To the Editor:China provides free antiretroviral therapy(ART)for people with human immunodeficiency virus(HIV),typically using two nucleoside reverse transcriptase inhibitors(NRTIs)and one non-nucleoside reverse trans...To the Editor:China provides free antiretroviral therapy(ART)for people with human immunodeficiency virus(HIV),typically using two nucleoside reverse transcriptase inhibitors(NRTIs)and one non-nucleoside reverse transcriptase inhibitor(NNRTI).This regimen has significantly reduced mortality and slowed HIV spread over the past 20 years.展开更多
Background In 2003,China implemented free antiretroviral therapy(ART)for people living with HIV(PLHIV),establishing an eligibility threshold of CD4<200 cells/μl.Subsequently,the entry criteria were revised in 2012...Background In 2003,China implemented free antiretroviral therapy(ART)for people living with HIV(PLHIV),establishing an eligibility threshold of CD4<200 cells/μl.Subsequently,the entry criteria were revised in 2012(eligibility threshold:CD4≤350 cells/μl),2014(CD4≤500 cells/μl),and 2016(treat-all).However,the impact of treat-all policy on HIV care and treatment indicators in China is unknown.We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China.Methods Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019,from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China.We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators:monthly proportion of 30-day ART initiation,mean CD4 counts(cells/μl)at ART initiation,and mean estimated time from infection to diagnosis(year).We built separate models according to gender,age,route of transmission and region.Results Monthly data on ART initiation and collection were available for 75,516 individuals[gender:83.8%males;age:median 39 years,interquartile range(IQR):28-53;region:18.5%Northern China,10.9%Northeastern China,17.5%Southern China,49.2%Southwestern China].In the first month of treat-all,compared with the contemporaneous counterfactual,there was a significant increase in proportion of 30-day ART initiation[+12.6%,incidence rate ratio(IRR)=1.126,95%CI:1.033-1.229;P=0.007]and mean estimated time from infection to diagnosis(+7.0%,IRR=1.070,95%CI:1.021-1.120;P=0.004),while there was no significant change in mean CD4 at ART initiation(IRR=0.990,95%CI:0.956-1.026;P=0.585).By December 2019,the three outcomes were not significantly different from expected levels.In the stratified analysis,compared with the contemporaneous counterfactual,mean CD4 at ART initiation showed significant increases in Northern China(+3.3%,IRR=1.033,95%CI:1.001-1.065;P=0.041)and Northeastern China(+8.0%,IRR=1.080,95%CI:1.003-1.164;P=0.042)in the first month of treat-all;mean estimated time from infection to diagnosis showed significant increases in male(+5.6%,IRR=1.056,95%CI:1.010-1.104;P=0.016),female(+14.8%,IRR=1.148,95%CI:1.062-1.240;P<0.001),aged 26-35(+5.3%,IRR=1.053,95%CI:1.001-1.109;P=0.048)and>50(+7.8%,IRR=1.078,95%CI:1.000-1.161;P=0.046),heterosexual transmission(+12.4%,IRR=1.124,95%CI:1.042-1.213;P=0.002)and Southwestern China(+12.9%,IRR=1.129,95%CI:1.055-1.208;P<0.001)in the first month of treat-all.Conclusions The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes.To advance the work of rapid ART,efforts should be made to streamline the testing and ART initiation process,provide comprehensive support services,and address the issue of uneven distribution of medical resources.展开更多
The global pandemic of 2019 coronavirus disease(COVID-19)is a great assault to public health.Presymptomatic transmission cannot be controlled with measures designed for symptomatic persons,such as isolation.This study...The global pandemic of 2019 coronavirus disease(COVID-19)is a great assault to public health.Presymptomatic transmission cannot be controlled with measures designed for symptomatic persons,such as isolation.This study aimed to estimate the interval of the transmission generation(TG)and the presymptomatic period of COVID-19,and compare the ftting effects of TG and serial interval(S)based on the SEIHR model incorporating the surveillance data of 3453 cases in 31 provinces.These data were allocated into three distributions and the value of AIC presented that the Weibull distribution fitted well.The mean of TG was 5.2 days(95%C:4.6-5.8).The mean of the presymptomatic period was 2.4 days(95%CI:1.5-3.2).The dynamic model using TG as the generation time performed well.Eight provinces exhibited a basic reproduction number from 2.16 to 3.14.Measures should be taken to control presymptomatic transmission in the COVID-19 pandemic.展开更多
To the Editor:High-frequency resistance(typically≥15-25%viral quasispecies)detected by conventional resistance assays has long been associated with failure of antiretroviral therapy(ART)to suppress viral replication,...To the Editor:High-frequency resistance(typically≥15-25%viral quasispecies)detected by conventional resistance assays has long been associated with failure of antiretroviral therapy(ART)to suppress viral replication,[1]but the impact of pre-existing lowfrequency resistance on virological response is controversial.Previous studies have shown an increased likelihood of virological response failure in patients with preexisting low-frequency resistance mutations after initiation of antiviral therapy,especially primary ART regimens containing non-nucleoside reverse transcriptase inhibitors(NNRTIs).[2]However,some studies have concluded differently,suggesting that pre-existing lowfrequency resistance mutations do not correlate with viral response failure.[3]This may be related to the method of detection of pre-existing low-frequency resistance mutations.展开更多
基金This study was funded in part by the project of Nanjing Infectious Disease Clinical Medical Center and the project of Innovation center for infectious disease of Jiangsu Province(NO.CXZX202232)the Jiangsu Provincial Health Commission Medical Research Foundation(No.M2022030)+1 种基金the Nanjing Medical Science and Technique Development Foundation(No.ZKX21037)the Research Project of Nantong Municipal Health Commission(No.MS2023077).
文摘To the Editor:China provides free antiretroviral therapy(ART)for people with human immunodeficiency virus(HIV),typically using two nucleoside reverse transcriptase inhibitors(NRTIs)and one non-nucleoside reverse transcriptase inhibitor(NNRTI).This regimen has significantly reduced mortality and slowed HIV spread over the past 20 years.
基金This study was supported by the Shenzhen Science and Technology Innovation Commission Basic Research Program[JCYJ20190807155409373]the Natural Science Foundation of China Excellent Young Scientists Fund[82022064]+6 种基金Natural Science Foundation of China International/Regional Research Collaboration Project[72061137001]the Sanming Project of Medicine in Shenzhen[SZSM201811071]the High Level Project of Medicine in Longhua,Shenzhen[HLPM201907020105]Special Support Plan for High-Level Talents of Guangdong Province[2019TQ05Y230]the Fundamental Research Funds for the Central Universities[58000-31620005]Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences[2020-JKCS-030]All funding parties did not have any role in the design of the study or in the explanation of the data.
文摘Background In 2003,China implemented free antiretroviral therapy(ART)for people living with HIV(PLHIV),establishing an eligibility threshold of CD4<200 cells/μl.Subsequently,the entry criteria were revised in 2012(eligibility threshold:CD4≤350 cells/μl),2014(CD4≤500 cells/μl),and 2016(treat-all).However,the impact of treat-all policy on HIV care and treatment indicators in China is unknown.We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China.Methods Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019,from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China.We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators:monthly proportion of 30-day ART initiation,mean CD4 counts(cells/μl)at ART initiation,and mean estimated time from infection to diagnosis(year).We built separate models according to gender,age,route of transmission and region.Results Monthly data on ART initiation and collection were available for 75,516 individuals[gender:83.8%males;age:median 39 years,interquartile range(IQR):28-53;region:18.5%Northern China,10.9%Northeastern China,17.5%Southern China,49.2%Southwestern China].In the first month of treat-all,compared with the contemporaneous counterfactual,there was a significant increase in proportion of 30-day ART initiation[+12.6%,incidence rate ratio(IRR)=1.126,95%CI:1.033-1.229;P=0.007]and mean estimated time from infection to diagnosis(+7.0%,IRR=1.070,95%CI:1.021-1.120;P=0.004),while there was no significant change in mean CD4 at ART initiation(IRR=0.990,95%CI:0.956-1.026;P=0.585).By December 2019,the three outcomes were not significantly different from expected levels.In the stratified analysis,compared with the contemporaneous counterfactual,mean CD4 at ART initiation showed significant increases in Northern China(+3.3%,IRR=1.033,95%CI:1.001-1.065;P=0.041)and Northeastern China(+8.0%,IRR=1.080,95%CI:1.003-1.164;P=0.042)in the first month of treat-all;mean estimated time from infection to diagnosis showed significant increases in male(+5.6%,IRR=1.056,95%CI:1.010-1.104;P=0.016),female(+14.8%,IRR=1.148,95%CI:1.062-1.240;P<0.001),aged 26-35(+5.3%,IRR=1.053,95%CI:1.001-1.109;P=0.048)and>50(+7.8%,IRR=1.078,95%CI:1.000-1.161;P=0.046),heterosexual transmission(+12.4%,IRR=1.124,95%CI:1.042-1.213;P=0.002)and Southwestern China(+12.9%,IRR=1.129,95%CI:1.055-1.208;P<0.001)in the first month of treat-all.Conclusions The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes.To advance the work of rapid ART,efforts should be made to streamline the testing and ART initiation process,provide comprehensive support services,and address the issue of uneven distribution of medical resources.
基金the National Natural Science Foundation of China(82041026,81673275,11961071,91846302)the Huai'an Key Laboratory for Infectious Diseases Control and Prevention(HAP201704).
文摘The global pandemic of 2019 coronavirus disease(COVID-19)is a great assault to public health.Presymptomatic transmission cannot be controlled with measures designed for symptomatic persons,such as isolation.This study aimed to estimate the interval of the transmission generation(TG)and the presymptomatic period of COVID-19,and compare the ftting effects of TG and serial interval(S)based on the SEIHR model incorporating the surveillance data of 3453 cases in 31 provinces.These data were allocated into three distributions and the value of AIC presented that the Weibull distribution fitted well.The mean of TG was 5.2 days(95%C:4.6-5.8).The mean of the presymptomatic period was 2.4 days(95%CI:1.5-3.2).The dynamic model using TG as the generation time performed well.Eight provinces exhibited a basic reproduction number from 2.16 to 3.14.Measures should be taken to control presymptomatic transmission in the COVID-19 pandemic.
基金supported by the 2020 Annual Medical Research Project of Jiangsu Commission of Health(No.ZDA 2020014)the Key Project supported by Medical Science and Technology Development Foundation,Nanjing Department of Health(Nos.ZKX 22040 and ZKX 19048)
文摘To the Editor:High-frequency resistance(typically≥15-25%viral quasispecies)detected by conventional resistance assays has long been associated with failure of antiretroviral therapy(ART)to suppress viral replication,[1]but the impact of pre-existing lowfrequency resistance on virological response is controversial.Previous studies have shown an increased likelihood of virological response failure in patients with preexisting low-frequency resistance mutations after initiation of antiviral therapy,especially primary ART regimens containing non-nucleoside reverse transcriptase inhibitors(NNRTIs).[2]However,some studies have concluded differently,suggesting that pre-existing lowfrequency resistance mutations do not correlate with viral response failure.[3]This may be related to the method of detection of pre-existing low-frequency resistance mutations.
