Doravirine (DOR)-containing antiretroviral therapy (ART) has been recommended as first-line ART by China treatment guidelines since 2021. However, Real-world studies on DOR in China are scarce. We evaluated the real-world effectiveness of DOR-containing ART in Chinese people with HIV-1 (PWH), including treatment-naïve people regardless of viral load (VL) at baseline and treatment-experienced people regardless if they were virologic suppression (VS) or not. This was a retrospective, multicenter, observational study using medical chart review in seven hospitals, covering top-tier infectious disease hospitals across regions in China. All the participants who initiated DOR-containing ART during August 2021 and September 2023 were included and followed until September 2024. At baseline, higher proportions of the 352 participants were male (84.9

In China, non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens remain widely utilized as first-line antiretroviral therapy (ART) despite issues of low resistance barriers and significant side effects, leading to frequent treatment interruptions and virologic failures. Timely drug-resistance testing is often inaccessible, complicating subsequent treatment management. This trial aims to fill this critical gap by comparing the efficacy, safety, and tolerability of the single-tablet regimen (STR) of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) with the multi-tablet regimen (MTR) of dolutegravir plus lamivudine plus tenofovir disoproxil fumarate (DTG+3TC+TDF) in people living with HIV (PLWH) experiencing virologic failure. This multicenter, open-label, randomized controlled non-inferiority trial will enroll 374 PLWH experiencing virologic failure of first-line NNRTI-based therapy from 14 clinics across China. Participants will be randomized 1:1 to receive either a once-daily STR of BIC/FTC/TAF or a once-daily MTR of DTG+3TC+TDF. The primary endpoint is the proportion achieving viral suppression (HIV-1 RNA < 50 copies/mL) at week 48. Secondary endpoints include the time to viral suppression, emergence of resistance-associated mutations (RAMs), immunologic markers, treatment adherence, patient-reported outcomes, and safety profiles. Data will be analyzed using intention-to-treat (ITT) and per-protocol (PP) populations, with non-inferiority defined using a margin of 12

This study aimed to characterize the longitudinal trajectories of depression, anxiety, and poor sleep among MSM newly diagnosed with HIV, and secondarily to explore potential causal relationships of HIV infection on these mental health outcomes. A prospective repeated-measures study was conducted between 2017 and 2020 at Beijing Youan Hospital. Newly diagnosed MSM patients with HIV were consecutively enrolled. Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), while sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Follow-up assessments were performed at 4, 12, and 24 weeks to track longitudinal changes in mental health status. As a complementary approach, Mendelian randomization (MR) analysis was employed to explore potential causal relationships of HIV infection on depression, anxiety, and sleep disturbances. A total of 1,170 MSM newly diagnosed with HIV were enrolled. The prevalence of depression, anxiety, and poor sleep decreased from 26.82

Incomplete immune reconstitution (IIR) is a serious complication affecting 10 to 40% of people living with HIV (PLWH) despite effective antiretroviral therapy, leading to increased morbidity and mortality. Current risk prediction models rely on single-time point measurements and lack dynamic assessment capabilities. We developed a dynamic joint prediction system for IIR risk (DJPSIIR) using Bayesian joint modeling to analyze longitudinal data from 21,862 PLWH across 31 Chinese provinces (2003-2024). The system integrates continuous CD4+ T cell counts and CD4/CD8 ratios with clinical parameters to generate real-time risk predictions. DJPSIIR demonstrated strong discriminatory performance with area under receiver operating characteristic curves of 0.890 to 0.912 for 5- to 7-year predictions, consistently outperforming expert assessments and 19 machine learning algorithms across multiple validation cohorts. Our dynamic prediction system enables precise identification of high-risk individuals and could transform clinical decision-making by facilitating timely interventions to prevent IIR progression in HIV care.

Despite sustained virological suppression under antiretroviral therapy (ART), a substantial proportion of people living with HIV (PLWH) fail to achieve adequate immune reconstitution. However, long-term real-world evidence characterizing immune recovery trajectories and determinants of immunological non-response (INR) has not yet been fully characterized, particularly in Asian populations. In this retrospective cohort study, we analyzed longitudinal immunological data from 8,637 PLWH who initiated ART between 2005 and 2019 at a large HIV treatment center in China and achieved sustained viral suppression. CD4 counts, CD8 counts, and CD4/CD8 ratios were assessed longitudinally to characterize immune reconstitution patterns, and Kaplan-Meier analyses and logistic regression models were used to evaluate factors associated with immune recovery and INR. We observed a biphasic pattern of immune reconstitution, with rapid early increases in CD4 counts and CD4/CD8 ratios followed by slower, sustained improvements over long-term ART. Nevertheless, normalization of the CD4/CD8 ratio occurred less frequently than CD4 count recovery, indicating persistent immune dysregulation in a subset of patients despite virological control. Lower baseline CD4 count and older age were the strongest predictors of incomplete immune reconstitution, with individuals initiating ART at advanced stages of immunodeficiency showing markedly reduced probability and slower tempo of immune normalization. These findings highlight the heterogeneity of immune recovery under long-term ART and underscore the importance of incorporating baseline immune status and age into risk stratification strategies. Longitudinal assessment of both CD4 counts and CD4/CD8 ratios may provide complementary insights into immune restoration and inform individualized monitoring and management of PLWH receiving ART.

OBJECTIVES:Incomplete immune reconstitution (IIR) affects 10-40% of people living with HIV (PLWH) despite suppressive antiretroviral therapy (ART), increasing morbidity and mortality. We investigated whether baseline triglyceride-glucose index (TYG), a marker of insulin resistance, predicts long-term IIR risk in PLWH. METHODS:This multicentre retrospective cohort study analyzed 11076 PLWH from three Chinese HIV centers (2009-2020) using a 4-year landmark design. IIR was defined as CD4 <350 cells/μl after >4 years of ART with sustained virological suppression. Center-stratified Cox models with time-varying effects estimated hazard ratios (HRs) for TYG. RESULTS:Over a median follow-up of 7.74 years, higher baseline TYG was associated with a lower risk of IIR. There was borderline evidence of a stronger inverse association over time (P = 0.080), with the HR decreasing from 0.795 (95% CI: 0.733-0.862) at year 5 to 0.733 (95% CI: 0.639-0.842) at year 10. Results remained robust across sensitivity analyses. The association was more pronounced in younger participants (<60 years), those with better baseline immune status (CD4 ≥200 cells/µl, WHO stage I/II), virological suppression, favorable lipid profiles, and higher hemoglobin levels. CONCLUSIONS:Baseline TYG may aid risk stratification for IIR in PLWH.

Background:We compared the effectiveness and safety profiles of doravirine, lamivudine, tenofovir disoproxil fumarate (DOR/3TC/TDF) with bictegravir, emtricitabine, tenofovir alafenamide fumarate (BIC/FTC/TAF) in people with HIV (PWH) who had achieved virological suppression on efavirenz (EFV)-based antiretroviral regimens. Methods:This study was a single-center, real-world, prospective observational cohort study. The main inclusion criteria: PWH aged ≥18 years who had received an EFV-containing regimen for ≥6 months and achieved confirmed virological suppression. Participants were stratified according to clinical decisions to switch to DOR/3TC/TDF or BIC/FTC/TAF. The primary effectiveness end point was the proportion of participants with HIV-1 RNA ≥50 copies/mL at week 48, with a preset 4% noninferiority margin. Results:A total of 349 participants received at least 1 dose of study drugs (142 in DOR group, 207 in BIC group). At 48 weeks, 2 (1.4%) in the DOR group and 1 (0.5%) in the BIC group had HIV-1 RNA ≥50 copies/mL (estimated treatment difference [ETD], 1.0%; 95% CI, -1.6% to 3.7%), establishing noninferiority. In the BIC group, mean CD4 counts decreased significantly by ∼76.5 cells/µL at week 48 (95% CI, -111.801 to -41.218; P < .001) compared with baseline. Over 48 weeks, adverse event rates were comparable between the 2 groups (P = .758). At week 48, the BIC group exhibited a baseline-adjusted mean increase of 0.269 mmol/L in total cholesterol (TC) and 0.171 mmol/L in low-density lipoprotein cholesterol (LDL-C), while the DOR group demonstrated a mean reduction of 0.453 mmol/L in triglycerides (TG), 0.412 mmol/L in TC, and 0.241 mmol/L in LDL-C relative to baseline. All β values for the group-time interaction terms were negative (P < .001). The change in body weight from baseline to week 48 in the DOR group was 1.8 kg lower than that in the BIC group (95% CI, -2.474 to -1.114; P < .001). Conclusions:In previously virologically suppressed PWH on an EFV-based regimen, the switch to DOR/3TC/TDF maintained virological suppression noninferior to that of BIC/FTC/TAF, with favorable metabolic profiles.

Background:Experience with Dolutegravir/Lamivudine (DTG/3TC) for rapid initiation of antiretroviral therapy (ART) in newly diagnosed people living with HIV (PLWH) remains scarce. We conducted a study to evaluate the effectiveness and safety of DTG/3TC for rapid ART. Methods:This retrospective, real-world study was conducted among treatment-naïve PLWH at three centers in Beijing, Nanjing, and Qingdao. Participants were stratified into the rapid group (≤7 days) and the non-rapid group (>7 days) based on the time from HIV diagnosis to ART initiation. The primary endpoint was the rate of virological suppression (VS) at week 48, which was assessed using both intention-to-treat (ITT) and per-protocol (PP) analyses in accordance with the Food and Drug Administration (FDA) Snapshot algorithm. Results:A total of 145 participants were enrolled between February 2022 and October 2023 (57 in the rapid group and 88 in the non-rapid group). The median time for the two groups to ART initiation was 4.0 (3.0, 5.0) and 17.0 (12.3, 25.5) days, respectively (P < 0.001). No significant baseline differences were observed between the two groups. ITT analysis showed that the 48-week VS rates were 93.0% [95% confidence interval (CI): 86.1%-99.8%] in the rapid group and 90.9% (95% CI: 84.8%-97.0%) in the non-rapid group (P = 0.765). Multivariable logistic regression analysis, adjusted for age, baseline CD4 counts, baseline VL, and treatment initiation pattern, confirmed that rapid ART was not significantly associated with VS at week 48 [adjusted odds ratio (OR) = 1.100, 95% CI: 0.291-4.164, P = 0.888]. Subgroup analyses further demonstrated consistent results: no significant differences in VS rates were detected across subgroups (all P > 0.05). The median increases in CD4 counts from baseline at week 48 were 232 and 243 cells/μL in the rapid and non-rapid groups, respectively (P = 0.951). Throughout the 48-week follow-up period, changes in liver function, renal function, and lipid levels from baseline did not differ significantly between the two groups. Conclusion:Our study provides clinical evidence supporting the effectiveness and safety of DTG/3TC for rapid ART in treatment-naïve PLWH, with outcomes comparable to those of non-rapid initiation.

BackgroundGlobal and Chinese efforts still face significant gaps in achieving the first 95% of the “95-95-95” target, with persistently high and rising rates of late HIV diagnosis. This study evaluates RNA/DNA quantification, RNA qualitative, and ELISA assays to optimize HIV testing strategies.MethodsA prospective cross-sectional study evaluated 215 first-time HIV testers from June 2024 to May 2025. Using clinical diagnosis as the reference standard, we assessed four methods' sensitivity, specificity, and subgroup performance, with tandem testing strategies simulation for optimal detection.ResultsDNA quantitative detection demonstrated optimal performance with 100% sensitivity and specificity. RNA quantitative assay showed 99.02% sensitivity and 100% specificity, while ELISA achieved 99.02% sensitivity and 98.23% specificity. RNA qualitative testing exhibited 99.02% sensitivity but lower specificity (75.22%). ROC revealed superior diagnostic performance for DNA quantitative (AUC = 1.000) and RNA quantitative (AUC = 0.995) compared to RNA qualitative (AUC = 0.871). All methods maintained consistent sensitivity across CD4+ T cell levels. Simulation of tandem strategies identified ELISA combined with DNA quantitative testing as optimal (net sensitivity: 99.02%, net specificity: 100%, total tests: 318). For 18 WB-indeterminate samples, DNA/RNA quantitative methods achieved 100% diagnostic accuracy, outperforming RNA qualitative (94.44%) and ELISA (83.33%).ConclusionDNA quantitative detection shows high diagnostic value in initial HIV testing, overcoming challenges from undisclosed ART-induced RNA suppression and resolving WB-indeterminate misclassifications to reduce late diagnosis risks. This study supports Nucleic acid tests into diagnostic algorithms and validates the superior performance of ELISA screening followed by DNA confirmation, offering actionable strategies to shorten diagnostic delays and advance national AIDS control objectives.

To comprehend the current state of death anxiety among Chinese college students during the COVID-19 pandemic, analyze its influencing factors, and provide recommendations for mitigating death anxiety among these students. From March to May 2023, utilizing a cluster sampling method, students from three universities in Changzhou, Jiangsu, were selected as research participants. The investigation employed a general information questionnaire, the PTSD Checklist for DSM-5 (PCL-5), the Chinese Version Templer-Death Anxiety Scale (CT-DAS), and the brief version of the Big Five Inventory (BFI-10). Multivariate linear regression analysis was performed to examine the factors influencing death anxiety among Chinese college students during the COVID-19 pandemic. The total average score of death anxiety among the college students in this study was 44.35 ± 8.21. There was a positive correlation between death anxiety scores and both PTSD symptoms scores and neuroticism (r = 0.134, 0.255, both P < 0.01), and a negative correlation between death anxiety scores and extraversion, agreeableness, conscientiousness, and age (r=-0.135, -0.049, -0.172, -0.093, all P < 0.01). Multivariate linear regression analysis indicated that gender, age, place of origin, COVID-19 infection, PTSD symptoms scores, neuroticism, extraversion, and conscientiousness were significant factors influencing death anxiety among college students (all P < 0.05). Death anxiety among Chinese college students during the COVID-19 pandemic is relatively high and is associated with gender, age, place of origin, COVID-19 infection, PTSD symptoms scores, and personality traits. Appropriate intervention strategies can be formulated based on these influencing factors.

In China, approximately 13% of people living with human immunodeficiency virus (HIV) (PLWH) are receiving lopinavir/ritonavir (LPV/r)-based regimens. These PLWH typically have a history of either treatment failure or intolerance to first-line efavirenz-based regimens. Given the considerable pill burden and adverse effects associated with LPV/r, treatment optimization is important for this population. This multicenter retrospective study aimed to evaluate the efficacy and safety of switching from LPV/r-based regimens to the single-tablet regimen of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Virological suppression rates (HIV-RNA < 40 copies/mL) were primarily compared between the 48-week periods before and after switching to BIC/FTC/TAF. CD4 counts and metabolic data were also assessed. A total of 461 PLWH were recruited between January 2021 and December 2023, with 92.2% being male, a median age of 38 years, and a median antiretroviral therapy duration of 8 years. Prior to initiating LPV/r, 23.0% (106/461) had documented virological failure. During LPV/r treatment, 18.9% (20/106) of these individuals experienced viral rebound. Among all participants, the overall virological suppression rates significantly increased from 94.6% (pre-switch) to 98.6% (post-switch) (P < 0.001). Notably, among participants with prior virological failure, suppression rates improved significantly from 81.1% to 97.2% (P < 0.001), whereas no significant difference was observed in those without such history (from 98.6% to 99.2%, P = 0.764). The median triglyceride level decreased from 2.4 mmol/L to 1.8 mmol/L (P < 0.001), while no difference in CD4 counts was observed. These findings demonstrate that BIC/FTC/TAF is an effective and metabolically favorable treatment option for PLWH switching from LPV/r based regimens, regardless of whether they have a prior history of virological failure.

BACKGROUND:Despite antiretroviral therapy (ART), 10-40 % of people living with HIV (PLWH) fail to normalize CD4+ T cells, known as immune non-responders (INR), associated with poor clinical outcomes. Due to the complex pathogenesis and the absence of effective treatments, early prediction and intervention of INR are critical. With the rapid advancements in artificial intelligence, particularly in machine learning (ML), developing an interpretable ML model to identify individuals at high risk of INR can facilitate personalized treatment strategies and improve clinical management. METHODS:This retrospective study was conducted from a long-term multicenter cohort involving 30938 PLWH attending three hospitals from January 2003 to December 2023. Seven ML algorithms were employed to construct prediction models. The area under the receiver operating characteristic curve (AUC), precision-recall curves, calibration plots, clinical impact curves, and decision curve analysis were used to evaluate and identify the optimal model. We evaluated the final model using internal cross-validation and validated it in an external cohort. The Python-based Streamlit framework was applied to develop a web platform. RESULTS:11287 PLWH, including 1325 (11.74 %) INR, were analyzed in the derivation cohort. Twenty baseline clinical indicators of PLWH were used to construct ML models. After feature reduction and comparative evaluation, the 9-feature RF model demonstrated strong discrimination (AUC = 0.864), superior calibration, and favorable clinical utility, outperforming the traditional model (AUC = 0.856) and other models. The model performance was also confirmed in internal validation (mean AUC = 0.884 ± 0.003) and the external validation (AUC = 0.855). CONCLUSIONS:In this study, an interpretable ML model with nine baseline clinical indicators was constructed for early INR prediction in ART-naïve PLWH and was incorporated into a convenient web platform to facilitate individualized treatment and management.

Background:The single-tablet regimen Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate (DOR/3TC/TDF) has been included in international guidelines and recommendations and was approved by China's National Medical Products Administration (NMPA) in early 2021 for adult human immunodeficiency virus (HIV)-1 infections. This study presents real-world results of a retrospective analysis of patients who initiated DOR/3TC/TDF at a Chinese HIV center. Methods:This retrospective analysis was carried out on patients who received DOR/3TC/TDF (initial or switch) at the outpatient clinic of the Infection Center in Beijing Youan Hospital in China. Patients' baseline characteristics, reasons for switching to DOR/3TC/TDF, along with the preliminary clinical, laboratory - based efficacy, safety, and tolerability data, were collected. All evaluations were in strict accordance with the protocols of our center. The statistical analysis was mainly descriptive, aiming to assess the changes in laboratory parameters from the baseline to the data - collection deadline, which was December 31, 2024. Result:From May 16 to October 29, 2024, 205 patients were prescribed DOR/3TC/TDF, either as an initiation or a switch. The cohort consisted mainly of males (96.1%), with a median age of 36.0 (31.0, 41.0) years. By the analysis deadline, the entire group had used DOR/3TC/TDF for 149.0 (90.0, 202.0) days. Among them, 40 patients were treatment-naïve, with a median HIV-1 ribonucleic acid (HIV-1 RNA) of 4.1 (3.7, 4.6) log10 copies/mL. At weeks 12 and 24, 64.5% [95% confidence interval (CI): 45.4, 80.8%] and 91.3% (95% CI: 72.0, 98.9%) of the participants achieved HIV-1 RNA < 50 copies/mL. Subgroup analysis showed that high viral load (VL) (≥105 copies/mL) and low CD4 counts (< 200 cells/μL) at baseline did not affect virological efficacy. The results of immune reconstitution were also satisfactory, with CD4 counts increased from 350 (264, 465) cells/μL at baseline to 541.0 (415.8, 789.5) cells/μL by the end of the follow-up (p > 0.05). 165 patients (80.5%) had treatment experience, and the most common cause for switching was treatment simplification (40%). After the switch, an equally high proportion of patients [97.6% (95% CI: 93.7, 99.3%) vs. 96.4% (95% CI: 92.2, 98.7%)] achieved HIV-1 RNA undetectable or <50 copies/mL (p > 0.05). Compared to baseline, there were no significant changes in liver enzymes and renal function (p > 0.05), while body weight, random blood glucose and blood lipid levels decreased significantly (p < 0.05). Among patients with central nervous system (CNS) symptom, both the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) scores, as well as the proportion of patients with scores greater than 7 points, decreased significantly post-switch (p < 0.05). Conclusion:We provided an observational report on the effectiveness and safety of the short-term use of DOR/3TC/TDF in routine clinical practice.

With the advancement of combination antiretroviral therapy (cART), the global number of new human immunodeficiency virus (HIV) infections and HIV-related mortality has significantly declined. However, the high proportion of "late presentation" (defined as presenting to care with a low CD4 cell count or AIDS-defining events) among HIV-infected individuals remains a significant challenge in HIV prevention and treatment. HIV late presentation is associated with increased clinical risk, complex management, and higher risk of transmission, and represents a significant barrier to achieving the "95-95-95" targets and ending the HIV epidemic. Currently, both nationally and internationally, there is a lack of specific clinical guidelines for this population. Therefore, the China Association for Promotion of Health Science and Technology convened experts in the field to discuss the definition, clinical characteristics, risks, and cART of late presenters based on the latest research evidence and clinical practices both domestically and internationally. Specific recommendations were formulated to guide healthcare professionals in their clinical practice.

The long-term effects of combined antiretroviral therapy (ART) on liver fibrosis patterns in adults living with human immunodeficiency virus (HIV) and chronic hepatitis B virus (HBV) are not well understood. Therefore, this study aimed to investigate the trajectories of liver fibrosis and identify the associations of baseline variables with different patterns of liver fibrosis evolution. A total of 333 individuals with HIV/HBV co-infection and undergoing long-term ART were enrolled in this study. Demographic, clinical, and biochemical data were collected at baseline and during annual visits. Group-based trajectory models (GBTMs) were used to detect the patterns of liver fibrosis evolution based on longitudinal data of fibrosis-4 (Fib-4) and aspartate aminotransferase to platelet ratio index (APRI) scores. Logistic regression analysis was performed to identify baseline predictors of liver fibrosis evolution. The median age of all participants was 33 years. Among them, 89.5% initially received TDF-containing ART. GBTMs identified two distinct patterns of liver fibrosis evolution using either APRI or Fib-4 scores. The majority of individuals (78.5% for APRI and 75.3% for Fib-4; pattern A) showed stable or low fibrosis with no progression, while the remaining participants showed regression from high fibrosis levels (21.5% for APRI and 24.7% for Fib-4; pattern B). Pattern A participants were younger and had higher CD4+ cell counts, higher lymphocyte cell counts, higher white blood cell counts, and lower platelet counts at baseline compared to pattern B participants. For HIV/HBV co-infected patients with varying degrees of initial liver fibrosis, long-term ART has shown distinct patterns of alleviating liver fibrosis.

An increasing number of treatment guidelines recommend rapid initiation of antiretroviral therapy (ART) after the diagnosis of human immunodeficiency virus (HIV) infection. However, data on the association between rapid ART initiation and alterations in brain structure and function remain limited in people with HIV (PWH). A cross-sectional analysis was conducted on HIV-positive men who have sex with men (MSM) undergoing ART. Fifty-four participants who started ART within 30 days of confirmed HIV diagnosis (rapid ART group) and 20 participants who started ART more than 6 months of confirmed HIV diagnosis (non-rapid ART group) completed clinical assessments and multimodal magnetic resonance imaging scans to obtain both anatomical and resting-state functional images. Compared to PWH in the non-rapid ART group, those in the rapid ART group exhibited a greater total gray matter volume (P = 0.001) and functional changes, including a lower amplitude of low-frequency fluctuations in the left angular gyrus (P < 0.001). Moreover, the results of the main effects and interactions indicated that rapid ART initiation had main effects on major imaging outcomes. The validation analysis results in participants who started ART within 7 days of confirmed HIV diagnosis generally corroborated and complemented the aforementioned findings. Our study demonstrated brain gray matter volume atrophy and functional alterations in PWH of the non-rapid ART group compared to those in the rapid ART group, suggesting that rapid ART initiation may be associated with better brain structure and function changes in HIV-positive MSM.

BACKGROUND:Although the annual number of newly reported human immunodeficiency virus (HIV) infections in Beijing has shown a continuous decline since 2016, the population of people living with HIV (PLWH) has maintained a persistent upward trend. This retrospective study aimed to analyse data from newly diagnosed PLWH from 2015 to 2023 in Beijing to develop precision interventions. METHODS:All newly diagnosed PLWH were subjected to sequence splicing, quality control, information matching, and analysis for pretreatment drug resistance (PDR) and molecular transmission network. The Stanford Drug Resistance Database was used to analyse drug resistance, and Hyphy and Cytoscape software were used to construct a molecular transmission network with the gene distance threshold of 0.015. RESULTS:A total of 3,569 newly diagnosed PLWH were included in this study. A total of 42 HIV-1 subtypes were identified, with CRF01_AE being the most common subtype, followed by the CRF07_BC and B subtypes. However, for the first time, the dominant strain shifted from CRF01_AE to CRF07_BC in 2023. A total of 340 drug-resistant sequences were obtained, and the overall prevalence of PDR was 9.53% from 2015 to 2023. The most common mutations were distributed among V179, K103, M184, S68 and M46, which presented diverse distributions and combined mutation features. A total of 64 transmission clusters were identified in the network, among which CRF07_BC was dominated by large spreading clusters, whereas CRF01_AE was dominated by small- and medium-sized spreading clusters. The largest cluster for CRF07_BC expanded rapidly from 8 cases in 2015 to 161 cases in 2023. CONCLUSIONS:This study revealed the prevalence of HIV-1 drug resistance and molecular transmission network in Beijing. The change in the dominant HIV strain of participants should be emphasized. Subtype CRF07_BC is prone to forming fast-spreading clusters, and targeted interventions should be designed to prevent high-risk transmission sources and reduce new HIV infections.

The Acquired Immunodeficiency Syndrome Professional Group of the Society of Infectious Diseases of the Chinese Medical Association formulated the first edition of the Chinese Guidelines for the Diagnosis and Treatment of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (referred to as the Guidelines) in 2005. The 2024 edition of the Guidelines has been compiled by updating the 2021 fifth edition, incorporating the latest research advancements in antiviral therapy, comprehensive management, opportunistic infections, concurrent tumors, and the prevention and intervention of HIV infection. The new edition also introduces a new section on "Incomplete immune reconstitution", proposes the concept of "HIV vulnerable populations" for the first time with recommendations for their diagnosis and treatment. This edition of the Guidelines covers 14 sections: epidemiology, pathogenic characteristics, laboratory tests, pathogenesis, clinical presentation and staging, diagnostic criteria, common opportunistic infections, antiretroviral therapy, immune reconstitution inflammatory syndrome, incomplete immune reconstitution, AIDS-related neoplasms, prevention of mother-to-child transmission and conception in serodiscordant couples, pre- and post-exposure prophylaxis, and whole-course management of HIV infection. This edition of the Guidelines aims to assist clinical physicians in making informed decisions in the diagnosis, treatment, and management of HIV/AIDS and will be periodically revised and updated based on domestic and international research progress.

IntroductionPneumocystis pneumonia (PCP) is a common and serious complication of HIV/AIDS, with a higher prevalence in patients not receiving antiretroviral therapy. Due to the high mortality rate of PCP, accurate prediction of its case fatality rate is very important for clinical treatment. We aimed to develop a risk model for the near-term prognosis of people with HIV/AIDS and PCP and verify its effectiveness.MethodsThis single-center, retrospective observational study was conducted at Beijing Youan Hospital from January 2012 to October 2022. 972 AIDS patients with Pneumocystis pneumonia met our criteria were recruited. The patients were divided into death group and survival group according to clinical outcome during hospitalization. Data of the two groups were collected including general information and laboratory test results. 53 medical characteristics of the two groups were collected. Prediction variables were screened with Multivariate logistic regression analysis and Lasso regression model. We used ROC curve to identify the discrimination of training and testing data sets. The Shapley Additive exPlanation (SHAP) method was applied to explain the final model and the weights of features.ResultsThe overall mortality rate among hospitalized patients was 17.8%. We found that the best prediction effect can be obtained when ALB, PO2, TBIL, LDH, CD4+ T lymphocyte counts are incorporated into the PCP risk prediction model. The model had a perfect discrimination with AUC of 0.994 and 0.947 in training and validation cohorts. The prognosis risk grade was divided into three grades: low-risk group (0-25 points with mortality of 5.9%), moderate-risk group (25-50 points with mortality of 45.1%) and high-risk group (above 50 points with mortality of 80%). There is a statistically significant difference in mortality among these three grades (χ2 = 419.271, P<0.001).ConclusionWe developed and validated a model of the prognostic risk level of PCP in patients of AIDS with the results of blood tests reviewed by patients at routine visits. The model is more convenient to use, allowing clinicians to obtain a determined probability value of PCP mortality with simple calculations within the first 72 hours of the patient’s admission.