Dynamic Model Prediction And Analysis Of HIV/AIDS Epidemic Among Men Who Have Sex With Men In China

Section 1Preliminary analysis of antiviral therapy and death among HIV-infected men who have sex with men in partial areas of China[Background]China appeared first case of Human Immunodeficiency Virus(HIV)infection in 1985,the progression of the disease so far,AIDS had become one of the most serious public health problems in the world.In 2003,the government introduced the "Four Frees and one care" policy,which provides free antiviral treatment(ART)for HIV infected people in China.By June 2016,the national reported 627 000 people living with HIV(PLHIV),194 400 peaple were dead.A total of 522 000 HIV/AIDS patients were treated with ART,a total of 421 900 patients is being treated,accounting for the total number of treatment of 80.8%.However,most of the previous studies on ART effects are limited to short durations of follow up and smaller sample sizes,while treatment outcomes require long-term follow-up of large sample studies.[Objective]According to the data of the baseline CD4 + T cells,the degree of education,the marital status and other information,the influencing factors of antiviral therapy and death were analyzed among HIV-infected men who have sex and men(MSM).The study provides a reference for studying the long-term prognosis and the improvement of treatment strategy of HIV-infected MSM.[Methods]The data of the "Integrated Management System for HIV/AIDS Prevention and Control" were collected and the data from June 2000 to June 2015 were included in the study.The basic information of HIV/AIDS patients in 6710 HIV/AIDS patients in MSM population was statistically described,and the Cox proportional hazards model was used to analyze the influencing factors of antiviral therapy and death,Kaplan-Meier was used to estimate the survival rate of HIV/AIDS patients.[Results]A total of 6710 MSM patients with HIV/AIDS were enrolled in this study.The median follow-up was 31 months.During the follow-up period,ART coverage reached 73.5%and mortality was 0.04,the mortality rate for patients receiving ART was 0.036 and the mortality rate for untreated was 0.095.Cox proportional hazards model analysis showed that baseline CD4+T cell count was 100 cell/μL to 199 cells cell/μL(AHR = 1.25,95%CI:1.05-1.51)was more susceptible to antiretroviral therapy than HIV patients whose baseline CD4+T cell count is≤99 cell/μL.Acceptance of ART(AHR = 0.18;95%CI:0.13-0.25)was a protective factor for death compared with HIV patients who did not receive ART.Baseline CD4+T cells were counted between 100 cell/μL and 199 cell/μL(AHR = 0.16,95%CI:0.10-0.24),200 cell/μL to 349 cell/μL(HR = 0.05,95%CI:0.03-0.08)and≥350 cell/μL(RH = 0.40,95%CI:0.21-0.74)compared to baseline CD4+T cell count less than or equal to 99 cell/μL HIV infection is a protective factor for death.The overall survival rate was higher in patients with MSM who received antiretroviral therapy and CD4 + T cell counts are ≥350 cell/μL.[Conclusion]Based on the medical services provided by the Chinese government and the promotion of ART,the mortality rate is low of patients,the patient’s baseline status is strongly related to the therapeutic effect and death,suggesting that better control of HIV/AIDS in future work requires an urgent need to accelerate the expansion of antiretroviral treatment and its timeliness.Section 2Using a dynamic model to predict AIDS epidemic among men who have sex with men in China[Background]At present,the proportion of sexually transmitted infections among HIV infected people is the highest in China.In 2016,the year of the newly discovered 124600 people living with HIV/AIDS patients,67.1%of heterosexual transmission,and 27.6%of homosexual transmission.Since 2008,with the development of the outbreak in new infections among MSM population proportion is higher and higher,with the in-depth development of ART,the incidence of drug resistance is becoming higher and higher.Because of the particularity among MSM population,the current HIV/AIDS case report number and the number of actual infection gap is larger,it is necessary to estimate and projections for the AIDS epidemic.The dynamics model of the infectious disease can be used to analyze the high risk behavior and treatment of the MSM population in order to understand the development trend of the epidemic and the influencing factors[Objective]Predicting the changes of AIDS epidemic,antiviral therapy and drug resistance in MSM population from 2005 to 2025,to analyze different interventions and the same measures the influence of different level of epidemic diseases,work for HIV/AIDS among MSM population in our country to provide reliable theory basis.[Methods]The dynamics model of the infectious disease was used to simulate the AIDS epidemic in the MSM population.The baseline parameters and the initial values of the variables needed in the model were determined according to the previous literature,the meta-analysis and the existing database,and the basic regeneration number R0 was calculated by using the regeneration matrix.The total number of infections,the total number of AIDS and the total number of patients were analyzed under different parameters(and the intensity of the intervention).We use Matlab7.0(The Math Works Inc.,U.S.)for data simulation and graphics rendering.[Results]The basic number of regenerations R0 was 3.4863,which means that when all MSM populations were susceptible,the average number of patients introduced was 3.49.In 2025,the total number of HIV is about 1.26×106 cases,the total number of AIDS is about 4.01×105 cases,the total number of antiretroviral therapy is about 4.20×105 cases,and the total number of resistant patients is about 1.63×105 cases,Total resistance to total treatment of the proportion of about 0.39.Changes in the parameters of the simulation results show that the interventions strengthened result the total number of HIV infection to increase the trend of slowing down,when the transmission coefficient β0 value of 0.6,the total number of HIV began to decline.Treatment coverage increased the total number of HIV infection increased.Interventions strengthened and increased treatment coverage slowed down the increase of overall trend of AIDS growth,when the transmission coefficient β0 value of 0.4 and HIV infection in three stages of treatment coverage were 0.6,0.8,1,the total number of AIDS began to decline.Drug resistance decreased to 0.03,the total number of drug-resistant began to decline.[Conclusion]At present,China’s MSM population of AIDS is not completely eliminated,and will continue to spread;the total number of HIV infection,the total number of AIDS and the total number of drug resistance to 2025 is still on the rise,unsafe sex is the MSM population in the main factors of AIDS epidemic.Suggesting that facing the China’s MSM population AIDS prevention and control of the grim situation should increase the intensity of intervention measures,promote the use of condoms,expand the coverage of ART and improve patient compliance,in order to control the MSM population AIDS epidemic development.