Tao Qiu

The epidemic of HIV syphilis chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu China 2009.

Background In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs. Methods In order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009. Results In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03–20.75), 1.91(95%CI 1.14–3.21) and 2.36(95%CI 1.07,5.24). Conclusion Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too.

Differences in natural killer cell quantification and receptor profile expression in HIV-1 infected Chinese children

Natural killer (NK) cells are believed to play a role in the progression of human immunodeficiency virus 1 (HIV-1) disease, and NK cell levels are reduced in individuals with chronic HIV-1 infection. To assess the effects on quantity of NK cells and the changes of NK cell receptors in HIV-1 infected children via mother-to-child transmission, the percentage of NK cells is quantified and the changes in the NK cell receptor profiles in 20 HIV-1 infected children who are not progressing into AIDS were examined. The results showed that NK cell percentage was decreased in the HIV-1 infected children. The expression of NKp30 on NK cells was increased, while the expressions of CD16, NKp44, NKp46, NKp80, NTB-A, CD244, KIR2D, KIR3DL1 and NKG2D on NK cells were decreased in the HIV-1 infected children. NK cell cytolytic activity was elevated in HIV-1 infected children. These results indicate that the acute changes in NK cell percentage and NK cell receptors in HIV-1 infected children are different from the HIV-1 infected adult individuals. Moreover, serum concentrations of IL-18 were elevated in HIV-infected children compared to HIV-uninfected controls. These differences probably play a role in protecting against transmission of maternal HIV-1 virus and guiding the therapeutic strategies for HIV-1 infected children.

Changes in NK cell counts and receptor expressions and emergence of CD3dim/CD56+ cells in HIV-1 infected patients in China.

Natural killer (NK) cells are believed to play a role in human immunodeficiency virus 1 (HIV-1) disease progression, and NK cell levels are reduced in individuals with chronic HIV-1 infection. In the present study, we compared the frequency and phenotype of peripheral blood CD3-CD56+ NK cells in HIV-1 infected patients in China who were infected through different routes of transmission, including heterosexual and homosexual sexual contact, and blood transmission through injection drug use or importation of blood or blood products. The results showed significantly reduced numbers of CD3-CD56+ NK cells with no association with route of transmission. The expression of CD16 on CD3-CD56+ NK cells in HIV-1 infected patients was similar to that in healthy controls. Among the examined receptor (KIR3DL1, NKp80, NKp44, CD244, NKG2D, and NTBA) expressions, only KIR3DL1 and NKp80 expressions on CD3-CD56+ NK cells were suppressed in HIV-1-infected patients compared to healthy controls, and no significant difference was observed between patients upon comparison of different routes of transmission. A subset of CD3(dim)/CD56+ cells was dramatically increased in HIV-1-infected patients. This study suggests that changes in NK cell count and receptors are not related to the route of HIV-1 transmission. A new subset of CD3(dim)/CD56+ cells emerged only in HIV-1-infected patients, and may play a role in limiting viral spread, eliminating infected cells, and slowing the progression from HIV-1 infection to AIDS.

A Novel HIV-1 CRF01_AE/B recombinant among men who have sex with men in Jiangsu Province, China.

CRF01_AE and subtype B are the two of major HIV-1 clades circulating in China. HIV spread more rapidly among men who have sex with men (MSM) than among populations with other risk behaviors. In Jiangsu province in China, the HIV-1 incidence among MSM was more than 3.8%. Our previous study showed that almost equal proportions of CRF01_AE, B, and CRF07_BC were circulating among MSM. Moreover, many kinds of CRF01Bs have been identified among MSM in Southeast Asia in recent years. It is therefore inevitable that recombination between CRF01_AE and subtype B will emerge among MSM in Jiangsu province in China. Here we identify a novel recombinant of CRF01_AE/B that has a distinctly different genome structure from other CRF01Bs and unique recombinant forms (URFs) previously identified. An analysis of the near full-length sequence of JS2010001 showed that it is composed of at least three interlaced CRF01_AE and B segments. Recently, many kinds of URFs and C circulating recombinant forms (CRFs) have emerged among MSM in China within a short period of time, which suggests that dual infection of HIV-1 among MSM in China is very common and that more effective intervening measures to prevent the spread of HIV among MSM should be taken.

Prevalence of HIV Antiretroviral Drug Resistance and Its Impacts on HIV-1 Virological Failures in Jiangsu, China: A Cross-Sectional Study

Antiretroviral therapy (ART) has been shown to improve survival of patients with Human Immunodeficiency Virus (HIV) infection and to reduce HIV-1 transmission. Therefore, the Chinese central government initiated a national program to provide ART free of charge to HIV-1 patients. We conducted a cross-sectional survey in Jiangsu province to determine the level of drug resistance (DR) in HIV-1 infected patients and the correlates of DR in virological failures in 2012. Approximately 10.4% of the HIV-1 patients in the study experienced virological failure after one year of ART and were divided into drug sensitive and drug resistant groups based on genotype determination. The viral loads (VLs) in the drug resistant group were significantly lower than the drug sensitive group. There were two independent predictors of virological failure: male gender and increasing duration of treatment. The primary mutations observed in the study were against nucleoside reverse transcriptase inhibitors (NRTIs) which were M184V (79.45%) and K103N (33.70%) in nonnucleoside reverse transcriptase inhibitors (NNRTIs). The overall rate of DR in Jiangsu province is still relatively low among treated patients. However, close monitoring of drug resistance in male patients in the early stages of treatment is vital to maintaining and increasing the benefits of HIV ART achieved to date.

siRNA Against KIR3DL1 as a Potential Gene Therapeutic Agent in Controlling HIV-1 Infection

OBJECTIVES The aim of this study was to develop a small interfering RNA (siRNA) against the expression of KIR3DL1 receptor on natural killer (NK) cells, in order to promote the ability of NK cells to destroy human immunodeficiency virus (HIV)-infected cells and thus prevent failure of siRNA therapy targeting human immunodeficiency virus type 1 (HIV-1) virus among HIV-1 infected patients in vitro. METHODS A siRNA targeting KIR3DL1 was synthesized and then modified with cholesterol, methylene, and sulfate. The inhibitory action of the siRNAs on primary cultured NK cells was detected. The amount of IFN-γ and TNF-α secretions in NK cells was measured. The intended functions of NK cells in vitro were analyzed by CFSE and PI methods. RESULTS There were no significant differences in inhibiting the expression of KIR3DL1 on NK cells between the modified and unmodified siRNAs, while inhibition by each of them differed significantly from controls. The amount of IFN-γ and TNF-α secretions in the NK cells was abundant due to unsuccessful expression of KIR3DL1 on NK cells, which further promoted function of the NK cells. CONCLUSION The siRNA against KIR3DL1 could enhance the ability of the NK cells to kill the HIV-1 infected cells in vitro and successfully prevented the failure of siRNA therapy targeting the HIV-1 virus. Therefore, it can act as a potential gene therapeutic agent among HIV-1 infected people.

Emergence of peripheral CD3+CD56+ cytokine-induced killer cell in HIV-1-infected Chinese children

Cytokine-induced killer (CIK) cells are immune effector cells characterized by co-expression of CD3 and CD56 molecules. We examined the quantities of CIK cells and the changes of these cell expressing NK cell receptors in HIV-1-positive children infected via mother-to-child transmission. The percentage of CIK cells was quantified and the changes in the surface cell receptor profiles in 18 HIV-1-infected children were examined. We found that CIK cell percentages were dramatically increased in HIV-1-infected children. Furthermore, the expressions of CD16, NKp30, NKp44, NKp46, NKp80 and CD244 on CIK cells were decreased, while the expressions of KIR3DL1 and NKG2D on CIK cells were increased in HIV-1-infected children. However, the expressions of KIR2D and NTB-A on CIK cells did not change in the HIV-1-infected children. CIK cells possessed the characteristics of promoting the maturation of dendritic cells and killing functions in HIV-1-infected children. Moreover, serum concentrations of IL-4 and IFN-γ were significantly increased in HIV-1-infected children compared with the HIV-negative controls. These changes likely occurred as a protective mechanism against transmission of maternal HIV-1 virus and thereby helped to limit viral spread, eliminate infected cells and help HIV-1-infected patients to slow the progression to AIDS.

Low prevalence of the transmitted HIV-1 drug resistance among newly diagnosed HIV-1 individuals in Jiangsu Province, China during 2009-2011.

BackgroundPrevalence of The transmitted HIV drug resistance (THDR) has been reported in many countries. In China, the low level THDR was found in only a few provinces. To know the transmitted HIV drug resistance in east of China, we investigated THDR during 2009–2011 in Jiangsu province of China.MethodsBetween January and August of 2009, 2010, and 2011, we consecutively collected 50, 54, 53 blood specimens respectively from qualified individuals at surveillance sentinel sites in Jiangsu province according to protocol of HIV Drug Resistance Threshold Survey (HIVDR-TS) recommended by WHO. The region of pol gene including protease and partial retro-transcriptase was amplified, sequenced and edited. Then the sequences were submitted to HIV drug resistance database to analysis transmitted HIV drug resistance mutations using Calibrated Population Resistance tool. The reference sequences of different HIV-1 subtypes were downloaded from HIV database and Genebank. The phylogenetic trees were inferred using the neighbor-joining method.ResultsOur results show that THDR has been at low level from 2009 to 2011, only K101E and V179D mutation was detected which did not belong to the major HIV-1 drug resistance mutations. Phylogenetic analysis showed that CRF01_AE is the predominant subtype, and followed by CRF07_BC and B subtype. Subtype B consists of the two distinct clusters.ConclusionsThe low level of THDR suggests that anti-retroviral treatment was implemented more effectively and THDR surveillance should be conducted two years later in Jiangsu province of China. CRF01_AE has become the predominant subtype and dual infection of HIV may be common in Jiangsu province.

Trends in late HIV diagnosis among men who have sex with men in Jiangsu province, China: Results from four consecutive community-based surveys, 2011-2014

Objectives To examine trends in HIV testing, late HIV diagnosis and associated factors among men who have sex with men (MSM) in Jiangsu province, China. Methods Four consecutive community-based cross-sectional surveys were conducted among MSM from 2011 to 2014 in eight cities in the province. Participants were recruited from MSM venues and via the internet. HIV bio-behavioral surveys were conducted to collect demographic and behavioral data and measure HIV infection. HIV-infected participants with CD4 counts less than 350 cells/uL were defined as having a late HIV diagnosis. Chi-square trend tests were used to compare temporal changes over the years and multivariable logistic regression analyses were used to identify factors associated with late diagnosis. Results A total of 2,441, 2,677, 2,591 and 2,610 participants were enrolled in 2011, 2012, 2013 and 2014, respectively. Testing for HIV in the last 12 months decreased over the time period, from 59.9% to 52.5% (p<0.001). Late HIV diagnosis remained high and steady, ranging from 33.3% to 44.2% over the years with no significant change over time (p = 0.418). MSM who were older than 24 years (aOR = 1.748, p = 0.020 for 25–39 years old; aOR = 3.148, p<0.001 for 40 years old or older), were recruited via internet (aOR = 1.596, p = 0.024), and did not have an HIV test in the past 12 months (aOR = 3.385, p<0.001) were more likely to be late diagnosed. Conclusions Our study showed a plateau in HIV testing among MSM in China, in parallel to high levels of late diagnosis. Emerging and innovative strategies such as HIV self-testing and reaching more MSM by internet, both highly acceptable to MSM in China, may reduce late diagnosis.

Immunologic treatment failure among HIV-infected adult patients in Jiangsu province, China

The National Free Antiretroviral Treatment Program was implemented in Jiangsu Province, China in 2005. We conducted a retrospective, open cohort study to determine treatment failure rates and associated risk factors. Data were obtained from the national web-based antiretroviral treatment database. WHO criteria were used to define immunologic treatment failure. Kaplan-Meier methods were used to determine treatment failure rates and Cox proportional hazards modeling was used to identify risk factors. A total of 5,083 (87.8%) having at least one CD4 cell count measure were included from 2005 to 2013. Overall, 30.4% had immunologic treatment failure with cumulative treatment failure rates increasing to 50.5% at month 60 and 64.1% at month 90. Factors predicting treatment failure included being treated in the Centers for Disease Control and Prevention system (HR 1.69, 95% CI 1.14–2.50, p = 0.009) or jail hospital (HR 1.20, 95% CI 1.08–1.34, p = 0.001), and having a baseline CD4 count >350 cells/uL (HR 2.37, 95% CI 1.94–2.89. p < 0.001). Immunologic treatment failure was moderate to substantial among treated HIV patients. Providing second-line regimens and shifting treatment providers to professional hospitals should be considered to consolidate gains in averting morbidity and mortality.