Clinical And Laboratory Characterization Of HIV-1 Infected Patients Diagnosed In The First Hospital Of China Medical University

Objective:Acquired immune deficiency syndrome,also known as AIDS,is a major infectious disease that seriously endangers human health caused by human immunodeficiency virus infection.Since AIDS was first discovered,countries and regions around the world have been affected by lt.China's HIV epidemic is serious,the AIDS epidemic has not been effectively controlled.In 2014,UNAIDS proposed a 90-90-90 target,that is,90%of HIV infected people were diagnosed,90%of the infected people found to receive antiviral treatment,and 90%of the infected people receiving treatment to achieve virological control.By 2016,seven countries including Sweden,Botswana,Cambodia and Denmark,have announced that they have reached the 90-90-90 target.In China by September 2018,821,000 HIV/AIDS patients survived,including 135,000 new infections reported in 2017.At the end of 2017,80%of the infected patients received antiviral treatment,and more than 90%of the patients achieved virol ogical control.The key and difficult task is that 90%of the patients were diagnosed.Medical institutions are the main channels for HIV infection screening in China,with the detection amount accounting for more than 70%.Those diagnosed through hospital screening account for 45.0%?55.5%of all the infected people,and more than 40%of the infected people are already in the AIDS stage at the time of diagnosis.Delayed diagnosis affects the prognosis of patients and is not conducive to the control of HIV transmission.In the past,the research on HIV testing in medical institutions in China mainly focused on the analysis of basic demographic characteristics and time change trend,or the analysis of the viological characteristics of the infected patients,but lacked the combined analysis of clinical and clinical characteristics and virological characteristics of the infected patients.This study conducted a joint analysis on the clinical characteristics and virological characteristics of patients with HIV infection/AIDS diagnosed in the first affiliated hospital of China medical university in 2014,so as to provide a basis for the hospital to effectively HIV infection and promote early diagnosis.Methods:in this study,a total of 48,302 outpatients and inpatients who were screened for HIV infection in the first affiliated hospital of China medical university from may to December,2014 were collected.By retrospective analysis,the hospital information system and laboratory information system of our hospital were used to anonymously collect the socio-demographic information,department of medical treatment,reason of medical treatment,number of CD4+T cells and HIV viral load test results of HIV infected patients confirmed by confirmed experiments.After the collection of plasma samples from the remaining patients clinically detected,the plasma HIV genomic RNA was extracted,and the HIV pol gene region was amplified using nested PCR method,and the 1.0-kb fragment of virus pol region was amplified(HXB2:2253-3278 NTS).The products of the second round of amplification were identified by agarose gel electrophoresis,and the results of the gel imaging analysis system were observed.The second round products with positive target fragments were purified and then Sanger sequencing was performed.The returned virus sequences were spliced for phylogenetic analysis and recombination analysis.Data were first input into Excel software for preliminary descriptive statistical analysis.SPSS 19.0 statistical analysis software was used for data processing.Chi-square test was used for the distribution of abnormal laboratory indicators and viral genotype,and rank-sum test was used for the number of CD4+T cells.P<0.05 was considered statistically significant.Results:113(0.23%)cases came from 14 cities in Liaoning province and 4 nearby provinces were newly diagnosed as HIV-1 infection out of 48302 clinical patients.113 cases visited 34 clinical departments,with the top 3 source departments of dermatology clinic 38.9%(44/113),emergency dept.15.9%(18/113)and infectious dept.11.5%(13/113).88.5%(100/113)cases were males,and 57.5%(65/113)was under the age of 40.The top 3 hospitalize reasons were active detection23.0%(26/113),non-specific symptom 20.4%(23/113)and respiratory disease 19.5%(22/113).CD4 T cell count of 67.1%(49 out of 73)patients was below 200 cells/?L.40%(12/30)patients' viral load was above 51g copies/ml.CRF01_AE(78.4%,76/97),CRF07 BC(11.3%,11/97)and subtype B(4.1%,4/97)were the main genotypes among the 97 patients withpol sequences available.Moreover,88.7%(86/97)strains clustered with the 3 HIV-1 lineages identified among Chinese men who have sex with men(MSM).Conclusions:A wide range of clinic departments may be visited by HIV infected patients,who were characterized by male-orientated,young,severe immune deficiency and carrying virus phylogenetically linked with MSM population,implying the profound effect of MSM on local HIV-1 epidemic.Above findings called for a more active HIV screening strategy in hospital to improve the early diagnosis of HIV infection.