Rapidly Spreading Human Immunodeficiency Virus Epidemic Among Older Males and Associated Factors: A Large-scale Prospective Cohort Study in Rural Southwest China

Chen, Huanhuan; Wu, Xinghua; Chen, Li; Lu, Huaxiang; Tang, Zhenzhu; Shen, Zhiyong; Pan, Stephen W.; Ruan, Yuhua; Shao, Yiming

doi:10.1097/olq.0000000000000957

Cited by 27 publications

(27 citation statements)

References 23 publications

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“…This study found that younger people were more likely to be infected through NMNCHC, while older people were more likely to be infected through CHC. People over 50 years old are still sexually active, and they may seek sex with FSWs or casual partners, especially those who do not have spouses or stable sexual partners (17,18). The aphrodisiac usage promoted this behavior and enhanced the risk (19).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Commercial or Non-Commercial Contact in Non-Marital Heterosexual Transmission from Chinese HIV/AIDS Case Reporting System in 2018: A Cross-Sectional Study

Dong¹,

Ma²,

Cai³

et al. 2020

Preprint

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Background: In recent years, HIV transmission through heterosexual contact has been on the rise, accounting for more than 69% in 2017{Cui, 2020 #27}. Therefore, an in-depth understanding of the characteristics of heterosexual transmission will greatly improve our effectiveness in preventing AIDS.Methods: All identified People Living With HIV/AIDS (PLWHAs) reported as transmitted through heterosexual transmission in the Chinese HIV/AIDS Case Reporting System (CRS) in 2018 were included in this study. A multivariate logistic regression model was applied to evaluate the relationship between socio-demographic characteristics and the overall risk of being transmitted through commercial heterosexual contact (CHC) or non-marital non-commercial heterosexual contact (NMNCHC).Results: A total of 92026 cases of non-marital heterosexual transmission with no missing data were included in the analysis. There were 40244 (43.73%) cases infected through CHC and 51782 (56.27%) infected through NMNCHC. One year increase in age was associated with 0.98 times the odds of being reported as infected through NMNCHC (aOR = 0.98, 95% CI = 0.9783-0.9806, p < 0.0001), signiﬁcantly higher odds of infection through NMNCHC was observed with females (aOR = 8.39, 95% CI = 8.03-8.77, p < 0.0001), non-farmers (OR =1.22, 95% CI = 1.18-1.26, p < 0.0001), minorities (aOR = 1.94, 95% CI = 1.86-2.02, p < 0.0001), those with education level of college and above (aOR = 1.49, 95% CI = 1.38-1.61, p < 0.0001), and migrants in the different city of the same province (aOR = 1.28, 95% CI = 1.21-1.34, p < 0.0001). Conclusions: Among heterosexual transmission, Younger people, ethnic minorities, migrants within province, as well as those with comparatively higher socioeconomic status were more likely to be transmitted through non-marital non-commercial heterosexual contact (NMNCHC). More interfere measures and targeted strategies should be made for the HIV transmission through this route.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Commercial or Non-Commercial Contact in Non-Marital Heterosexual Transmission from Chinese HIV/AIDS Case Reporting System in 2018: A Cross-Sectional Study

Dong¹,

Ma²,

Cai³

et al. 2020

Preprint

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“…Lower education and risk awareness levels among older PLWH may post challenges for effective implementation of HIV prevention and care. 5 Compared with younger adult cases, older PLWH in Chongqing were more likely to be divorced and had heterosexual transmission. These profiles of HIV epidemic in Chongqing reflect the epidemic across China.…”

Section: Discussionmentioning

confidence: 99%

“…3 A smaller but increasing share of older adult cases are attributable to new infections in later life. [4][5][6] Older PLWH may have different demographic and sociobehavioral profiles and clinical and immunological conditions, which affect outcomes of the disease. [7][8][9][10][11] Both patients and clinicians often underestimate the risk of HIV among older adults, and this low-risk perception may cause delays in HIV testing and diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…A prospective cohort study among rural residents in southwestern China found that HIV incidence was 2.7 per 10,000 person years in all participants, but 71.3 among a subpopulation of males 50-69 years of age who had less than secondary schooling and were divorced or widowed. 5 Another Chinese study found that older HIV-infected adults reported a lower level of wellbeing, higher level of depression, and poorer quality of life. 18 A qualitative study found that older males had prevalent unsafe sex, and both male and female older adults had low awareness of HIV risk.…”

Section: Introductionmentioning

confidence: 99%

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Higher Risks of Virologic Failure and All-Cause Deaths Among Older People Living with HIV in Chongqing, China

Wu¹,

Zhou²,

Zhang

et al. 2019

AIDS Research and Human Retroviruses

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Older people living with HIV (PLWH) may have delayed diagnosis and access to care and therefore have poorer disease outcomes. Little is known about HIV care and disease outcomes among older PLWH in China. This retrospective cohort study used data from all adult HIV/AIDS cases during 1988-2017 in Chongqing, China from two national databases. We compared demographic and behavioral profiles, HIV care, virologic suppression, and mortality between two age groups of 18-49 and ‡50 years. Multivariate logistic and cox regression analyses were used to calculate adjusted odds ratio (AOR) and adjusted hazard ratio (AHR) among older versus younger PLWH. Of 46,580 adult HIV/AIDS cases, 76.1% were men and 38.2% were 50 years of age or older. The proportion of older cases in men increased from 2.4% in 2002 to 51.8% in 2017, and in women from 3.3% to 57.9%. Older PLWH had a lower CD4 count than their younger counterparts at HIV diagnosis (median 323 vs. 391 cells/lL; p < .001). The average time from HIV diagnosis to initiation of antiretroviral therapy (ART) were 6.3 months among older and 12.8 months among younger PLWH ( p < .001). Nearly one tenth (9.6%) had virologic failure within 12 months of ART initiation, and the odds of virologic failure among older PLWH was 80% higher [AOR 1.8; 95% confidence interval (CI), 1.1-3.0] than among younger ones after controlling for calendar year of initiating ART and other covariates. The mortality rate within 12 months of initiating ART was 9.8 deaths per 100 person years, and the risk of mortality among older PLWH was three times among younger ones (AHR, 3.1; 95% CI, 2.1-4.6). Older people represented an increasing proportion of new HIV/AIDS cases and were more likely to have virologic failure and mortality within 12 months of ART initiation.

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“…From 1978, as commercial sex activity increased across the country [6], the proportion of newly reported HIV infections/acquired immune de ciency syndrome (AIDS) patients through heterosexual transmission increased dramatically. Nowadays, CRF07_BC and CRF08_BC have become the most epidemic strains in China [7,8] and drug-driven epidemic has been shifting to sexually transmission-driven epidemic [9]. There were other B/C CRFs reported in the last few years, such as CRF57_BC (identi ed in Baoshan, Western Yunnan) [10], CRF62_BC and CRF64_BC (identi ed in Ruili/Dehong, Western Yunnan) [11].…”

Section: Introductionmentioning

confidence: 99%

The origin and spread of CRF85_BC, driven by heterosexual transmission among older people in Sichuan, China

Feng

Liang

et al. 2020

Preprint

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Background: CRF_BC recombinants, including CRF07_BC and CRF08_BC, were considered the predominant subtypes in China. Since the discovery of HIV-1 circulating recombinant form CRF 85_BC in Southwest China in 2016, this BC recombinant forms had been reported in different regions of China. However, the history and magnitude of CRF85_BC transmission were still to be investigated. Method: We conducted the most recent molecular epidemiology of HIV-1 among newly reported HIV-1 infected patients in Sichuan in 2019 by sequencing and phylogenetic analysis of 1291 pol sequences. Then, we used maximum likelihood approach and the Bayesian Markov chain Monte Carlo (MCMC) sampling of pol sequences to reconstruct the phylogeographic and demographic dynamics of the CRF85_BC.Results: HIV-1 CRF85_BC (68/1291, 5.27%) became the fourth most prevalent strain revealing a significant increase in local population. CRF85_BC were only found in heterosexually infected individuals and the majority of CRF85_BC (95.45%) were circulating among the people living with HIV aged 50 years and over (PLHIV50+), suggesting a unique prevalent pattern. The founder lineages of CRF85_BC were likely to have first emerged in Yunnan, a province of Southwest China bordering Sichuan, in the early 2000s. It then spread exponentially to various places (including Guangxi, Sichuan, et al) and became endemic around 2008.6 (2006.7-2010.2) in Sichuan. Conclusion: Taken together, our ﬁndings on HIV-1 subtype CRF85_BC infections provided new insights into the spread of this virus and extended the understanding of the HIV epidemic in China.

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Rapidly Spreading Human Immunodeficiency Virus Epidemic Among Older Males and Associated Factors: A Large-scale Prospective Cohort Study in Rural Southwest China

Abstract: Supplemental digital content is available in the text.Human immunodeficiency virus incidence was associated with males, older age, less than secondary schooling and not currently being married.

Cited by 27 publications

References 23 publications

Factors Associated with Commercial or Non-Commercial Contact in Non-Marital Heterosexual Transmission from Chinese HIV/AIDS Case Reporting System in 2018: A Cross-Sectional Study

Factors Associated with Commercial or Non-Commercial Contact in Non-Marital Heterosexual Transmission from Chinese HIV/AIDS Case Reporting System in 2018: A Cross-Sectional Study

Higher Risks of Virologic Failure and All-Cause Deaths Among Older People Living with HIV in Chongqing, China

The origin and spread of CRF85_BC, driven by heterosexual transmission among older people in Sichuan, China

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