Jing You

Impact of viral replication inhibition by entecavir on peripheral T lymphocyte subpopulations in chronic hepatitis B patients

BackgroundTo investigate dynamic fluctuations of serum viral load and peripheral T-lymphocyte subpopulations of chronic hepatitis B patients and their correlation during entecavir therapy.MethodsFifty-five patients received entecavir 0.5 mg/d therapy. Serum HBV DNA load was measured by Real-Time-PCR, and the levels of peripheral T-lymphocyte subpopulations by flow cytometry biweekly, every four weeks and every eight weeks during weeks 1–12, 13–24 and 24–48, respectively. Multilevel modelling was used to analyse the relationship between these variables.ResultsOf the 55 patients, all HBeAg positive and with detectable HBV DNA, the majority (81.8%) had serum levels of HBV DNA over 107 copies per milliliter. HBV viral load dropped sharply during the first two weeks. In 28 and 43 patients, the level became undetectable from week 24 and 48, respectively. Using pre-therapy level as the reference, a significant decrease in CD8+ T cells and increase in CD4+ T cells were found from week 12. Both parameters and CD4+/CD8+ ratio steadily improved throughout the 48 weeks. Multilevel analyses showed that the level of decrement of HBV DNA was associated with the increment of T-lymphocyte activities only in the later period (4–48 week). After 4 weeks of therapy, for each log10 scale decrement of HBV DNA, the percentage of CD4+ lymphocyte was increased by 0.49 and that of CD8+ decreased by 0.51.ConclusionT-lymphocyte subpopulations could be restored partially by entecavir treatment in patients with chronic hepatitis B concurrently with reduction of viremia.

Comparison of survival rates between Chinese and Thai patients with breast cancer.

BACKGROUND The burden and severity of a cancer can be reflected by patterns of survival. Breast cancer prognosis between two countries with a different socioeconomic status and cultural beliefs may exhibit wide variation. This study aimed to describe survival in patients with breast cancer in China and Thailand in relation to demographic and clinical prognostic information. MATERIALS AND METHODS We compared the survival of 1,504 Chinese women in Yunnan province and 929 Thai women in Songkhla with breast cancer from 2006 to 2010. Descriptive prognostic comparisons between the Chinese and Thai women were performed by relative survival analysis. A Cox regression model was used to calculate the hazard ratios of death, taking into account the age, disease stage, period of diagnosis and country. RESULTS The overall 5-year survival proportion for patients diagnosed with breast cancer for Yunnan province (0.72) appeared slightly better than Songkhla (0.70) without statistical significance. Thai women diagnosed with distant and regional breast cancer had poorer survival than Chinese women. Disease stage was the most important determinant of survival from the results of Cox regression model. CONCLUSIONS Breast cancer patients in Kunming had slightly greater five-year survival rate than patients in Songkhla. Both Chinese and Thai women need improvement in prognosis, which could conceivably be attained through increased public education and awareness regarding early detection and compliance to treatment protocols.

Development of internalized and personal stigma among patients with and without HIV infection and occupational stigma among health care providers in Southern China

Background HIV/AIDS-related stigma is a major barrier of access to care for those infected with HIV. The aim of this study was to examine, validate, and adapt measuring scales of internalized, personal, and occupational stigma developed in Africa into a Chinese context. Methods A cross-sectional study was conducted from January to September 2015 in Kunming, People’s Republic of China. Various scales were constructed on the basis of the previous studies with modifications by experts using exploratory and confirmatory factor analyses (EFA + CFA). Validation of the new scales was done using multiple linear regression models and hypothesis testing of the factorial structure invariance. Results The numbers of subjects recruited for the development/validation samples were 696/667 HIV-positive patients, 699/667 non-HIV patients, and 157/155 health care providers. EFA revealed a two-factor solution for internalized and personal stigma scales (guilt/blaming and being refused/refusing service), which were confirmed by CFA with reliability coefficients (r) of 0.869 and 0.853, respectively. The occupational stigma scale was found to have a three-factor structure (blaming, professionalism, and egalitarianism) with a reliability coefficient (r) of 0.839. Higher correlations of factors in the HIV patients (r=0.537) and non-HIV patients (r=0.703) were observed in contrast to low-level correlations (r=0.231, 0.286, and 0.266) among factors from health care providers. Conclusion The new stigma scales are valid and should be used to monitor HIV/AIDS stigma in different groups of Chinese people in health care settings.

Can socio-economic differences explain low expectation of health services among HIV patients compared to non-HIV counterparts?

BackgroundThe health service of China has encountered significant challenges due to inequalities in socio-economic determinants of health. HIV patients are known to suffer from social stigma, and may receive inadequate responsiveness from health providers. Before assessing the responsiveness they receive, it is important to know their expectations. We aimed to compare levels of expectation towards the healthcare service among HIV and non-HIV patients with adjustment for socio-economic factors.MethodsA cross-sectional study was conducted during January and February, 2015 among two consecutive groups of HIV positive and non-HIV patients in two hospitals in Kunming, China. Patients’ expectation towards eight domains of health system responsiveness was measured using 40 vignettes; five per domain. Each vignette was ranked from 1 “very good” to 5 “very bad”, and the responses were summed to obtain a total score for each domain. Differences in total scores were compared between the two groups and adjusted for other factors using multiple linear regression.ResultsThe three domains with the highest scores, reflecting high expectation, were prompt attention, basic amenities and choice. Adjusted for other factors, HIV patients had significantly lower levels of expectation in all domains compared to the non-HIV group. Age was associated with the basic amenities domain, with young adults having higher expectations than other age groups. Minority ethnic groups had lower expectation towards dignity, prompt attention and autonomy domains compared to Han ethnicity. Those who lived in a home with 2–4 family members had higher expectations towards confidentiality than those who lived alone.ConclusionPatients with HIV have significantly lower levels of expectations even after adjusting for socio-economic factors. Assessment of health system responsiveness based on their judgments above may give biased results toward favorable service quality.

PP-108 Prevalence of transfusion-transmitted virus in patients with viral liver disease

Introduction: Primary liver cancer accounts for only 1 2% of malignant tumors found at autopsy in western countries. However, in some parts of Africa and Asia it may account for up to 20 30% of all types of malignancy. The high frequency of HBsAg positivity in individuals with Hepatocellular Carcinoma (HCC) strongly suggests that chronic HBV infection may contribute in some way towards the development of 1ry liver cell carcinoma. Although HCC is probably caused by one or more environmental carcinogens, a hereditary predisposition to the tumor has not been excluded. Aim: Determine the incidence of HBsAg carriers patients suffering from primary HCC and detect the association between primary HCC and HLA. Subjects and Methods: The material consisted of twenty patients diagnosed as HCC based on Ultrasonographic examination and by Histopathology. Laboratory investigations; liver biopsy, HBsAg, Anti-HBcAg (IgM) and HLA typing using lymphocyte microcytotoxicity technique. Results: The 20 studied cases were negative for HBcAb IgM and 10 patients were positive for HBsAg. HLA typing revealed significant rise of HLA-A9, HLA-B5 among HCC patients. HLAA9 was significantly increased in HBsAg positive and negative cases. HLA-B5 was significantly increased in HBsAg positive cases only while HLA-B8 was significantly increased in HBsAg negative cases only. In cases with mixed hepatic cirrhosis and Schistosomal hepatic fibrosis which were negative for HBsAg showed significant increase in HLA-A9. Conclusions: 1. Significant association of HBsAg positivity in patients with HCC. 2. Significant association of HLA-A9 and HLA-B5 with HCC. 3. HLA-A9 in patients mixed cirrhosis and Schistosomal hepatic fibrosis may be predisposing to HCC.