reaching a peak in 2011, excluding the first year. Associating with fellow drug users 1-4 times during the past month, injecting for 15+ years and having multiple sexual partners during the past 3 months predicted higher percentages for HIV and/or HCV testing (p<0.05), while those injecting 4+ times per day in the past month and those who had ever shared needles were less likely to take both tests (p<0.05). Having multiple sexual partners, a longer duration of injection drug use and sharing needles or sharing more frequently were major risk factors for HIV, HCV and HIV/HCV co-infection (p<0.05).

CONCLUSIONS

The prevalence of HIV and HCV were high and quite stable among new IDU entrants in MMT. Publicising MMT, routine screening, and behavioural and structural interventions is needed.

Cancer risk factors among people living with HIV/AIDS in China: a systematic review and meta-analysis

Cancer is a leading cause of death among people living with HIV/AIDS (PLWHA). We conducted a systematic review and meta-analysis to evaluate prevalence of cancer risk factors among Chinese PLWHA based on 102 articles. Random effects meta-analysis was used to calculate the summary prevalence estimate (sPrev) and 95% confidence interval (CI) for each cancer risk factor by demographic group. Overall, the sPrev for each risk factor among Chinese PLWHA was: 41.1% (95% CI: 35.3–46.9%) for current smoking; 30.3% (95% CI: 23.3–37.4%) for current alcohol consumption; 24.4% (95% CI: 14.7–30.2%) for overweight and obesity; 12.5% (95% CI: 10.6–14.3%) for hepatitis B virus infection; 29.1% (95% CI: 23.6–34.5%) for hepatitis C virus infection; 33.9% (95% CI: 24.3–43.5%) for high-risk human papillomavirus infection from cervical samples and 78.6% (95% CI: 69.4–87.7%) from anal samples; 2.7% (95% CI: 0.7–4.7%) for Epstein-Barr virus (EBV) immunoglobulin M (IgM) positivity, 94.7% (95% CI: 90.7–98.8%) for EBV IgG positivity and 25.6% (95% CI: 12.4–38.8%) for EBV DNA positivity; 14.9% (95% CI: 12.4–17.4%) for human herpes virus 8 infection. The prevalence of major cancer risk factors was high among PLWHA in China, suggesting an urgent need for interventions to reduce cancer risk in this high-risk group.

Prevalence and Determinants of Cryptosporidium Infection in an Underdeveloped Rural Region of Southwestern China

Few studies have focused on the epidemiology of Cryptosporidium in resource-challenged settings in China. We report a community-based cross-sectional study to investigate the prevalence of Cryptosporidium infection and its risk factors and associations with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections. The prevalence of Cryptosporidium infection was 12.6% (95% confidence interval = 11.0-14.3). Individuals living in households with ≥ 5 family members and raising domestic pigs tended to have a greater risk of Cryptosporidium infection. In addition, Cryptosporidium infection was significantly associated with HBV infection. There were no significant associations of Cryptosporidium infection with HIV viral load and HBV viral load. Further studies are needed to determine the association of Cryptosporidium infection with HBV infection.

Prevalence of and risk factors associated with Cryptosporidium infection in an underdeveloped rural community of southwest China

Background

Cryptosporidium spp. is an important intestinal protozoan causing diarrhea in humans, livestock, and wild animals. Cryptosporidium infection remains a major public health issue, but its epidemiology in humans is still unclear, particularly in rural China. This study was designed to determine the prevalence of and risk factors associated with Cryptosporidium infection in a rural southwestern Chinese community.

Methods

A community-based cross-sectional survey was conducted among 687 residents of a small town in a Yi autonomous prefecture of southwest China in 2014. Blood samples were examined using a broad set of quality-controlled diagnostic methods for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection. Univariable and multivariable analyses were performed to determine the risk factors associated with Cryptosporidium infection.

Results

The majority of the participants were Yi people with poor living conditions and unsatisfactory hygiene habits, and the study area was of very low socioeconomic status. Of the 615 individuals included in the analysis, 14 (2.3%) were HIV positive, 51 (8.3%) were infected with HBV, and 74 (12.0%) had Cryptosporidium infection. The prevalences of HIV/HBV, HIV/Cryptosporidium, and HBV/Cryptosporidium co-infections were 0.3%, 0.3%, and 1.8%, respectively. The prevalence of HBV infection was higher in individuals with Cryptosporidium infection (χ²  = 5.00, P = 0.03). Owning livestock or poultry was an important risk factor for Cryptosporidium infection (aOR = 2.27, 95% CI: 1.01–5.08, P < 0.05). Cryptosporidium infection was significantly associated with HBV infection (aOR = 3.42, 95% CI: 1.47–7.92, P < 0.01), but not with HIV infection (aOR = 0.57, 95% CI: 0.07–4.39, P = 0.59).

Conclusions

The prevalence of Cryptosporidium infection was high in the rural area of southwestern China that was investigated, and there was a significant association between HBV infection and Cryptosporidium infection. Further investigations are needed to determine the significance of Cryptosporidium infection in patients infected with HBV.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-016-0223-9) contains supplementary material, which is available to authorized users.

Zidovudine- versus Tenofovir-Based Antiretroviral Therapy for the Initial Treatment of HIV Infection in the Ethnic Minority Region of Liangshan Prefecture, Sichuan Province, China

BACKGROUND

Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World Health Organization guidelines for HIV-naive patients, has been limited in resource-constrained settings. The aim of this study was to evaluate the effectiveness of zidovudine-(ZDV) versus TDF-based HAART in the Yi minority region of Sichuan Province, China at a single HIV treatment center.

METHODS

The primary end point was the attainment of an HIV viral load <50 copies/mL. Secondary end points included change in CD4 level, adverse reactions, mortality, and sustained virologic suppression.

RESULTS

Of the 361 total participants, recipients of TDF-based HAART were more likely to achieve viral load <50 copies/mL (60% versus 46%, odds ratio [OR] = 1.7, P = .016) as well as sustained virologic suppression (61% versus 28%, OR = 3.4, P = .001). Tenofovir (adjusted odds ratio [OR_adj] = 1.71, P = .025) and female sex (OR_adj = 1.93, P = .003) were identified as independent predictors of achieving HIV viral load <50 copies/mL in the multivariate logistic regression analysis.

CONCLUSION

Among Chinese Yi minority HIV-infected participants, TDF-based HAART was superior to ZDV-based HAART for initial treatment of HIV infection, suggesting TDF-based HAART should be the regimen of choice in China.

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.

A cross-sectional study of the feasibility of pharmacy-delivered harm reduction services among people who inject drugs in Xichang, China

Background

HIV prevalence is high in Liangshan, China (1.1 %). In 2012, people who inject drugs (PWID) in Xichang, the capital city, contributed to 60.0 % of the HIV infections. The goal of the current study was to examine the feasibility of implementing pharmacy-delivered harm reduction services (PDHRS) for PWID.

Methods

Face-to-face structured interviews with 403 PWID included questions on PWID’s experiences of syringe services and their specific experiences, acceptance, and potential usage of PDHRS.

Results

There were some reports of harassment/bad treatment from pharmacists (12.2 %) and police (17.6 %). Non-prescription syringe sales (NPSS) from pharmacies in single piece were the main source (82.1 %) of syringes. 72.5 % of PWID reported visiting 31.5 % of the identified pharmacies. Most (74.7 %) PWID disposed of their used syringes by throwing them away. Only one PWID brought used syringes back to a pharmacy in the past 30 days. Half of the PDHRS, such as printed materials about HIV, Hepatitis C and STIs; risk reduction services; (16.9 %) and sharps container to dispose of syringes (0.2 %) were offered by a few pharmacies (<20 % for each service). The acceptance rates among PWID toward currently offered services were high (≥91.1 %). All potential PDHRS were acceptable by most (68–95.3 %) PWID, and correspondingly 67–94.5 % of PWID reported they would use each service if offered.

Conclusions

NPSS from pharmacies provided many PWID in Liangshan with new syringes. However, disposal of used syringes was problematic. At the time of investigation, half of 16 assessed PDHRS were already available in pharmacies in Xichang. PWID were ready to use all the potential PDHRS and14 of 16 PDHRS were feasible to provide. HIV testing kits may be available in pharmacies in the future. Many pharmacy-delivered harm reduction services are feasible and acceptable among PWID in Xichang, China.