Study On STD Coinfection And Characteristics Of HIV-1 Subtypes Among HIV/AIDS Patients In Yunnan Province

Objective1.To study the epidemiological characteristics of sexually transmitted diseases（STD）coinfection among HIV/AIDS patients in Yunnan Province,then obtaining the incidence of syphilis,Neisseria gonorrhea（NG）,Syphilis and herpes simplex virus type 2（HSV-2）,Chlamydia trachomatis（CT）and Mycoplasma genitalium（MG）infection and analyzing the influencing factors.At last,we provide basis for comprehensive prevention and control of STD and AIDS.2.To investigate the subtypes and epidemiological characteristics of HIV-1 epidemic subtypes in men who have sex with men（MSM）among HIV/AIDS patients in Yunnan Province,then analyzing the possible correlation between HIV-1 subtypes and STD coinfection.Methods1.From September 2020 to June 2021,HIV/AIDS patients will be recruited through the antiviral treatment clinic in Yunnan Provincial Hospital of Infectious Diseases in a cross-sectional study.Cluster sampling was used to collect patients who did not receive antiretroviral therapy（ART）,and convenient sampling was used to collect patients who had received antiretroviral therapy.Blood samples and first-voided urine samples were collected with the patient’s informed consent.Real-time polymerase chain reaction methods were used for diagnosing CT,NG and MG.Syphilis and HSV-2 tests were also performed.2.For all men who have sex with men in ART-naive group,Viral RNA was extracted from plasma,gag and env genes were sequenced.Phylogenetic and evolutionary analyses were performed.Results1.A total of 406 HIV/AIDS patients were collected,including 204 cases in the group without ART and 202 cases in the group that had received ART.Among the 406 participants,the overall prevalence of STIs was 47.0%and 45.1%in ART-naive individuals and 49.0%in individuals receiving ART,respectively.The testing frequencies were 11.6%（11.8%vs.11.4%）,33.2%（29.4%vs.37.1%）,3.2%（3.4%vs.3.0%）,2.0%（3.4%vs.0.5%）and 4.7%（6.4%vs.3.0%）for active syphilis,HSV-2,CT,NG and MG,respectively.The percentage of multiple infections in both groups was 10.8%（22/204）in ART-naive participants and 9.9%（20/202）in participants receiving ART.The ART-naive individuals had a higher diversity of STIs,coinfections and more sexual partners,and the prevalence of CT,NG and MG was also higher in this study.The incidence of genital tract discomfort was only 0.5%（2/406）,and most patients remained silent or self-reported asymptomatically in this study.However,self-reported asymptomatic patients were not eliminated from having a laboratory-diagnosed STI.Female sex,an age between 18 and 35 years,ever injecting drugs,homosexual or bisexual status,HIV/HBV coinfection,and not receiving ART were identified as risk factors.2.Among 204 patients who did not receive ART,79 were MSM,and 72 of them obtained viral RNA and successfully genotyped.HIV-1 epidemic subtypes were CRF07_BC（43.1%,31/72）,CRF01_AE（36.1%,26/72）,URF（15.3%,11/72）,CRF55₀1B（2.8%,2/72）and CRF68₀1B（2.8%,2/72）.URF were including CRF01_AE/CRF07_BC（63.6%,7/11）,CRF07_BC/CRF01_AE（18.2%,2/11）,CRF07_BC/CRF08_BC（9.1%,1/11）and CRF07_BC/B（9.1%,1/11）.Univariate Logistic regression analysis showed that there was no significant difference in the incidence of sexually transmitted diseases among HIV-1 subtypes among HIV-positive MSM in Yunnan Province.Conclusion1.The incidence of sexually transmitted diseases among HIV/AIDS patients in Yunnan province was high,HSV-2,syphilis and MG were the most common STIs in HIV-infected individuals.The ART-naive individuals had a higher diversity of STIs,which may face greater threats of STIs and remain in a more dangerous situation.We found a high prevalence（6.4%）of MG in ART-naive individuals,which was higher than the common incidence of CT（3.4%）and NG（3.4%）.MG cause asymptomatic disease mostly,but its synergistic effect with HIV cannot be underestimated.HIV-positive individuals tend to neglect or hide their genital tract discomfort;thus,we suggest strengthening STI joint screening and treatment services among HIV-infected individuals regardless of whether they describe genital tract discomfort.At the same time,we need to screening HIV when the curable STIs are diagnosed,with the aim of promoting HIV prevention and control.2.This study revealed that there are multiple HIV-1 genotypes in MSM in Yunnan province,and the genetic diversity is increasing year by year.There was no significant difference in the incidence of STD infection among different HIV-1 subtypes.These findings may help develop HIV prevention strategies for men who have sex with men.