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Teeter L.D.,Houston Methodist Research Institute | Ha N.P.,Houston Methodist Research Institute | Ma X.,Houston Methodist Research Institute | Wenger J.,Center for Infectious Diseases | And 3 more authors.
Tuberculosis | Year: 2013

Tuberculosis genotypic clustering is used as a proxy for recent transmission. The association between clustering and recent transmission becomes problematic when the genotyping method lacks specificity in defining a cluster, as well as for clusters with extensive jurisdictional histories and/or common genotypes. We investigated the four largest spoligotype/12 loci MIRU-VNTR-defined clusters in Harris County, Texas from 2006-2012 to determine their historical contribution to tuberculosis morbidity, estimate the contributions from recent and remote transmission, and determine the impact of secondary genotyping on cluster definition. The clusters contained 189, 64, 51 and 38 cases. Each cluster was linked to cluster(s) previously identified by Houston Tuberculosis Initiative; 3 since 1995 and the fourth in 2002. Among cases for which timing of Mycobacterium tuberculosis transmission relative to tuberculosis disease could be ascertained, nearly equal proportions were associated with recent and remote transmission. The extent to which genotyping with an additional 12 MIRU-VNTR loci modified the cluster definition varied from little or no impact for the two smaller clusters to moderate impact for the larger clusters. Tuberculosis control measures to reduce morbidity associated with large clusters must involve strategies to identify and treat individuals who recently acquired infection, as well as persons infected for years. © 2013 Elsevier Ltd.

Zou H.,National Center for Control and Prevention | Wu Z.,National Center for Control and Prevention | Yu J.,Beijing Xicheng District Center for Disease Control and Prevention | Li M.,Beijing Xicheng District Center for Disease Control and Prevention | And 4 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2010

Objectives: To assess HIV and syphilis infections among men who have sex with men who use the internet (MSMUI) and their risk behaviors. Methods: In 2007, 429 MSMUI were recruited via the internet in Beijing and Urumqi, China. A questionnaire was administered, and a blood specimen was collected and tested for HIV and syphilis. Results: Median age of participants was 25 years. Median number of lifetime sexual partners was 10. 90.7% ever had sex with a cyber friend. Rates of condom use in the last oral, insertive, and receptive anal sex were 9.1%, 66.3%, and 60.4%, respectively. Infection rates of HIV, syphilis, and HIV/syphilis coinfection were 4.8%, 11.4%, and 1.7%, respectively. Factors associated with HIV infection were being ≤24 years [odds ratio (OR) = 2.85, 95% confidence interval (CI): 1.05 to 7.75], syphilis positive (OR = 4.78, 95% CI: 1.68 to 13.58), used non-water-based liquid as lubricant (OR = 8.03, 95% CI: 1.03 to 62.52), and having bleeding gums or oral ulcers during condom-free oral sex (OR = 3.17, 95% CI: 1.13 to 8.88). Conclusions: MSMUI engage in high-risk sexual behaviors and have a high prevalence of HIV and syphilis infections. The internet is the predominant venue for the majority of MSMUI to find sexual partners. It is urgent to implement effective intervention programs targeting this group. Copyright © 2010 by Lippincott Williams & Wilkins.

Liu H.W.,Center for Control and Prevention
Zhonghua shi yan he lin chuang bing du xue za zhi = Zhonghua shiyan he linchuang bingduxue zazhi = Chinese journal of experimental and clinical virology | Year: 2011

To characterize the Gag-Specific T lymphocyte responses and identify immunodominant region recognized in Chinese HIV-1 recombinant subtype B/C infectors. 10 antiretroviral treatment (ART) naive HIV-1 recombinant subtype B/C infectors with infected time in 1 year, 25 ART-naive infectors with infected time > 3 years and 10 HIV-1-seronegative healthy individuals were enrolled. HIV-1-specific T lymphocyte responses were analyzed by an IFN-gamma Elispot assay against 123 overlapping peptides spanning HIV-1 Gag protein in the present study. Gag-specific T lymphocyte responses of interferon-gamma secretion were identified in 8(8/10) Chinese HIV-1 recombinant subtype B/ C infectors with infected time in 1 year, the specific T lymphocytes are mainly targeted at five seperated peptides. Responses were identified in 17(68%) infectors with infected time more than 3 years, the specific T lymphocytes are mainly targeted at one peptide in p17 and six in p24. There was obviously positive correlation (P = 0.0318, r = 0.519) between the magnitude of responses and viremia in infectors infected time > 3 years. The magnitude of response in infectors infected in 1 year was significantly higher than group infected time > 3 years (P = 0.021). None of healthy individuals produced positive responses. HIV-1 recombinant subtype B/C Infectors at different stages of diseases recognize different region of gag.

Chen M.,Center for Control and Prevention | Yang L.,Center for Control and Prevention | Ma Y.,Center for Control and Prevention | Su Y.,Center for Control and Prevention | And 9 more authors.
PLoS ONE | Year: 2013

Background: Yunnan has the longest endured Human Immunodeficiency Virus-1 (HIV-1) epidemic in China, and the genetic diversity of HIV-1 constitutes an essential characteristic of molecular epidemiology in this region. To obtain a more comprehensive picture of the dynamic changes in Yunnan's HIV-1 epidemic, a cross-sectional molecular epidemiological investigation was carried out among recently infected individuals. Methodology/Principal Findings: We sequenced partial gag (HXB2:781-1861) and env (HXB2:7002-7541) genes from 308 plasma samples of recently infected patients. With phylogenetic analysis, 130 specimens generated interpretable genotyping data. We found that the circulating genotypes included: CRF08_BC (40.8%), unique recombinant forms (URFs, 27.7%), CRF01_AE (18.5%), CRF07_BC (9.2%), subtype B (2.3%) and C (1.5%). CRF08_BC was the most common genotype, and was predominant in both intravenous drug users (IDUs) and heterosexually transmitted populations. CRF08_BC and CRF07_BC still predominated in eastern Yunnan, but CRF08_BC showed increasing prevalence in western Yunnan. Strikingly, the URFs raised dramatically in most regions of Yunnan. Seven different types of URFs were detected from 12 prefectures, suggesting that complicated and frequent recombination is a salient feature of Yunnan's HIV-1 epidemic. Among URFs, two BC clusters with distinctive recombination patterns might be potential new CRF_BCs. CRF01_AE was no longer confined to the prefectures bordering Myanmar, and had spread to the eastern part of Yunnan, especially the capital city of Kunming, with a large number of infections in the transient population. The ratios of the main genotypes showed no statistical differences between infected IDUs and heterosexually transmitted infections. Conclusions/Significance: The changing patterns of the dominant HIV-1 genotypes in Yunnan indicate the complex evolving dynamic nature of the epidemic. Understanding new trends in molecular epidemiology of HIV-1 infection is critical for adjusting current prevention strategies and vaccine development in Yunnan. © 2013 Chen et al.

Zou H.,National Center for Control and Prevention | Zou H.,University of Melbourne | Wu Z.,National Center for Control and Prevention | Yu J.,U.S. Center for Disease Control and Prevention | And 4 more authors.
PLoS ONE | Year: 2013

Objective: To explore the feasibility of using Internet outreach to encourage men who have sex with men (MSM) to get tested for HIV at voluntary counseling and testing (VCT) clinics in Beijing and Urumqi, China. Methods: From June to August 2007, two volunteers contacted MSM using instant messaging, online chat rooms, mobile phone, and e-mail (active recruitment). Banners with study information were put at the front pages of three major Chinese gay websites (passive recruitment). Those contacted were offered a modest financial incentive to seek HIV testing at existing VCT clinics. Those who subsequently sought HIV testing services at VCT clinics and provided informed consent completed a questionnaire and a blood draw to test for HIV and syphilis. Results: A total of 3,332 MSM were contacted and 429 attended VCT clinics. One out of every 4 men that were recruited through instant messaging actually went for HIV testing, while the recruitment yields for online gay chat rooms, mobile phone contact, and email were 1:6, 1:10, and 1:140, respectively. The majority of participants (80%, 317/399) reported being motivated to seek HIV testing out of concern for their health, and only 3% (11/399) reported being motivated by the financial incentive. Active recruitment tend to recruit MSM who are younger (X2 = 11.400, P = 0.001), never tested for HIV (X2 = 4.281, P = 0.039), tested less often (X2 = 5.638, P = 0.018). Conclusion: Internet outreach is a promising way to encourage MSM to seek HIV testing at existing VCT clinics. Active recruitment can target MSM who are younger, never tested for HIV and tested less often. © 2013 Zou et al.

Yuan Y.,Center for Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2011

To understand the prevalence of HIV-1 drug resistance and its main factors in AIDS patients receiving to HAART in Zhecheng county, Henan province. By cross-sectional survey, 378 AIDS patients who had received the national free antiretroviral therapy from July 2003 to March 2009 in Zhecheng county of Henan were selected. All recruits were interviewed and blood samples were collected. HIV-1 viral loads were measured by real-time polymerase chain reaction, HIV genotypic resistance was determined by an in-house polymerase chain reaction to amplify the HIV-1 pol gene region. Among 378 subjects receiving antiretroviral therapy, the prevalence of successful viral suppression was 42.9% (162/378), and HIV-1 drug resistance was detected in 47.1% (178/378) patients. The rate of resistance-associated mutations to non-nucleotide reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) was 46.6% (176/378), 37.8% (143/378) and 1.9% (7/378), respectively. Multivariate logistic regression analysis showed that the main risk factors associated with the prevalence of drug resistance included drug non-adherence (ratio of on-time drug intake in the past month < 90%:≥ 90% = 64.5% (40/62):43.7% (138/316), OR = 2.3, 95%CI: 1.3 - 4.1), and initiation of anti-retroviral therapy (ART) with didanosine (DDI) (ART with DDI:ART with lamivudine (3TC) = 53.3% (137/257):33.9% (41/121), OR = 2.3, 95%CI = 1.1 - 4.5). The prevalence of HIV-1 drug resistance among ART patients in Zhecheng county of Henan was high. Drug non-adherence and initiation of ART with DDI were the main factors of drug resistance.

Prussing C.,Johns Hopkins University | Castillo-Salgado C.,Johns Hopkins University | Baruch N.,Center for Control and Prevention | Cronin W.A.,Center for Control and Prevention
Public Health Reports | Year: 2013

Objectives. Tuberculosis (TB) disproportionately affects members of socioeco-nomically disadvantaged and minority populations in the U.S. We describe the geospatial distribution of TB cases in Maryland, identify areas at high risk for TB, and compare the geospatial clustering of cases with genotype clustering and demographic, socioeconomic, and TB risk-factor information. Methods. Addresses of culture-positive, genotyped TB cases reported to the Maryland Department of Health and Mental Hygiene from January 1, 2004, to December 31, 2010, were geocoded and aggregated to census tracts. Geospatial clusters with higher-than-expected case numbers were identified using Poisson spatial cluster analysis. Case distribution and geospatial clustering information were compared with (1) genotype clustering (spoligotypes and 12-locus MIRU-VNTR), (2) individual-level risk and demographic data, and (3) census tract-level demographic and socioeconomic data. Results. We genotoyped 1,384 (98%) isolates from 1,409 culture-positive TB cases. Two geospatial clusters were found: one in Baltimore City and one in Montgomery and Prince George's counties. Cases in these geospatial clusters were equally or less likely to share genotypes than cases outside the geospatial clusters. The two geospatial clusters had poverty and crowding in common but differed significantly by risk populations and behaviors. Conclusions. Genotyping results indicated that recent transmission did not explain most geospatial clustering, suggesting that geospatial clustering is largely mitigated by social determinants. Analyses combining geospatial, genotyping, and epidemiologic data can help characterize populations most at risk for TB and inform the design of targeted interventions. © 2013 Association of Schools and Programs of Public Health.

Cui W.G.,Center for Control and Prevention
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi | Year: 2013

To understand the prevalence of drug resistance in AIDS patients who had been receiving HAART in a long run, in Shenqiu county, Henan province. This cross-sectional study included 120 HIV infected patients who began receiving ART (antiretroviral therapy) in 2003. Viral loads and CD(4)(+) T cells counts were measured, and In-house drug resistance test was performed in VL > 1000 copies/ml patients. 114 cases out of 120 patients had complete viral load data. Among them, 33 cases having viral loads less than 50 copies/ml, and the remaining viral loads showed an average of lg (4.09 ± 1.10) copies/ml. The average of CD(4)(+) T cell counts was (377 ± 218) cells/ml, with 64 (53.3%) cases showing their CD(4)(+) T cell counts higher than 350 cells/ml. In 67 patients, 58 of them showed genotypic resistance, and 40 cases showed reverse transcriptase inhibitors (RTIs) resistance. The ratios of nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) resistance were 53.4% (31/58) and 67.2% (39/58), respectively. There were no differences of drug resistance ratio in the three treatment programs. The highest drug resistance rates in NRTIs and NNRTIs were zidovudine, lamivudine, nevirapine. However, protease inhibitors (PIs) resistance variants were not found. The prevalence of drug-resistant strains seemed to be high in Shenqiu country, Henan province. Long-term follow-up monitoring strategy should be developed to optimize the timely treatment programs.

PubMed | Center for Control and Prevention
Type: Journal Article | Journal: Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi | Year: 2016

AIDS has gradually changed from a fatal disease to a manageable chronic disease since the advent of antiretroviral drugs. In 2003, China initiated a national free antiretroviral treatment program for people living with HIV/AIDS, several death evaluation indicators have been used to evaluate public health effect of the program. Death evaluation indicators used frequently in domestic and overseas include mortality, case fatality rate, excess mortality, standard mortality ratio, years of potential life lost, disability-adjusted life year and life expectancy. This paper summarizes the different death indicators applied in effectiveness evaluation of HIV/AIDS prevention and treatment, elaborates the application range and significance of these indicators and suggests the research in related life expectancy and burden of disease which have not been conducted in China.

PubMed | Center for Control and Prevention
Type: Journal Article | Journal: Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi | Year: 2016

To understand the misreporting rate regarding the routes of transmission among the reported HIV patients in Yili prefecture of Xinjiang, since 2011.An investigation focusing on the route of transmission among people living with HIV/AIDS was carried out to clarify the responsible reasons for the situation.The overall incorrect reporting rate on the route of transmission was 10.8%.The proportion of heterosexual transmission route was over estimated by 63.8% to 72.0%. However, the proportion of injecting drug was underestimated by 27.5% to 22.2%. The number of cases being confirmed as through heterosexual transmission but incorrectly reported was quite high, contributing 82.6% of all the incorrectly reported cases. Most of the patients that incorrect reported, were moved from injecting drug use to heterosexual transmission, which contributed 79.5% of all the total incorrectly reported cases. Results from multi-factor analysis showed that the risk related to incorrect reporting was 3.64 times in males than in females. People who anticipated to receive HIV testing were 2.23 times more than those who had not. Old-age groups were 3.511, 4.053, 4.415 and 6.524 times higher than those people who were aged below 16 years.The proportion of heterosexual transmission route was over- estimated while the proportion on injecting drug use was underestimated. However, the transmission pattern had changed from injecting drug use at the early epidemic stage, to current sexual transmission mode. We recommended that more attentions should be paid to patients who were males, at older age or those who had no expectation in receiving the HIV testing, during the initial following-up stage.

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