Publications (5)15.99 Total impact
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Article: Trends and predictors in methadone maintenance treatment dropout in Shanghai, China: 2005-2011.
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ABSTRACT: Abstract Background: The methadone maintenance treatment (MMT) program has been implemented in Shanghai since 2005. This study aims to portray the trend of MMT dropout and identify predictive factors that may influence dropout in Shanghai MMT clinics, which could assist in the intervention strategy development. Methods: A retrospective evaluation was used in the Shanghai component of the National MMT data management system between January 1, 2005 and December 31, 2011. Cox model for recurrence events was employed to estimate hazard ratio (HR) predicting dropout during the follow-up period. Results: Of all 6169 participants, 63% dropped out of the program at least once (ranging from 0 to 10 times), and 74% of them did not return by the end of this study. The average monthly incidence rate of dropout was 4.4% with a range from 0 to 9.3%. Adjusted analyses demonstrated that the individuals with methadone tapering didn't have a more probability of dropping out compared to those with stable dosage (HR=1.07, 95%CI: 0.90-1.27). However, there was a higher dropout rate among younger individuals (<30 years vs. ≥50 years old; HR=1.41, 95%CI: 1.16-1.71), among those who were less educated (HR=1.48, 95%CI: 1.17-1.87), among those who shared needles with others (HR=1.29, 95%CI: 1.06-1.58), among those whose urine tested positive for opiates (HR=1.69, 95%CI: 1.51-1.89), and among those who had a low average methadone dose at the initial stable stage of treatment (≤35mg/day vs. >65mg/day; HR=1.39, 95%CI: 1.19-1.63). Conclusions: Shanghai has been facing the challenge of keeping a high MMT retention rate. Methadone tapering after the stable treatment stage with sufficient dosage could be attempted to popularize in the MMT program, aside from considering comprehensive interventions among specific populations, such as the young, poorly educated, opiate-positive and needle sharing individuals.Current Medical Research and Opinion 04/2013; · 2.38 Impact Factor -
Article: Genetic diversity and drug resistance of human immunodeficiency virus type 1 (HIV-1) strains circulating in Shanghai.
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ABSTRACT: The HIV-1 epidemic in Shanghai is rapidly increasing. To better understand the HIV-1 genetic diversity and the mutations associated with resistance to protease inhibitors (PIs) and reverse transcriptase inhibitors (RTIs), 95 antiretroviral (ARV)-treated and treatment-naive HIV-1-seropositive individuals living in Shanghai were investigated. The HIV-1 pol gene in 70 of the 95 plasma samples was successfully amplified and analyzed. The result showed that CRF01_AE predominated in Shanghai with 42.9%, followed by subtype B (10%), B' (12.9%), CRF07_BC (11.4%), CRF08_BC (10%), CRF02_AG (4.3%), G (2.9%), and K (1.4%). In addition, three new intersubtype and/or inter-CRF recombinants were detected including B'/CRF01_AE (1.4%), U/G (1.4%), and U/CRF01_AE (1.4%). The mutations conferring primary and secondary resistance to PIs were detected in 3 of 70 (4.3%) patients and the mutations conferring resistance to RTIs were identified in 12 of 70 (17.2%) patients, among whom 11 of 15 (73.3%) and 1 of 55 (1.8%) were ARV-treated and treatment-naive individuals, respectively (p < 0.01). This study reveals the emergence of genetic diversity of HIV-1 currently circulating in Shanghai. HIV-1 infection by heterosexual contact is still a major route for introduction of HIV-1 variants into this city in recent years. It is believed that this information may help to guide recommendations for diagnostic assays, vaccine design, and antiretroviral regimen strategies in China.AIDS Research and Human Retroviruses 07/2007; 23(7):847-56. · 2.25 Impact Factor -
Article: Normal values for CD4 and CD8 lymphocyte subsets in healthy Chinese adults from Shanghai.
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ABSTRACT: The aim of this study was to establish reference ranges for lymphocyte subsets in Chinese adults. Venous blood specimens were obtained from 614 healthy, human immunodeficiency virus (HIV)-seronegative adults in Shanghai. Flow cytometry was used to determine percentages and absolute numbers of CD4 and CD8 T lymphocytes. Mean values for CD4 and CD8 lymphocytes were 727 and 540 cells/microl, respectively, yielding a CD4/CD8 ratio of 1.49. While CD8 lymphocyte values varied with age and gender, no significant differences in CD4 lymphocyte values were observed. Shanghai adults had approximately 100 fewer CD4 lymphocytes/microl on average than Caucasians, suggesting that lower CD4 lymphocyte cutoffs for classifying and monitoring HIV infection may be needed in China.Clinical and Diagnostic Laboratory Immunology 08/2004; 11(4):811-3. · 2.51 Impact Factor -
Article: Identification and distribution of HIV type 1 genetic diversity and protease inhibitor resistance-associated mutations in Shanghai, P. R. China.
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ABSTRACT: To investigate the genetic diversity of the HIV-1 circulating in Shanghai and to analyze the mutations in the protease (PR) gene associated with resistance to protease inhibitors (PIs). The genetic diversity of HIV-1 and PI resistance-associated mutations was studied in 40 Shanghai HIV-1-seropositive treatment-naive residents. The patients studied were exposed to the infection mainly through contaminated blood products (hemophiliacs) (n = 17) and sexual contacts (n = 19). Samples from 2 injecting drug users (IDUs) and 2 children born to HIV-1 infected mothers were also analyzed. HIV-1 partial gag, pol, and env genes in infected plasma samples were amplified by reverse transcriptase polymerase chain reaction, sequenced, and phylogenetically analyzed. Analysis of PI resistance-associated amino acid substitution in PR was performed. HIV-1 genes in 38 of the 40 plasma samples were successfully amplified and analyzed. Polymerase chain reaction amplification was successful for 16/17 hemophilia patients and 18/19 sexually infected individuals. While all the 16 hemophilia patients infected through contaminated blood products were infected with subtype B', the 18 patients infected through sexual contact were infected with several subtypes including subtype A (n = 2), B (n = 4), B' (n = 1), C (n = 2), CRF08_BC (n = 1), CRF01_AE (n = 7), and intersubtype recombinant CRF01_AE/B (n = 1). The 2 IDUs were infected with CRF08_BC and the 2 children born to HIV-1 infected mothers were infected with subtype B' and CRF01_AE. PI resistance-associated amino acid substitutions were found at 1 codon in primary and 7 codons in secondary regions of the PR gene. Amino acid substitutions were more frequently found in the B/B' sequences (69%) than in the non-B sequences (31%). Substitutions characteristic with the subtype B/B' sequences mainly among hemophiliacs included L63P (87%), A71V/T (27%), and V77I (93%) while those that characterized the non-B sequences mainly found among heterosexuals included M36I (69%) and K20R (19%). This study reveals the presence of multiple HIV-1 subtypes and recombinants infecting Shanghai residents. The broad HIV-1 diversity is being introduced into this city through heterosexual contacts. This study also reveals that viruses infecting these treatment-naive patients have acquired both primary or secondary mutations in their PR genes. These studies should provide the basis for further epidemiologic surveys of HIV-1 subtypes and set strategies for treatment intervention and vaccine programs.JAIDS Journal of Acquired Immune Deficiency Syndromes 10/2003; 34(1):91-101. · 4.43 Impact Factor -
Article: Identification and Distribution of HIV Type 1 Genetic Diversity and Protease Inhibitor Resistance-Associated Mutations in Shanghai, P. R. China
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ABSTRACT: Objective: To investigate the genetic diversity of the HIV-1 circulating in Shanghai and to analyze the mutations in the protease (PR) gene associated with resistance to protease inhibitors (PIs). Design: The genetic diversity of HIV-1 and PI resistance-associated mutations was studied in 40 Shanghai HIV-1-seropositive treatmentnaive residents. The patients studied were exposed to the infection mainly through contaminated blood products (hemophiliacs) (n = 17) and sexual contacts (n = 19). Samples from 2 injecting drug users (IDUs) and 2 children born to HIV-1 infected mothers were also analyzed. Methods: HIV-1 partial gag, pol, and env genes in infected plasma samples were amplified by reverse transcriptase polymerase chain reaction, sequenced, and phylogenetically analyzed. Analysis of PI resistance-associated amino acid substitution in PR was performed. Results: HIV - 1 genes in 38 of the 40 plasma samples were successfully amplified and analyzed. Polymerase chain reaction amplification was successful for 16/17 hemophilia patients and 18/19 sexually infected individuals. While all the 16 hemophilia patients infected through contaminated blood products were infected with subtype B′, the 18 patients infected through sexual contact were infected with several subtypes including subtype A (n = 2), B (n = 4), B′ (n = 1), C (n = 2), CRF08_BC (n = 1), CRF01_AE (n = 7), and intersubtype recombinant CRF01_AE/B (n = 1). The 2 IDUs were infected with CRF08_BC and the 2 children born to HIV-1 infected mothers were infected with subtype B′ and CRF01_AE. PI resistance-associated amino acid substitutions were found at 1 codon in primary and 7 codons in secondary regions of the PR gene. Amino acid substitutions were more frequently found in the B/B′ sequences (69%) than in the non-B sequences (31%). Substitutions characteristic with the subtype B/B′ sequences mainly among hemophiliacs included L63P (87%), A71V/T (27%), and V77I (93%) while those that characterized the non-B sequences mainly found among heterosexuals included M36I (69%) and K20R (19%). Conclusion: This study reveals the presence of multiple HIV-1 subtypes and recombinants infecting Shanghai residents. The broad HIV-1 diversity is being introduced into this city through heterosexual contacts. This study also reveals that viruses infecting these treatment-naive patients have acquired both primary or secondary mutations in their PR genes. These studies should provide the basis for further epidemiologic surveys of HIV-1 subtypes and set strategies for treatment intervention and vaccine programs. In China, home to 1/5 of the world's population, HIV has spread to all 31 provinces, regions, and municipalities 1 and is currently moving into new groups of the population. 2 Epidemiologic surveillance studies in China reveal that transmission of HIV-1 by injecting drug users (IDUs) is the predominant route of HIV transmission, with prevalence rates >70% among this group of patients, in some border communities in Xingjiang, Yunnan, and Guangxi provinces. 3 Heterosexual transmission has been on the increase in recent years, as has been shown with increased prevalence in patients with sexually transmitted diseases. 4 HIV infection by HIV-contaminated blood and blood products has been reported in different parts of China. 4 Shanghai, located in the east of China, is one of the largest cities with 16.74 million inhabitants and receiving about 4 million migrants annually, some of who come with HIV infection, thus increasing the HIV-1 epidemic in this city. Shanghai has been ranked the 9th for its HIV-1 epidemic in China. 4 The main modes of HIV-1 transmission in this city are reported to be by IDUs (35%), sexual contacts (33%), and the use of contaminated blood products (20%). 5,6 While HIV-1 subtype information in Shanghai is sparse, several HIV-1 subtypes (A, B, B′, C, D, F, and G), 3 circulating recombinant forms (CRFs) (CRF01_AE, CRF07_BC, and CRF08_BC) as well as HIV-2 have been identified in different parts of China. 7,8 Information on the HIV-1 subtype distribution in different risk groups in China is sparse. Although some heterosexuals in Shanghai were found to be infected with HIV-1 subtype C, little is known on the HIV-1 genetic diversity among different risk groups in Shanghai. To track the HIV-1 genetic distribution in this city, the subtypes infecting different risk groups must be studied. Amino acid substitutions that lead to drug resistance in patients during treatment with protease inhibitors (PIs) have been extensively characterized into primary (major) and secondary (minor) mutations. 9-11 Primary mutations significantly decreases sensitivity to ≥1 PI drugs, 9,10 while secondary mutations may not result in a significant decrease in sensitivity but are associated with an increase in viral fitness (replication capacity). 9,12 Thus, the appearance of a primary mutation in a genome already containing secondary mutations could influence the speed at which highly resistant viruses are selected during therapy. Information on PI resistance-associated mutations in HIV-1-infected patients in China is lacking. To establish successful treatment strategies for HIV-1 patients in China, there is the need to characterize the natural polymorphisms associated with PI resistance in drug-naive HIV-1-infected individuals. The present study has examined the genetic diversity and natural polymorphisms associated with PI resistance of HIV-1 strains infecting residents of Shanghai, China.JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2003; 34(1):91-101. · 4.43 Impact Factor
