| Section 1Assessment of antiretroviral therapy in partial areas of China[Background] Since the China National Free Antiretroviral Treatment Program (NFATP) was established in 2003, the remarkable acceleration in treatment has been obvious. By December 2013, more than 278000 people have received first-line highly active antiretroviral therapy (HAART). All HIV-infected individuals who meet the national treatment criteria are eligible to receive treatment, and treatment has been implemented in all 31 provinces, autonomous regions and municipalities in China. The limitations of previous studies reporting the effects of HAART in developing countries were the relatively small sample sizes or short durations of follow-up.[Objective] To analysis outcomes of antiretroviral therapy with viral load and CD4+T cell count monitoring, to investigate factors associated with virological and immunological failure, so as to give advice on treatment strategy for HIV infectors.[Methods] Data of patients who received antiretroviral therapy were collected retrospectively from the database of NFATP, which was an open cohort of antiretroviral-naive HIV infectors. Data were collected between January 2003 and January 2014. HIV-positive patients who met the national treatment guidelines were eligible to receive antiretroviral treatment. The endpoints were virological and immunological failure, which were assessed by using Kaplan-Meier curves. Factors associated with endpoints were investigated by Cox proportional hazard regression.[Results] 2172 patients were included in the study. The median age were 36,78.5% were male and 48.2% were infected through heterosexual behavior. The median follow-up time was 31 months,63 (2.9%) patients died because of AIDS-related disease.292 (13.4%) and 400 (18.4%) patients experienced virological and immunological failure respectively. Adjusted Cox regression analysis indicated that infection route, baseline viral load and WHO stage were associated with virological failure, whereas age, baseline CD4 cell count and WHO stage were risk factors for immunological failure.[Conclusion] Sustained virological and immunological outcomes show that patients have responded positively to long-term antiretroviral treatment with low mortality. This study provides important information for clinicians and policymakers in the region as they begin to evaluate and plan for the future needs of their own rapidly expanding programs.Section 2Study of dynamic model on effects of antiretroviral therapy among men who have sex with men[Background] Sexual behavior has become the dominating transmission route of HIV in China, while proportion of homosexual behavior is increasing in recent years. Some studies has been set to explore the change of epidemic among men who have sex with men (MSM), but few has taken drug resistance into consideration. Therefore, a comprehensive analysis on high-risk behavior and treatment of MSM is of necessity, so as potential trends and factors of epidemic among this population can be learned.[Objective] To estimate trends of HIV among MSM, explore the impact of different control measures and different levels of a particular measure, provide evidence for AIDS prevention and control.[Methods] Deterministic dynamics model was used to simulate epidemic trends of HIV among MSM, parameters and initial values of variables were mainly extracted from previous literature and studies. Mainly analyze the trends of total infectors, AIDS patients, numbers of drug resistance infectors and proportion among all infectors. Simulation of data and drawing of figures were implemented by Matlab 2009a and Microsoft Excel 2013, respectively.[Results] HIV epidemic among MSM was continuing upward trend in general. According to the results of model simulation, there would be 1.71×106 total infectors at 2015, and the figure become 3.22×106 at 2020. The number of AIDS patients would be 2.59×105 at 2015 and become 6.30×105 at 2020. Proportions of drug resistant infectors and primary drug resistant ones among all infectors and treatment-naive ones were 35.8% and 25.3% at 2020, respectively. After changing parameters of model, simulation results showed that enhancement of intervention, improvement of treatment coverage and reduce of exiting treatment are helpful for epidemic control, while reducing incidence of drug resistance and exit rate of treatment were beneficial for controlling proportions of infectors with drug resistance.[Conclusion] The epidemic of HIV among MSM is and still will be severe in China, more efforts should be made on intervention, treatment coverage and treatment adherence in future work to keep the epidemic controlled. |
PDF Full Text Request