Screening Acute HIV Infections among Chinese Men Who Have Sex with Men from Voluntary Counseling & Testing Centers

Recent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking.An open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5–7.9) and 7.1 (95% CI: 5.4–9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of$3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9.The HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run

Polymorphisms in lncRNA CCAT1 on the susceptibility of lung cancer in a Chinese northeast population: A case–control study

Abstract Object To explore the association of rs1948915, rs7013433 in long noncoding RNA (lncRNA) CCAT1 and rs6983267 in MYC enhancer region with the risk of lung cancer in a Chinese northeast population, a case–control study was conducted. Methods The hospital‐based case–control study contained 669 lung cancer patients and 697 healthy controls. Taqman® Probe allele resolution was used for genotyping. The differences between the case–control groups were analyzed using Student t‐test and chi‐square test. Logistic regression analysis was used to assess the relationship between the genotypes and the risk of lung cancer. Cross‐generation analysis was used to explore the relationship between gene–environment interaction and lung cancer. Results There was no association between the three selected single‐nucleotide polymorphisms (SNPs) and the susceptibility of lung cancer. Rs1948915 CT was correlated with lung adenocarcinoma. In female stratification, rs1948915 CT/CC was associated with a decreased susceptibility of lung cancer significantly. Additionally, the additive and multiplicative interaction models showed that there was no interaction between the three selected SNPs and smoking status in lung cancer. Conclusions There may be an association between lung adenocarcinoma and rs1948915 polymorphism in the Chinese northeast population, while rs7013433 and rs6983267 might have no association. There was no interaction between the three selected SNPs and smoking status

Immunological and Virological Benefits Resulted from Short-Course Treatment during Primary HIV Infection: A Meta-Analysis

<div><p>Objectives</p><p>To assess the potential immunological and virological effects that result from short-course antiretroviral treatment during primary HIV infection (PHI). And to investigate whether treatment initiation time, treatment duration and follow-up time after treatment interruption would affect these post-treatment immunovirological outcomes.</p> <p>Methods</p><p>We systematically searched PubMed, Cochrane Library (to September 2013) and retrieved conference abstracts for studies regarding effects of early treatment during PHI on CD4 count and viral load (VL). Using the method of calculating weighted mean differences with Stata11.0, we conducted meta-analyses on the effect of early treatment on CD4 count and VL. Then we performed subgroup analyses by follow-up time after treatment interruption, treatment initiation time and treatment duration. Baseline immunovirological characteristics were also analyzed to account for potential bias. </p> <p>Results</p><p>Compared to the untreated arm, treatment during PHI not only increased CD4 count by 85.92 cells/μl but also lowered viral load by 0.30 log copies/ml within one year after treatment interruption. However, the benefits declined gradually, reaching no significance 12-24 months after treatment interruption. Baseline immunovirological characteristics and sensitivity analyses of randomized controlled trials indicated that the benefits mentioned above were underestimated. Extending treatment duration beyond 12 months did not increase efficacy.</p> <p>Conclusions</p><p>Short-course treatment during PHI was associated with immunological and virological benefits which last for at least one year after treatment interruption. The conclusions from our study would help the decision-making in the clinical management of PHI. </p> </div

Forest plots of meta-analyses on impact of short-course treatment during PHI on post-treatment CD4 count.

<p>Dots represent the individual study estimates; boxes, study weights; and lines, 95% CIs.</p

Flow diagram of search, review and data extraction.

<p>Flow diagram of search, review and data extraction.</p

Forest plots of meta-analyses on impact of short-course treatment during PHI on post-treatment viral load.

<p>Dots represent the individual study estimates; boxes, study weights; and lines, 95% CIs.</p

Performance of 3^rd ELISA and NAAT on HIV Diagnosis in MSM High-risk Population.

<p>Performance of 3^rd ELISA and NAAT on HIV Diagnosis in MSM High-risk Population.</p

Explanation of Abbreviation Symbol.

<p>Explanation of Abbreviation Symbol.</p

The Algorithm of the Procedures of the MSM Voluntary Counseling & Testing centers for HIV Testing and Diagnosis.

<p>HIV detection procedure, detecting time, algorithm of HIV-1 antibody screening and Pooled NAAT process, diagnostic criteria and principles of management are shown in the flow chart.</p

Flow Chart of the Study MSM High-risk Population and HIV Infection Detection Process.

<p>The numbers of study samples, HIV detection assays and the number of different results are shown in the flow chart. The different HIV statuses are indicated in the shaded areas. HIV prevalence and incidence are calculated based on the numbers in the shaded areas.</p