What is already known about this topic?:Antiretroviral therapy (ART) is the cornerstone of HIV care. In China, efavirenz-based regimens have long been widely used as first-line treatment, while integrase strand transfer inhibitor (INSTI)-based regimens are increasingly available. However, nationwide evidence on virologic outcomes across common first-line regimens remains limited. What is added by this report?:This nationwide cohort study found higher viral suppression with EFV 400 mg-based regimens compared with EFV 600 mg- and LPV/r-based regimens, while INSTI-based regimens showed the highest suppression overall. What are the implications for public health practice?:Findings support expanded use of INSTI-based regimens and consideration of EFV 400 mg-based regimens during ongoing optimization of first-line ART in China.

What is already known about this topic?:The impact of hepatitis C virus (HCV) co-infection on antiretroviral therapy (ART) outcomes in people living with human immunodeficiency virus (HIV) remains controversial across studies. What is added by this report?:Using stratified matching methods, we constructed two cohorts - one with HIV/HCV co-infection and one with HIV mono-infection - to compare ART outcomes. Our analysis revealed that HIV/HCV co-infected individuals faced significantly elevated risks of mortality, virological failure, and attrition relative to their HIV mono-infected counterparts. What are the implications for public health practice?:Enhanced prevention, screening, and management (including treatment) of hepatitis C virus within people living with human immunodeficiency virus should be prioritized and strengthened as part of routine clinical care.

Introduction:Although antiretroviral therapy (ART) suppresses human immunodeficiency virus (HIV) replication in most people living with HIV (PLWH), 10%-40% show inadequate CD4 reconstitution despite sustained virologic suppression, increasing risks of AIDS- and non-AIDS-related events. Prior studies have suggested that immunological nonresponse (INR) is particularly common among individuals starting ART with immunosuppression. In China, real-world evidence for long-term immune recovery in immunosuppressed PLWH remains limited. Methods:Immunosuppression was defined as a baseline CD4<350 cells/µL at ART initiation. At year 5, INR was defined as CD4<350 cells/µL and favorable immune recovery as CD4 ≥500 cells/µL. From China's National ART Cohort, we included PLWH (aged ≥15 years; baseline CD4 <350 cells/µL) initiating ART during 2013-2019 who achieved year-5 virologic suppression (≤50 copies/mL). We described 5-year CD4 changes and examined factors associated with year-5 immune outcomes. Results:Among 315,109 participants, the median CD4 count increased from 199 cells/µL at baseline to 424 cells/µL over 5 years of ART. At year 5, 111,899 (35.5%) had CD4≥500 cells/µL (favorable immune recovery). In contrast, 109,344 (34.7%) patients had a CD4 <350 cells/µL and were classified as having INR. Lower baseline CD4 counts, older age, male sex, heterosexual or injection drug transmission, HBsAg positivity, anti-HCV positivity, and delayed ART initiation were associated with higher odds of INR. Compared to continuous non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy, continuous protease inhibitor (PI)- and integrase strand transfer inhibitor (INSTI)-based therapies, and switching from NNRTI- to INSTI-based regimens showed higher odds of favorable immune recovery. Conclusions:Among PLWH who initiated ART with immunosuppression and achieved virologic suppression at 5 years, most experienced immune recovery; however, approximately one-third remained INR. Early diagnosis, timely ART initiation, and targeted long-term immunological monitoring are required for populations at increased risk of suboptimal immune recovery.

What is already known about this topic?:With the expanding coverage of antiretroviral therapy (ART), life expectancy among people living with human immunodeficiency virus (HIV) has increased significantly. However, relevant research evidence in China remains very limited. What is added by this report?:From 2013 to 2023, China witnessed a remarkable improvement in life expectancy among HIV-infected patients receiving ART, with the disparity compared to the general population narrowing annually. What are the implications for public health practice?:Our findings recognize the remarkable progress made in ART implementation in China over the past decade, providing timely evidence for improving the health status of HIV population and addressing the emerging challenges of an aging HIV population.

What is already known about this topic?:The advent of antiretroviral therapy (ART) has markedly decreased mortality rates among patients infected with human immunodeficiency virus (HIV). Globally, there has been a 43% reduction in acquired immunodeficiency syndrome (AIDS)-related deaths from 2010 to 2022. Additionally, prior research indicates that the initiation of ART at an early stage within China has substantially lowered mortality rates.What is added by this report?:Over the previous decade, following the implementation of China's universal ART access strategy, the patterns of mortality causes among HIV-infected individuals across the country have undergone significant alterations. In 2022, the all-cause mortality rate among this population was reported at 2.7%, with the non-AIDS-related mortality rate at 1.8%. However, it is important to consider that the accuracy of death reporting could contribute to potential misclassification of the underlying causes of death.What are the implications for public health practice?:Efforts to enhance health outcomes should persist in emphasizing the advancement of ART strategies, with a particular focus on mitigating non-AIDS-related mortality in the future.

Background To assess the prevalence of anemia before and after antiretroviral therapy (ART) initiation and to identify impact of anemia on mortality among HIV-infected patients in China during the Treat-All era. Methods All HIV-infected patients who newly initiated ART between January 1, 2017 and December 31, 2020 were enrolled and followed up to December 31, 2021 in China. We analyzed the prevalence of anemia before and after ART initiation. Generalized estimating equations were fitted to determine factors associated with anemia after ART. Time-dependent cox proportional hazards models were performed to estimate the effect of anemia on death. Results Of 436,658 patients at the baseline of ART initiation, the overall prevalence of anemia was 28.6%. During a median 2.65 (IQR: 1.80–3.51) years of follow-up after ART initiation, 376,325 (86.2%) patients had at least one Hb measurement (a total of 955,300 hemoglobin measurements). The annual prevalence of anemia after ART was 17.0%, 14.1%, 13.4%, 12.6% and 12.7%, respectively. Being anemic at the baseline of ART initiation (adjusted odds ratio, aOR = 6.80, 95% confidence interval (CI): 6.67–6.92) was the strongest factor associated with anemia after ART. Anemia status after ART showed a strong association with death after multivariable adjustment (mild anemia: adjusted hazard ratio (aHR) = 2.65, 95% CI: 2.55–2.76; moderate anemia: aHR = 4.60; 95% CI:4.40–4.81; severe anemia: aHR = 6.41; 95% CI:5.94–6.91). Conclusions In the era of ART universal access, pre-ART anemia was common among HIV-infected patients. Notably, a certain proportion of anemia still persisted after ART, and was significantly associated with death. We recommend strengthening the monitoring of patients at risk of anemia, especially in patients with baseline anemia or during the first year of ART, and timely treatment for correcting anemia.

目的 分析2003-2021年我国HIV/AIDS患者ART工作的进展情况.方法 利用2021年12月底国家艾滋病综合防治基本信息系统数据库,采用连续横断面研究方法,描述性分析我国2003-2021年ART工作的覆盖面和有效性两方面共4个指标的变化情况和主要特征.结果 截至2003、2006、2009、2012、2015、2018和2021年各年统计时点,我国HIV/AIDS累计启动ART的人数分别为3 965人、30 202人、78 302人、203 816人、463 767人、851 039人和1 262 749人,报告存活HIV/AIDS患者中正在接受ART的比例分别为15.9％、28.0％、35.7％、52.1％、69.5％、83.6％和92.6％;2006、2009、2012、2015、2018和2021年正在接受ART者病毒载量检测比例分别为5.2％、55.8％、90.1％、93.2％、90.9％和94.6％,在治且做过病毒载量检测者的病毒载量抑制比例(＜400copies/mL)分别为57.5％、77.1％、85.4％、89.6％、92.8％和95.4％.结论 近20年来,我国HIV/AIDS患者累计启动ART的人群规模增长迅猛,正在接受ART的比例不断提升;2012年以来病毒载量检测比例持续稳定在90％以上,正在接受ART者病毒载量抑制比例稳步提高并保持高水平.

The occurrence of acute infectious diseases or severe natural disasters has a negative impact on the medical system (1). A survey of 105 countries by the World Health Organization (WHO) from March to June 2020 found that health services were disrupted in 90% of countries due to the coronavirus disease 2019 (COVID-19) pandemic, with low- and middle-income countries being the most affected. Human immunodeficiency virus (HIV) treatment continuity and healthcare service delivery were also affected by the COVID-19 pandemic (2–3). In public health emergencies where social distancing and isolation regulations prevent people living with human immunodeficiency virus (PLHIV) from going to their regular clinics and hospitals for treatment, they may not receive timely medical services, leading to an increased risk of disruption of antiretroviral therapy (ART) (4-6). China has taken rigorous measures to contain the COVID-19 pandemic outbreak since early 2020. Lockdowns in cities have resulted in PLHIV who had travelled away from their hometowns being unable to return home and access HIV services from their usual healthcare providers (7). In China, more than 95% of PLHIV have taken free medication provided by government programs from clinics they have chosen themselves. The emergency measures have been summarized to maintain essential health services and continuous ART during the COVID-19 pandemic. We hope to share the experience of minimizing the antiretroviral supply risk and improve service in the future.

目的 分析2015-2019年期间我国接受ART成年HIV/AIDS患者病死率变化情况.方法 采用连续横断面研究方法,以自然年为单位,描述性分析全国2015-2019年历年接受ART成年HIV/AIDS患者主要特征及粗病死率,并以2015年年龄构成为标准,计算历年年龄标化病死率.结果 2015-2019年历年纳入分析的接受ART成年HIV/AIDS患者人数分别为416 360例、515 524例、623 995例、755 837例和885 037例,其中≥50岁者占比依次为28.04％、29.48％、31.04％、33.23％和36.00％;历年接受ART成年HIV/AIDS患者中死亡人数分别为9 920例、11 784例、12 880例、16 876例和19 961例,粗病死率依次为2.38％、2.29％、2.06％、2.23％和2.26％;2015-2019年年龄标化病死率依次为2.38％、2.24％、1.97％、2.06％和1.95％.结论 2015-2019年期间,我国接受ART成年HIV/AIDS患者中≥50岁者占比逐年增加,死亡人数有所增长,粗病死率和年龄标化病死率均趋于平稳.

Objective: To analyze the survival time and to explore the releated factors of antiretroviral therapy among HIV/AIDS patients in LiangShan Prefecture, Sichuan Province for reduction of AIDS death rate. Methods: The retrospective research method was used to collect relevant information from the Management Database of Antiviral Treatment from the National AIDS Comprehensive Prevention Information System. The Kaplan-Meier method was used to describe the survival distribution and to analyze the survival time by single factor and the model of Cox proportional riskanalysis was performed to analyze the survival time of HARRT by multi-factors analysis. Results: Total 14 219 adults and young persons aged ≥15 HIV/AIDS patients received antiviral treatment from 2005 to 2015. The average age of all cases was (36.10±9.41) years old and 10 021 were males (70.5%). The main route of infection was intravenous drug use (61.0%, 8 678 cases). At the end of the observation, 10001 cases (70.3%) were still treated, and 1 425 cases (10.0%) died; Cox Regression analysis showed that female (0.67 (0.55-0.81)), route of sexual infection (0.67 (0.56-0.79)), baseline CD4+T lymphocyte count 200-350 (0.41 (0.35-0.47)) and ≥350 (0.28 (0.24-0.34)), was a protective factor in death. At the beginning of treatment, the patient is clinically staging stage Ⅱ (0.70 (0.58-0.84)) and abnormal BMI (1.75 (1.50-2.03)), is a risk factor for death (P<0.05). Conclusion: Early antiviral treatment is of great significance in improving the anti-viral treatment effect of AIDS. Compliance education should be further strengthened so as to enhance their knowledge. And it is feasible to enhance the effect of treatment through nutritional support for prolonging patients survival time and improving the quality of life.

Backgroud: Women now account for about half of all people living with HIV worldwide, but researchers lack clear information and large population-based study about gender differences in treatment outcomes. Methods: A nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program was performed. Antiretroviral-naive patients older than 18 years initiating standard antiretroviral therapy between January 1, 2010, and December 31, 2011, were included and followed up to December 31, 2015. We used modified Poisson regression models to estimate the impact of gender on virological suppression and retention in treatment, and Kaplan–Meier analysis and Cox proportional hazard models to evaluate gender difference in mortality. Results: Sixty-eight thousand six hundred forty-six patients [46,083 (67.1%) men and 22,563 (32.9%) women] with HIV met eligibility criteria. Women were significantly more likely to achieve virological suppression than men both at 12 months [adjusted relative risk (aRR) 1.02, 95% confidence interval (CI): 1.01 to 1.03, P < 0.001] and 48 months (aRR 1.01, 95% CI: 1.00 to 1.02, P = 0.005) after initiating antiretroviral treatment. Women were also more likely to remain in treatment at 12 months (aRR 1.02, 95% CI: 1.01 to 1.02, P < 0.001) and 48 months (aRR 1.04, 95% CI: 1.03 to 1.05, P < 0.001), although the difference became insignificant in alive patients. All-cause mortality was lower in women than in men (2.34 vs. 4.03 deaths/100PY, adjusted hazard ratio 0.72, 95% CI: 0.67 to 0.77, P < 0.001). Conclusions: In China, women are more likely to achieve virological suppression, remain in treatment, and have a significantly lower risk of death than men. Future studies could take both biological and sociobehavioral factors into analysis to clarify the influence factors.

Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification. Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+ Lamivudine (3TC)+ Efavirenz (EFV) since 2012. There were 5 126 patients initiated TDF+ 3TC+ EFV therapy (TDF group) and 8 934 patients initiated AZT+ 3TC+ EFV therapy (AZT group). Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups. Cox proportional hazard model was used to investigate the risk factors associated with regimen modification. Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years. There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%. Two hundred patients who changed their initial regimen due to pregnancy were excluded. There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%. Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%. There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%. The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P<0.01). The risk of regimen modification in AZT group were significantly higher than that in TDF group (aHR=2.89, 95%CI: 2.57-3.24). The risk of toxicity-related regimen modification in AZT group was also significantly higher than that in TDF group (aHR=3.85, 95%CI: 3.34-4.45). Conclusions Patients initiated antiretroviral treatment with AZT+ 3TC+ EFV are more likely to change their initial regimen than those who initiated treatment with TDF+ 3TC+ EFV. Female, age >45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/L were risk factors associated with regimen modification. Key words: Acquired immunodeficiency syndrome; Antiretroviral therapy; Regimen change; Drug side effects; Tenofovir

目的 了解中国成人艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗失访比例及其影响因素.方法 对全国免费抗病毒治疗库中,2012年1月1日至12月31日开始抗病毒治疗的HIV/AIDS病人失访情况进行随访,随访截止到2014年12月31日.采用Cox比例风险模型分析队列失访率及其影响因素.结果 共有26 742名HIV感染者进入队列.12个月的累积失访率为7.6/100人年,24个月的累积失访率为10.5/100人年.Cox比例风险模型多因素分析显示,基线高CD4+T淋巴细胞组、注射吸毒、异性性传播以及初始治疗方案为齐多夫定/司坦夫定+拉米夫定+依非韦伦/奈韦拉平与较高的失访率相关(P＜0.05).结论 应该重点强化注射吸毒HIV/AIDS病人的干预措施,加强对高基线CD4+T淋巴细胞HIV/AIDS病人感染者的医疗咨询,对治疗药物有不良反应的病人要及时处理或更换治疗方案.

OBJECTIVE:To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago. METHODS:Retrospective cohort study and cross-sectional analysis had been conducted in this study. 368 449 cases that had received the ' free antiviral therapy' from 2002 to 2014 were selected from the National Treatment Database. Data from the baseline (initial time of ART, CD(4) cell count, and antiretroviral regimen) and from the follow-up program (dates and status of follow-up, CD(4) cell counts) were gathered and analysed by SAS 9.3. RESULTS:The number of cases that having received new treatment was increasing year by year, accounting for 75.4% of all the cases identified from 2010 to 2014. Constituent ratios of patients with baseline CD(4) cell count <200 cells/µl and clinical diagnosis of AIDS were decreasing from 81.0% in 2006 to 39.7 % in 2014. Status on drug optimization showed that: 3TC replaced DDI, EFV replaced NVP and TDF replaced D4T, making the utilization rates as 99.5%, 75.7%, and 60.6%, respectively, by 2014. Regions that were covered by the treatment accounted for 75.4% of all the counties/districts involved. The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model. Proportion on the twice-CD(4)-testing model had been 75.2% since 2010, with the rate of virological detection increased from 70.8% in 2010 to 87.4% in 2014 and the virological unsuccessful testing rate decreased from 17.6% in 2010 to 11.8% in 2014. Among all the patients, the 1, 5 and 10 year survival rates appeared as 92.2%, 80.5% and 69.6%, respectively. For patients with baseline CD(4) cell counts as <50 cells/µl or >350 cells/µl, the corresponding survival rates showed as 81.6% , 69.9% , 60.9% and 97.9%, 89.8% , 81.0%, respectively. CONCLUSION:China' s HIV/AIDS free antiretroviral therapy program appeared as a national treatment cohort which involved large number of participants, with new patients joining in, annually. Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO. Management program on treatment had gradually turned to hospital-based, with follow-up and laboratory testing programs guaranteed, ended up with satisfactory treatment effects.

由于突发公共卫生事件具有突发性、破坏性和不确定性等特点,如何应对此类事件,提高卫生应急决策能力等问题就摆在了决策者面前.随着中国经济的高速发展和政府改革的日益深入,我国政府的危机管理水平正迅速提高,已成功地处置了不少的突发公共卫生事件,如1998年长江中下游的特大洪水、2003年春天的SARS危机[1]、2009年“甲型H1N1流感”疫情、2008年四川汶川大地震等,积累了相当多处理突发公共卫生事件的经验,也为进一步完善政府危机管理机制奠定了基础[2].

"决策"一词最早出现在我国古籍《韩非子》中,解为"做出决定".从现代管理学意义上来讲,"决策"是从英文"Decision-Making"翻译而来的,是指人们在行动之前对目标和行动手段的探索、判断与抉择的全过程[1,2].把"决策"理解为一个过程,是因为人们对行动方案的确定并不是突然做出的,要经过提出问题、搜集信息、确定目标、拟定方案、分析评价、最终选定等一系列活动环节."机制"是泛指一个工作系统的组织或组织部分之间相互作用的过程和方式."决策机制"指的就是有关决策流程和方式的制度化的组合方式.

重复测量是指对同一观察对象的同一观察指标在不同时间点上进行多次测量,用于分析观察指标在不同时点上的变化规律.重复测量的数据在医学研究中非常常见,而重复测量方差分析是用以处理重复测量连续性数据主要的统计分析方法,为了更准确、方便地得到该统计方法所得结果的统计报表,本文通过以GLM广义线性模型为基础,编写SAS宏程序实现多变量重复测量方差分析统计报表的输出.

OBJECTIVE:To determine the major risk factors and their interactions of ischemic stroke (IS) and to develop a classification tree model to predict the incidence risk of IS for a Chinese population.METHODS:Exhaustive Chi-squared Automatic Interaction Detection (Exhaustive CHAID) algorithm of classification tree method was applied to build a prediction model for the incidence risk of IS under the design of 1:1 matched case-control study. The statistics of misclassification risk was used to evaluate the fitness of the model.RESULTS:In the prediction model, six variables of physical exercise, history of hypertension, tea drinking, HDL-c level, smoking status and educational level were in turn selected as the predictors of IS incidence risk. In the subgroup of lacking of physical exercise, individuals who had history of hypertension would have a significantly higher IS risk (92%) than that of the ones who had no history of hypertension (64%). The misclassification risk estimate of the prediction model was 0.21 with the standard error of 0.02, indicating that 79% of the cases could be classified correctly based on current prediction model.CONCLUSIONS:Lacking of physical exercise and history of hypertension are identified to be the prominent predicting variables of IS risk for a hospital population of southern China. Although CHAID analysis could provide detailed information and insight about interactions among risk factors of IS, we still need to validate our model and improve the vascular risk prediction for Chinese subjects in further studies.

Hypertension (HTN) is a leading cause of cardiovascular and cerebrovascular diseases. Lifestyle modification may be the preferential approach to prevent and control HTN. The purpose of this study was to evaluate the effects of a community intervention program, which focused on improving the HTN knowledge, diets and lifestyles in a rural Chinese area. The study was carried out in a rural area of the Hubei Province from May 2003 to April 2006. A total of 1632 participants were recruited. Of the participants, 826 from the town of Xiaoxita and 806 from the town of Fenxiang were assigned to the intervention group (group I) and to the control group (group C), respectively. Group I participants underwent an intervention that included HTN education and dietary and lifestyle guidance. Group C participants were not subjected to an intervention. The outcome measures included HTN knowledge, dietary and lifestyle behaviors, and prevalence, awareness, treatment and control rates of HTN. Along with the changes in HTN education (P<0.05), the participants in group I exhibited a significantly greater improvement in dietary habits and lifestyle behaviors, including reducing salty food intake (13.6%), fat intake (22.9%) and alcohol consumption (9.6%), after 3 years in comparison with those in group C (21.7, 31.9 and 18%, respectively). The prevalence of HTN was significantly lower in group I (22.5%) than in group C (36%) after the intervention strategies. The study showed that the implementation of a community intervention program involving HTN education and lifestyle modifications for rural residents is a powerful approach to reduce HTN prevalence and improve long-term health outcomes.

A multicentre prospective cohort study was performed in 17 intensive care units (ICUs) in tertiary care hospitals in Hubei Province, China. Ventilator-associated pneumonia (VAP) was defined according to modified criteria from the published literature. Among 4155 ventilated patients, the crude incidence and incidence rate of VAP were 20.9% and 28.9 cases per 1000 ventilator-days. Multivariate analysis using logistic regression revealed risk factors including male sex [risk ratio (RR): 1.5; P<0.001], coma (RR: 2.1; P<0.001), chronic obstructive pulmonary disease (RR: 1.4; P<0.001), infections at other sites (RR: 1.6; P=0.001), serious disease predating the onset of VAP (RR: 1.6; P<0.001) and interventions including antacid treatment (RR: 1.4; P<0.001), antimicrobial treatment (RR: 5.1; P<0.001), bronchoscopy (RR: 1.5; P=0.041) and tracheostomy (RR: 1.4; P=0.014). The most frequently isolated causative pathogens were Pseudomonas aeruginosa and Acinetobacter baumannii. Of all Staphylococcus aureus isolates, 45.7% were meticillin resistant. Rates, risk factors and causal pathogens of VAP in ICUs in Hubei differ from those reported from developed countries. These data show the need for more effective infection control interventions in Hubei, China.