HIV Epidemiology and Prevention in Southwestern China: Trends from 1996-2017

The aim of this review is to describe long-term HIV epidemiology and prevention trends in Guangxi, a provincial-level region located along a major drug trafficking corridor in southwestern China. Between 1996 and 2006, HIV transmission in Guangxi was primarily fueled by Injection Drug Use (IDU). Since 2006, heterosexual sex has become the dominant mode of HIV transmission, followed by drug injection. Moreover, older, heterosexual adults appear to be at increased risk for HIV. The vast majority of new HIV cases are attributed to local HIV subtypes already circulating within Guangxi (93%), though imported subtypes are associated with younger age groups. Since 2011, HIV incidence in Guangxi has stabilized, due in part to HIV prevention efforts that include expanded HIV testing, antiretroviral treatment, and other intervention measures. Between 1996 and 2017, Guangxi, China experienced dramatic changes in the primary HIV transmission mode and at-risk age group. Due in part to local and National AIDS control and prevention campaigns, HIV incidence trends in Guangxi no longer appear to be increasing.

[1]  Versione,et al.  Common Terminology Criteria for Adverse Events , 2020, Definitions.

[2]  Y. Ruan,et al.  Rapidly Spreading Human Immunodeficiency Virus Epidemic Among Older Males and Associated Factors: A Large-scale Prospective Cohort Study in Rural Southwest China , 2018, Sexually transmitted diseases.

[3]  Y. Hao,et al.  A mathematical model of biomedical interventions for HIV prevention among men who have sex with men in China , 2018, BMC Infectious Diseases.

[4]  H. Xing,et al.  Author Correction: HIV-1 Transmissions Among Recently Infected Individuals in Southwest China are Predominantly Derived from Circulating Local Strains , 2018, Scientific Reports.

[5]  J. Pachankis,et al.  An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context , 2018, JMIR mHealth and uHealth.

[6]  H. Xing,et al.  Comparison of different strategies for controlling HIV/AIDS spreading in MSM , 2018, Infectious Disease Modelling.

[7]  H. Xing,et al.  Treatment for HIV prevention study in southwestern areas of China , 2018, Infectious Disease Modelling.

[8]  D. Rawle,et al.  Dynamic Characteristics and HIV Infection of Men who have Sex with Men from 2011 to 2017 in Yinchuan, Ningxia, China , 2018, Current HIV research.

[9]  H. Xing,et al.  HIV-1 Transmissions Among Recently Infected Individuals in Southwest China are Predominantly Derived from Circulating Local Strains , 2018, Scientific Reports.

[10]  H. Xing,et al.  High Baseline CD4 Counts and Antiretroviral Therapy Cessation. , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Zhen-zhu Tang,et al.  HIV, syphilis and behavioral risk factors among men who have sex with men in a drug-using area of southwestern China , 2018, Medicine.

[12]  Y. Ruan,et al.  Decreasing HIV, Syphilis, and Hepatitis C Infection After a Decade of Harm Reduction Implementation Among Drug Users in Southwestern Areas of China. , 2018, Journal of Studies on Alcohol and Drugs.

[13]  H. Xing,et al.  Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program , 2018, Scientific Reports.

[14]  H. Xing,et al.  Effects of high CD4 cell counts on death and attrition among HIV patients receiving antiretroviral treatment: an observational cohort study , 2017, Scientific Reports.

[15]  Y. Ruan,et al.  Disparities in HIV and syphilis prevalence and risk factors between older male clients with and without steady sex partners in southwestern rural China , 2017, BMC Infectious Diseases.

[16]  Y. Ruan,et al.  Aphrodisiac Use and Associated Factors Among Older Male Clients of Low-Cost Female Sex Workers in Southwestern Rural Areas of China , 2017 .

[17]  B. Mustanski,et al.  Internalized Homophobia and Perceived Stigma: a Validation Study of Stigma Measures in a Sample of Young Men who Have Sex with Men , 2016, Sexuality Research and Social Policy.

[18]  S. Vermund,et al.  Impact of Depression and Anxiety on Initiation of Antiretroviral Therapy Among Men Who Have Sex with Men with Newly Diagnosed HIV Infections in China , 2017, AIDS patient care and STDs.

[19]  S. Vermund,et al.  Commercial sex and risk of HIV, syphilis, and herpes simplex virus-2 among men who have sex with men in six Chinese cities , 2016, BMC Infectious Diseases.

[20]  H. Xing,et al.  Effects of CD4 Cell Counts and Viral Load Testing on Mortality Rates in Patients With HIV Infection Receiving Antiretroviral Treatment: An Observational Cohort Study in Rural Southwest China. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  Y. Ruan,et al.  Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers , 2016, Medicine.

[22]  M. Postma,et al.  Health-related quality of life in HIV/AIDS patients on antiretroviral therapy at a tertiary care facility in Zimbabwe , 2016, AIDS care.

[23]  W. Mcfarland,et al.  Investigating HIV Infection and HIV Incidence Among Chinese Men Who Have Sex with Men with Recent Sexual Debut, Chongqing, China, 2011 , 2016, AIDS and Behavior.

[24]  C. Cohen,et al.  Patient-reported outcomes in the single-tablet regimen (STaR) trial of rilpivirine/emtricitabine/tenofovir disoproxil fumarate versus efavirenz/emtricitabine/tenofovir disoproxil fumarate in antiretroviral treatment-naive adults infected with HIV-1 through 48 weeks of treatment , 2016, AIDS care.

[25]  J. van Lunzen,et al.  Rilpivirine vs. efavirenz-based single-tablet regimens in treatment-naive adults: week 96 efficacy and safety from a randomized phase 3b study , 2016, AIDS.

[26]  H. Xing,et al.  Low Virologic Failure and Drug Resistance among HIV-Infected Patients Receiving Hospital-Based ART While Care and Outreach through Community in Guangxi, China , 2015, Front. Public Health.

[27]  P. Clay,et al.  Meta-Analysis of Studies Comparing Single and Multi-Tablet Fixed Dose Combination HIV Treatment Regimens , 2015, Medicine.

[28]  A. di Biagio,et al.  Efficacy, safety, and patient acceptability of elvitegravir/cobicistat/emtricitabine/tenofovir in the treatment of HIV/AIDS , 2015, Patient preference and adherence.

[29]  R. Speck,et al.  Patient-Reported Symptoms over 48 Weeks in a Randomized, Open-Label, Phase 3b Non-inferiority Trial of Adults with HIV Switching to Coformulated Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir DF Versus Continuation of Ritonavir-Boosted Protease Inhibitor with Emtricitabine and Tenofovir DF , 2015, The Patient - Patient-Centered Outcomes Research.

[30]  H. Xing,et al.  Genetic Characteristics of CRF01_AE Among Newly Diagnosed HIV-1-Infected 16- to 25-Year Olds in 3 Geographic Regions of Guangxi, China , 2015, Medicine.

[31]  M. Johnson,et al.  Patient-Reported Outcomes After a Switch to a Single-Tablet Regimen of Rilpivirine, Emtricitabine, and Tenofovir DF in HIV-1-Positive, Virologically Suppressed Individuals: Additional Findings From a Randomized, Open-Label, 48-Week Trial , 2015, The Patient - Patient-Centered Outcomes Research.

[32]  F. Dabis,et al.  Switch to Rilpivirine/Emtricitabine/Tenofovir Single-Tablet Regimen of Human Immunodeficiency Virus-1 RNA-Suppressed Patients, Agence Nationale de Recherches sur le SIDA et les Hépatites Virales CO3 Aquitaine Cohort, 2012–2014 , 2015, Open forum infectious diseases.

[33]  S. Vermund,et al.  Recreational drug use and risks of HIV and sexually transmitted infections among Chinese men who have sex with men: Mediation through multiple sexual partnerships , 2014, BMC Infectious Diseases.

[34]  R. Shafer,et al.  Lower prevalence of drug resistance mutations at first-line virological failure to first-line therapy with atripla vs. tenofovir + emtricitabine/lamivudine + efavirenz administered on a multiple tablet therapy , 2014, AIDS.

[35]  F. Maggiolo,et al.  Switching from an EFV-Based STR to a RPV-Based STR is Effective, Safe and Improves HIV Patients Health Status. , 2014, Value in Health.

[36]  Zunyou Wu,et al.  Aphrodisiac Use Associated with HIV Infection in Elderly Male Clients of Low-Cost Commercial Sex Venues in Guangxi, China: A Matched Case-Control Study , 2014, PloS one.

[37]  S. Vermund,et al.  HIV and syphilis prevalence trends among men who have sex with men in Guangxi, China: yearly cross-sectional surveys, 2008–2012 , 2014, BMC Infectious Diseases.

[38]  M. Cortés,et al.  Adherencia, satisfacción y calidad de vida relacionada con la salud en pacientes infectados por el VIH con tratamiento antirretroviral en España. Estudio ARPAS , 2014 .

[39]  T. Harrison,et al.  Prevalence of Transmitted HIV-1 Drug Resistance Remains Low in Guangxi, China, Eight Years after Scale-Up of Highly-Active Antiretroviral Therapy , 2014, Intervirology.

[40]  W. Guo,et al.  HIV/AIDS epidemic among older adults in China during 2005-2012: results from trend and spatial analysis. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[41]  Xiong He,et al.  Modeling the Impact on HIV Incidence of Combination Prevention Strategies among Men Who Have Sex with Men in Beijing, China , 2014, PloS one.

[42]  G. Colombo,et al.  Switching from an EFV-based STR to a RPV-based STR is effective, safe and improves HIV patients health status , 2014, Journal of the International AIDS Society.

[43]  H. Xing,et al.  HIV, Syphilis, and Behavioral Risk Factors among Female Sex Workers before and after Implementation of Harm Reduction Programs in a High Drug-Using Area of China , 2014, PloS one.

[44]  S. Cunningham,et al.  Realities of replication: implementation of evidence-based interventions for HIV prevention in real-world settings , 2014, Implementation Science.

[45]  W. Mcfarland,et al.  Alcohol use and HIV risk taking among Chinese MSM in Beijing. , 2013, Drug and alcohol dependence.

[46]  A. Wu,et al.  Patient reported outcome instruments used in clinical trials of HIV-infected adults on NNRTI-based therapy: a 10-year review , 2013, Health and Quality of Life Outcomes.

[47]  J. Meyers,et al.  Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV , 2013, BMJ Open.

[48]  H. Xing,et al.  Evaluation of Harm Reduction Programs on Seroincidence of HIV, Hepatitis B and C, and Syphilis Among Intravenous Drug Users in Southwest China , 2013, Sexually transmitted diseases.

[49]  M. Egger,et al.  Life Expectancies of South African Adults Starting Antiretroviral Treatment: Collaborative Analysis of Cohort Studies , 2013, PLoS medicine.

[50]  Wei Liu,et al.  Subtype CRF01_AE dominate the sexually transmitted human immunodeficiency virus type 1 epidemic in Guangxi, China , 2013, Journal of medical virology.

[51]  A. Phillips,et al.  Life expectancy living with HIV: recent estimates and future implications , 2013, Current opinion in infectious diseases.

[52]  Y. Ruan,et al.  HIV incidence among men who have sex with men in Beijing: a prospective cohort study , 2012, BMJ Open.

[53]  D. Morisky,et al.  Emerging HIV epidemic among older adults in Nanning, China. , 2012, AIDS patient care and STDs.

[54]  Yan Zhao,et al.  Expansion of China's free antiretroviral treatment program. , 2012, Chinese medical journal.

[55]  Y. Shao,et al.  Challenges and opportunities for HIV/AIDS control in China , 2012, The Lancet.

[56]  W. Mcfarland,et al.  Behavioral and serologic survey of men who have sex with men in Beijing, China: implication for HIV intervention. , 2012, AIDS patient care and STDs.

[57]  David P. Wilson,et al.  Human Immunodeficiency Virus Prevalence Is Increasing Among Men Who Have Sex With Men in China: Findings From a Review and Meta-Analysis , 2011, Sexually transmitted diseases.

[58]  B. Clotet,et al.  Rilpivirine versus efavirenz with two background nucleoside or nucleotide reverse transcriptase inhibitors in treatment-naive adults infected with HIV-1 (THRIVE): a phase 3, randomised, non-inferiority trial , 2011, The Lancet.

[59]  Shuntai Zhou,et al.  Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study. , 2011, The Lancet. Infectious diseases.

[60]  Y. Ruan,et al.  Sexual mixing patterns among social networks of HIV-positive and HIV-negative Beijing men who have sex with men: a multilevel comparison using roundtable network mapping , 2011, AIDS care.

[61]  W. Liu,et al.  Factors associated with HIV virologic failure among patients on HAART for one year at three sentinel surveillance sites in China. , 2011, Current HIV research.

[62]  Zunyou Wu,et al.  Scaling up prevention programmes to reduce the sexual transmission of HIV in China , 2010, International journal of epidemiology.

[63]  Zunyou Wu,et al.  Scaling up the national methadone maintenance treatment program in China: achievements and challenges , 2010, International journal of epidemiology.

[64]  Yan Gao,et al.  Design and implementation of a China comprehensive AIDS response programme (China CARES), 2003–08 , 2010, International journal of epidemiology.

[65]  H. Xing,et al.  Correlates of incident infections for HIV, syphilis, and hepatitis B virus in a cohort of men who have sex with men in Beijing. , 2010, AIDS patient care and STDs.

[66]  K. Mounzer,et al.  Patient-reported outcomes in virologically suppressed, HIV-1-Infected subjects after switching to a simplified, single-tablet regimen of efavirenz, emtricitabine, and tenofovir DF. , 2010, AIDS patient care and STDs.

[67]  Y. Ruan,et al.  Incidence of HIV-1, Syphilis, Hepatitis B, and Hepatitis C Virus Infections and Predictors Associated With Retention in a 12-Month Follow-Up Study Among Men Who Have Sex With Men in Beijing, China , 2009, Journal of acquired immune deficiency syndromes.

[68]  A. Regnault,et al.  Satisfactory cross-cultural validity of the ACTG symptom distress module in HIV-1-infected antiretroviral-naive patients , 2009, Clinical trials.

[69]  Ross J. Harris,et al.  Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries. , 2009, International journal of epidemiology.

[70]  Ray Y. Chen,et al.  Five-Year Outcomes of the China National Free Antiretroviral Treatment Program , 2009, Annals of Internal Medicine.

[71]  L. Richter,et al.  EDITORIAL , 2009, AIDS care.

[72]  S. Vermund,et al.  Risk Factors for Syphilis and Prevalence of HIV, Hepatitis B and C among Men Who Have Sex with Men in Beijing, China: Implications for HIV Prevention , 2009, AIDS and Behavior.

[73]  Jiahong Xu,et al.  The effect of highly active antiretroviral therapy on mortality among HIV-infected former plasma donors in China. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[74]  Y. Ruan,et al.  Impact of methadone on drug use and risky sex in China. , 2008, Journal of substance abuse treatment.

[75]  D. Bennett,et al.  World Health Organization surveys to monitor HIV drug resistance prevention and associated factors in sentinel antiretroviral treatment sites , 2008, Antiviral therapy.

[76]  Zunyou Wu,et al.  An evaluation of needle exchange programmes in China , 2007, AIDS.

[77]  H. Xing,et al.  Characterization of HIV-1 subtypes and viral antiretroviral drug resistance in men who have sex with men in Beijing, China , 2007, AIDS.

[78]  Y. Ruan,et al.  Risk factors of HIV infection and prevalence of co-infections among men who have sex with men in Beijing, China , 2007, AIDS.

[79]  I. Rodríguez,et al.  Preferencias, satisfacción y adherencia con el tratamiento antirretroviral: estudio ARPAS (II) , 2007 .

[80]  I. Rodríguez,et al.  Características psicométricas de la escala de satisfacción con el tratamiento antirretroviral (ESTAR): estudio ARPAS (I) , 2007 .

[81]  H. Xing,et al.  Relationship Between Syphilis and HIV Infections Among Men Who Have Sex With Men in Beijing, China , 2007, Sexually transmitted diseases.

[82]  Y. Ruan,et al.  HIV incidence, retention rate, and baseline predictors of HIV incidence and retention in a prospective cohort study of injection drug users in Xinjiang, China. , 2007, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[83]  S. Lai,et al.  Erratum: HIV prevalence among injection drug users in rural Guangxi China (Addiction (2006) 101, (1493-1498)) , 2007 .

[84]  S. Lai,et al.  HIV Incidence, Retention, and Changes of High-Risk Behaviors Among Rural Injection Drug Users in Guangxi, China , 2007, Substance abuse.

[85]  Y. Ruan,et al.  Demographic characteristics and risk behaviors associated with HIV positive injecting drug users in Xinjiang, China. , 2007, The Journal of infection.

[86]  Wei Hu,et al.  Continued spread of HIV among injecting drug users in southern Sichuan Province, China , 2007, Harm reduction journal.

[87]  S. Lai,et al.  HIV prevalence among injection drug users in rural Guangxi China. , 2006, Addiction.

[88]  S. Vermund,et al.  Risk of HIV/AIDS in China: subpopulations of special importance , 2005, Sexually Transmitted Infections.

[89]  Lu Yin,et al.  HIV Incidence and Factors Contributed to Retention in a 12-Month Follow-up Study of Injection Drug Users in Sichuan Province, China , 2005, Journal of acquired immune deficiency syndromes.

[90]  S. Lai,et al.  Molecular Epidemiology of HIV-1 Subtypes in Southern China , 2005, Journal of acquired immune deficiency syndromes.

[91]  H. Xing,et al.  Community-Based Survey of HIV Transmission Modes Among Intravenous Drug Users in Sichuan, China , 2004, Sexually transmitted diseases.

[92]  A. Wu,et al.  Incorporating quality of life measures in HIV clinical trials , 2002, HIV clinical trials.

[93]  Kong‐lai Zhang,et al.  Epidemiology of HIV in China , 2002, BMJ : British Medical Journal.

[94]  J. Casado,et al.  Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study , 2002, AIDS.

[95]  S. Berra,et al.  El EuroQol-5D: una alternativa sencilla para la medición de la calidad de vida relacionada con la salud en atención primaria , 2001 .

[96]  S. Lai,et al.  Changes in HIV-1 incidence in heroin users in Guangxi Province, China. , 2001 .

[97]  S. Lai,et al.  Changes in HIV‐1 Incidence in Heroin Users in Guangxi Province, China , 2001, Journal of acquired immune deficiency syndromes.

[98]  Jie Chen,et al.  A Recent Outbreak of Human Immunodeficiency Virus Type 1 Infection in Southern China Was Initiated by Two Highly Homogeneous, Geographically Separated Strains, Circulating Recombinant Form AE and a Novel BC Recombinant , 2000, Journal of Virology.

[99]  D. Podzamczer,et al.  Evaluating changes in health status in HIV-infected patients: Medical Outcomes Study-HIV and Multidimensional Quality of Life-HIV quality of life questionnaires , 2000, AIDS.

[100]  Y. Mao,et al.  [The survey of HIV prevalence among drug users in Guangxi, China]. , 2000, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[101]  W. Liu,et al.  Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi Province, China. , 1999, Journal of acquired immune deficiency syndromes.

[102]  H. Sato,et al.  Genetic similarity of HIV type 1 subtype E in a recent outbreak among injecting drug users in northern Vietnam to strains in Guangxi Province of southern China. , 1999, AIDS research and human retroviruses.

[103]  Navarro,et al.  Gran absceso silente en la pierna por Escherichia coli , 1999 .

[104]  S. Lai,et al.  Two subtypes of HIV-1 among injection-drug users in southern China , 1998, The Lancet.

[105]  C. Luo,et al.  HIV-1 subtype C in China , 1995, The Lancet.

[106]  K. Holmes,et al.  Risk factors for HIV infection among drug users in Yunnan Province, China: association with intravenous drug use and protective effect of boiling reusable needles and syringes , 1994, AIDS.

[107]  T. Mastro,et al.  HIV-1 subtype E in Yunnan, China , 1994, The Lancet.

[108]  S. Vermund,et al.  Relationship of Stigma and Depression Among Newly HIV-Diagnosed Chinese Men Who Have Sex with Men , 2016, AIDS and Behavior.

[109]  Li Li,et al.  [Study on the characteristics of commercial sexual behavior and the risk factors analysis of HIV infection among the old male clients, in Guangxi]. , 2015, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[110]  R. Morillo Verdugo,et al.  [Adherence, satisfaction and health-related quality of life in HIV-infected patients with antiretroviral therapy in Spain. The ARPAS study]. , 2014, Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria.

[111]  B. Wang,et al.  [Distribution of HIV-1 subtypes in Guangxi Zhuang Autonomous Region, 2008-2009]. , 2013, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[112]  D. Wild,et al.  A Comparative Review of Health-Related Quality-of-Life Measures for Use in HIV/AIDS Clinical Trials , 2012, PharmacoEconomics.

[113]  X. Badia,et al.  LA VERSION ESPANOLA DEL EUROQOL : DESCRIPCION Y APLICACIONES , 1999 .

[114]  D. Podzamczer,et al.  [Evidence-based medicine and the validation of quality-of-life questionnaires: the Spanish version of the MOS-HIV questionnaire for the evaluation of the quality of life in patients infected by HIV]. , 1999, Enfermedades infecciosas y microbiologia clinica.

[115]  J. Thomas.  HIV / AIDS in China: migrant population, drug injection responsible for increased transmission. , 1998, AIDSlink : Eastern, Central & Southern Africa.

[116]  A. F. Anderson,et al.  Prostitutes, prostitution and STD/HIV transmission in mainland China. , 1996, Social science & medicine.

[117]  A. Kasuya.  EuroQol--a new facility for the measurement of health-related quality of life. , 1990, Health policy.

[118]  A. Williams.  EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[119]  P. Lowinger.  The solution to narcotic addiction in the People's Republic of China. , 1977, The American journal of drug and alcohol abuse.