Objective: To determine the prevalence of drug-resistant HIV-1 and the efficacy of first-line highly active antiretroviral therapy (HAART) regimens consisted of generic nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor among 339 study subjects in rural areas of Hubei province, China.Methods: Two cross-sectional studies were conducted to investigate 150 HAART-naive (99 received subsequent therapy) between 2003 and 2005 and 288 HAART-experienced patients mainly between 2005 and 2006. Patients' CD4(+) T-cell count and viral load were determined. HIV-1 pol gene fragments were amplified from patients' plasma by reverse transcriptase-polymerase chain reaction, subsequently sequenced and analyzed.Results: About 83.5% of the patients were from rural villages. They were dominantly infected with subtype B' HIV-1 (96.7%) through paid blood donation (64.6%) and related blood transfusion (28.3%). We found that there was a steady increase of CD4 count over time among treated patients without detectable viral load (186/288, 64.6%). There was, however, an increasing prevalence of nucleoside reverse transcriptase inhibitor- and nonnucleoside reverse transcriptase inhibitor-resistant mutations among patients with detected viremia (102/288, 35.4%) after treatment for 3-6 (24.3%), 9-12 (57.1%), and 20-24 (63.3%) months, respectively. The increasing rates were associated with significant CD4 count drop and viral load increase. Some patients also developed multidrug-resistant mutants.Conclusions: We report the first HIV-1 drug resistance study after 2 years on HAART among Chinese patients living in rural villages. Our data suggest that a significant portion of patients are failing first-line regimens with a trend of AIDS progression. It is therefore necessary to maximize the drug adherence and to make affordable second-line HAART regimens available immediately Our results have implications for implementing HAART in underresourced developing country settings.

China is facing increased danger of a widespread HIV-1 epidemic in high-risk populations such as injecting drug users (IDUs) and paid blood donors (PBDs) and of further dissemination from these high-risk populations to the general public. The virus has spread to every province and autonomous region and the government estimates about 840000 infections of which only 89067 have been reported. However prevalence and incidence studies are woefully inadequate and the United Nations Joint Program on HIV/AIDS projects that there may be as many as 10 million infected people by 2010. Among all high-risk activities linked to HIV-1 transmission IDU appears to play the most important role in the epidemic thus far. Many of these HIV-infected IDUs reside in southwest provinces such as Yunnan Guangxi and Sichuan which is close to the Golden Triangle where 70% of the worlds heroin is produced. HIV-1 infection through illegal blood collection practices and blood transfusions in the central province of Henan constitutes a second important high-risk activity in China and it has recently generated a tremendous amount of media attention. (excerpt)

OBJECTIVE:To estimate prevalence of HIV/AIDS among children and the transmission routes in a highly endemic villages of AIDS.METHODS:Totally 208 high-risk women of child bearing age and 159 of their children aged 0 - 14 years were investigated. Their medical histories of blood donation or transfusion were collected, blood samples were taken and sera were separated for HIV test. Enzyme-linked immunosorbent assay (ELISA) and Western blot assay were performed for HIV antibody. The Nested-polymerase chain reaction (PCR) assay amplifying gag gene p17 was performed on samples of children aged less than 18 months.RESULTS:Thirty-seven HIV infected cases were found among 159 children aged 0 - 14 years of whom 33 were infected by mother-to-child transmission (89.2%, 33/37), 3 by blood transfusion (8.1%, 3/37) and one by iatrogenic route (2.7%, 1/37). Sixty seven mothers who were seropositive for HIV and their 86 children who were born after 1992 were investigated, 33 cases of them were infected with HIV. The rate of vertical transmission was 38.4% (33/86). The HIV vertical transmission rate among mothers with AIDS (68.8%, 22/32) was significantly greater than that among mothers with asymptomatic HIV infection (20.4%, 11/54, P < 0.05). The number of children infected with HIV through vertical transmission increased from 1993 to 2001. Among 37 children infected with HIV, 12 cases developed AIDS and 4 of them died, of whom 2 cases died from tuberculosis. The morbidity of AIDS was 27.3% (9/33). Ninety three point nine percent (31/33) of infected mothers didn't know their HIV seropositive status before pregnancy and delivery. Of 8 pregnant women infected with HIV, one had aggravation of AIDS, 2 miscarried, 2 terminated their pregnancy and 3 continued their pregnancy.CONCLUSION:Mother-to-child transmission of HIV was the major route of HIV/AIDS transmission to the children. The main reason leading to HIV infection in children was the lack of prenatal HIV counseling and testing for the high-risk women of childbearing age and lake of interventions. The countermeasures must be taken to control the further transmission of AIDS in order to protect the health of women and children in the highly endemic areas of AIDS.

Zhuang, Ke*; Gui, Xien‡; Su, Bo*; Tien, Po*; Chen, Zhiwei*†; Zhang, Linqi*† Author Information

Objective: To investigate the genetic background of HIV-1 strains among infected paid blood donors (PBD) in the Henan and Hubei provinces of China. Methods: The polymerase chain reaction was used to amplify HIV-1 gag p17 fragments and some 5'-half or full-length viral genomes from peripheral blood mononuclear cells. The HIV-1 sequences obtained were analysed using phylogenetic and recombinant approaches. Results: Among the total of 62 samples studied, 59 (95.2%) came from PBD. Of those 59 PBD, 45 were collected from 14 different geographical locations in Henan, whereas the remaining 14 were from five locations in Hubei. A total of 62 HIV-1 gag p17 fragments, three 5'-half and one full HIV-1 genome sequences were obtained. Phylogenetic analysis of these sequences suggests that PBD from Henan and Hubei, despite being geographically distant, harbored a group of genetically closely related HIV-1 B’ strains. No recombinant forms have been detected in this cohort. Conclusion: Our data indicate that the AIDS epidemic among PBD in Henan and Hubei is caused largely by HIV-1 subtype B', which contrasts greatly with the CB’ recombinant strains CRF-07 and CRF-08 currently dominating among the drug abusers in other regions of China. Our report has revealed the first complete genome background of the most dominant circulating HIV-1 strain in Henan and Hubei, which is essential for the design and development of an effective AIDS vaccine for the region.