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Chu C.E.,University of California at San Francisco | Wu F.,Sun Yat Sen University | He X.,Guangzhou Eighth Peoples Hospital | Ma Q.,UNC Project China | And 5 more authors.
AIDS Research and Human Retroviruses | Year: 2015

Our objective was to explore the social meaning of HIV and perceptions of an HIV cure among people who inject drugs (PWID) in Guangzhou, China, which speaks to ethical and resource challenges to development in this field. We conducted a qualitative research study using in-depth interviews. We analyzed interview transcripts from 29 PWID, eight physicians, and three social workers from an outpatient HIV clinic and two methadone maintenance treatment centers. The social meaning of HIV infection and perceptions of an HIV cure reflected patients' relationships with society, health systems, and physicians. First, HIV infection decreased perceived social worth and disrupted peer relationships. The possibility of being cured renewed patient hope for regaining physical well-being and achieving social mobility. However, the existence of a cure may not alter the HIV-related stigma due to its association with stigmatized behaviors and marginalized groups. Second, although stigma was a significant barrier to engagement in health care, hope for a cure may outweigh fears of stigma and enhance linkage to HIV testing and treatment as well as methadone services. A cure may exacerbate perceived health disparities if inaccessible to key affected populations such as PWID. The social implications of an HIV cure among this key affected population may inform the design and implementation of cure clinical trials. Careful management of patient expectations, focusing research on key affected populations, expanding HIV testing and treatment systems, improving access to harm reduction programs, and ensuring post-trial access are important considerations for HIV cure research. © Mary Ann Liebert, Inc. 2015.


PubMed | Guangzhou Eighth Peoples Hospital, UNC Project China, Sun Yat Sen University and University of North Carolina at Chapel Hill
Type: Journal Article | Journal: Asian Pacific journal of tropical disease | Year: 2016

There are over 100 clinical trials worldwide focused on developing an HIV cure. Research participants will assume substantial individual risks while receiving little or no individual benefit. Physicians will have important dual roles of leading HIV cure research studies and guiding patient expectations. Many low and middle-income nations have started HIV cure trials, including China. The goal of this study was to better understand physician attitudes, behaviors, and perceptions of HIV cure research within the context of China. We conducted a quantitative and qualitative evidence review of published literature on physician perceptions of HIV cure in China. Quantitative survey data revealed that physicians rarely believed HIV was curable, but this perception may be more common compared to other countries. Qualitative data showed that inconsistent terminology used among physicians may contribute to the perception of HIV as curable. The belief that HIV is curable among some physicians in China may be related to the influence of traditional Chinese medicine beliefs. Rather than seeking elimination of pathogens, traditional Chinese medicine aims to achieve harmony between organs and a vital life force. In this context, HIV infection can be seen as a temporary state of imbalance rather than an irreversible change. There is a wide range of physician perceptions about HIV cure in China. Conflicting information about HIV cure from physicians and other sources could thwart the progress of HIV cure research. Enhancing patient-physician communication about ongoing HIV cure research trials will be important for developing an HIV cure.


Li S.,Sun Yat Sen University | Jian F.-B.,Guangzhou Eighth Peoples Hospital | Zhan J.,Sun Yat Sen University | Zou B.-Y.,Sun Yat Sen University | Liao H.,Sun Yat Sen University
Journal of Chromatographic Science | Year: 2014

Photocyanine, a novel amphoteric phthalocyanine drug, showed favorable anticancer activity in vivo. Pharmacokinetic study in cancer patients is an important component in dose administration choice. In this study, a rapid, sensitive analytical method based on high-performance liquid chromatography with ultraviolet detection was developed and validated for the determination of four isomers of photocyanine (FD1-4) in cancer patients. Sample preparation involved liquid-liquid extraction with a combination of ultrasound and N,N-dimethyl formamide. Calibration curves (1/x2) offered satisfactory linearity for the four isomers of photocyanine. The lower limit of quantification (LLOQ) for FD1-3 isomers was 30 ng/mL, and LLOQ for FD-4 was 5 ng/mL. Inter-and intra-day accuracies for four isomers ranged from 96.6 to 105.5%, and 95.0 to 103.6%, respectively. Inter-and intra-day precision ranged from 4.8 to 8.9%, and 3.6 to 12.2%, respectively. Stability studies showed that photocyanine was stable. This method was successfully used to quantify photocyanine in a pharmacokinetic study in which a single-dose of photocyanine (0.1 μg/kg) was intravenously administered to patients with cancer. On the basis of the discovery that photocyanine has a half-life of 57.5 h in vivo, we suggest that avoiding light for a longer period is essential for patients undergoing photocyanine therapy. © The Author [2013].


Deng J.-J.,Guangzhou Eighth Peoples Hospital
World Chinese Journal of Digestology | Year: 2010

AIM: To explore the mechanism by which acupuncture promotes intestinal motility. METHODS: Thirty Sprague-Dawley rats were randomly divided into blank group, model group (receiving colocolic anastomosis) and acupuncture group. The acupuncture group underwent acupuncture at Zusanli, Sanyinjiao and Taichong daily for three continuous days. After acupuncture treatment, defecation was observed and intestinal propulsive rate was measured. Tissue samples of the colon which was 2 cm below the caecum were taken to observe the ultrastructure of interstitial cells of Cajal (ICC) and the Ache-ICC-SMC network. RESULTS: In the acupuncture group, the time to first postoperative passage of feces was shortened and intestinal propulsive rate was improved compared with the model group [(2.00 ± 0.47) d vs (2.50 ± 0.53) d, (66.30 ± 4.21)% vs (46.33 ± 5.56)% , both P < 0.05]. Compared with the blank group, the damage of ICC ultrastructure in the model group was more significant while that in the acupuncture group was milder. In the model group, the ENS-ICC-SMC structure was disorganized, and the number of ICC and their fluorescence intensity were greatly decreased compared with the blank group [(18.67 ± 6.11) vs (32.33 ± 5.51), (35.00 ± 9.54) vs (58.67 ± 10.21), both P < 0.05]. In contrast, in the acupuncture group, the damage of the network structure was milder, and the number of ICC and their fluorescence intensity were increased compared with the model group [(30.33 ± 3.21) vs (18.67 ± 6.11), (56.67 ± 9.45) vs (35.00 ± 9.54), both P < 0.05]. Similar results were also obtained for the number of VAChT-positive nerve fibres [(18.67 ± 3.79) vs (20.67 ± 3.21), (20.33 ± 5.13) vs (34.67 ± 6.81), (23.00 ± 4.58) vs (18.67 ± 3.79), (36.00 ± 8.19) vs (20.33 ± 5.13), all P < 0.05]. CONCLUSION: Acupuncture can improve intestinal motility in rats after abdominal operation perhaps by improving the repair and regeneration of ICC.


PubMed | Guangzhou Eighth Peoples Hospital, Johns Hopkins University, University of Utah, World Health Organization and North University of China
Type: Review | Journal: Journal of the International AIDS Society | Year: 2016

Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking.We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings.Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, Our study evaluated adherence interventions based on qualitative data from PLHIV and health providers. The study underlines the importance of incorporating social and cultural factors into the design and implementation of interventions. Further qualitative research is needed to evaluate ART adherence interventions.


PubMed | Guangzhou Eighth Peoples Hospital, Guangzhou University, University of California at San Francisco, Sun Yat Sen University and University of North Carolina at Chapel Hill
Type: Journal Article | Journal: Open forum infectious diseases | Year: 2016

Background. Hepatitis C virus (HCV) treatment access among human immunodeficiency virus (HIV)/HCV-coinfected people who inject drugs is poor, despite a high burden of disease in this population. Understanding barriers and facilitators to HCV treatment uptake is critical to the implementation of new direct-acting antivirals. Methods. We conducted in-depth interviews with patients, physicians, and social workers at an HIV treatment facility and methadone maintenance treatment centers in Guangzhou, China to identify barriers and facilitators to HCV treatment. We included patients who were in various stages of HCV treatment and those who were not treated. We used standard qualitative methods and organized data into themes. Results. Interview data from 29 patients, 8 physicians, and 3 social workers were analyzed. Facilitators and barriers were organized according to a modified Consolidated Framework for Implementation Research schematic. Facilitators included patient trust in physicians, hope for a cure, peer networks, and social support. Barriers included ongoing drug use, low HCV disease knowledge, fragmented reimbursement systems, HIV exceptionalism, and stigma. Conclusions. Expanding existing harm reduction programs, HIV treatment programs, and social services may facilitate scale-up of direct-acting antivirals globally. Improving integration of ancillary social and mental health services within existing HIV care systems may facilitate HCV treatment access.


PubMed | Guangzhou Eighth Peoples Hospital, University of South Florida and University of North Carolina at Chapel Hill
Type: | Journal: BMC infectious diseases | Year: 2015

End-stage liver disease and hepatocellular carcinoma due to hepatitis C virus (HCV) co-infection are increasingly common causes of death among HIV-infected individuals. However, there are few clinical investigations of HIV/HCV co-infected individuals from low and middle-income nations. Here, we compare the epidemiology of HCV-infected and HIV/HCV co-infected individuals in Southern China and examine hepatic fibrosis scores in co-infected individuals.We conducted a retrospective cross-sectional study of treatment-nave HIV/HCV co-infected and HCV mono-infected subjects. Bivariate and multivariate models were used to examine the association between demographics and HCV genotype. Among co-infected individuals, we also studied the relationship between fibrosis scores derived from non-invasive studies and HCV genotype.Data were collected from 175 HCV-infected individuals, including 89 (51 %) HIV/HCV co-infected individuals. HIV/HCV co-infection was correlated with intravenous drug use (AOR 46.25, p<0.001) and not completing high school (AOR 17.39, p<0.001) in a multivariate model. HIV/HCV co-infected individuals were more likely to be infected with HCV genotype 6a (p<0.0001) or 3a (p<0.023), whereas increased fibrosis (FIB-4 score) was associated with HCV genotype 3a infection ( 2.18, p<0.001).Our results suggest that intravenous drug use is driving HIV/HCV co-infection in Southern China. While additional studies are needed, HCV genotype 6a is more common and genotype 3a appears to be associated with more severe hepatic fibrosis in co-infected individuals.Future HIV/HCV co-infection research in China should focus on at risk populations, HCV testing uptake, and genotype-specific treatment.


PubMed | Guangzhou Eighth Peoples Hospital, Sun Yat Sen University and Guangdong 999 Brain Hospital
Type: Journal Article | Journal: International journal of STD & AIDS | Year: 2015

Diagnosing asymptomatic neurosyphilis (ANS) in HIV-infected patients is difficult. A recent report suggested that CXCL13 is a promising diagnostic marker for neurosyphilis in HIV-positive patients. However, whether CXCL13 can be a diagnostic marker for ANS in HIV-infected patients remains unknown. The purpose of our study was to determine the role of CXCL13 in diagnosing ANS in HIV-infected patients. This study comprised two study and three control groups. Two study groups included 12 HIV-infected patients with ANS and 25 patients with syphilis and HIV co-infection (without ANS). Three control groups included 9 patients with ANS without HIV infection, 25 HIV-infected patients without syphilis and 10 healthy volunteers. Concentrations of CSF CXCL13 were measured before and after neurosyphilis therapy. Our results showed that CSF CXCL13 concentrations were significantly increased in all of the HIV-infected patients with ANS, the 25 HIV patients with syphilis and the 9 ANS patients without HIV, but not in the patients of the other two control groups. CSF CXCL13 concentrations declined in the two study groups of patients following neurosyphilis therapy. Therefore, CSF CXCL13 concentrations could improve the diagnosis of ANS in HIV-infected patients.


PubMed | Yunnan Care Center, Capital Medical University, Guangzhou Eighth Peoples Hospital, The 6th People Hospital of Zhengzhou and PLA Fourth Military Medical University
Type: | Journal: AIDS research and therapy | Year: 2015

Human leukocyte antigen (HLA)-B*5701 is strongly associated with developing a hypersensitivity reaction to abacavir (ABC). Limited data exist on HLA-B*5701 prevalence in HIV-1-infected subjects in China. We investigated HLA-B*5701 prevalence in HIV-1-infected population including Han and non-Han ethnic groups.A prospective multi-centre study was designed to determine status of HLA-B*5701 in HIV-1-infected adults at six sites across China. HLA-B*5701 was tested by the method of PCR-SSP.From six centers, 3,000 HIV-infected patients [2,452 (81.7%) Han, 548 (18.3%) Non-Han] were recruited with a mean age of 36.7years old. The overall HLA-B*5701 prevalence was 0.86% [95% confidence interval (CI) 0.55-1.26%]. The prevalence of HLA-B*5701 among Han subjects was similar to that among non-Han subjects, which was 0.88% (95% CI 0.54-1.34%) and 0.76% (95% CI 0.19-1.93%), respectively (p value=0.787). There were no differences in prevalence of HLA-B*5701 between subjects born in Henan, Yunnan, Shanxi, Guangdong, Hebei, Beijing and other provinces (p=0.999).HLA-B*5701 prevalence is very low in HIV-infected Chinese subjects, both in the Han and Non-Han nationalities. And there are no differences among different birthplaces across China.


PubMed | Guangzhou Eighth Peoples Hospital, Capital Medical University, Academy of Military Medical science and Peking Union Medical College
Type: | Journal: Antiviral research | Year: 2015

This study investigated whether treatment with IFN- and ribavirin (RBV) reduces 2LTR circular HIV DNA in addition to the total and integrated HIV DNA. Two groups of patients were enrolled. Group 1 comprised HIV/HCV co-infected patients who were treated with highly active antiretroviral therapy (HAART), IFN- and RBV for 48 weeks. After the 48 weeks of treatment, IFN- and RBV treatment was discontinued and HAART was continued. Group 2 comprised HIV-infected patients who were treated with HAART. Real-time polymerase chain reaction (RT-PCR) was used to quantify the levels of HIV-1 DNA. We found that compared with Group 2 patients, Group 1 patients exhibited an obvious decrease in the CD4 cell count and the total DNA, 2LTR circular DNA, and integrated HIV DNA after 48 weeks of treatment. After the discontinuation of IFN- and RBV treatment in Group 1 patients, the levels of HIV DNA recovered. Therefore, we concluded that treatment with IFN- and ribavirin (RBV) reduces 2LTR circular HIV DNA.

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