Strategy for AIDS Prevention and Treatment

HIV/AIDS has been circulating in China for over 25 year. While making progress and achievements on HIV/AIDS prevention,there still are great challenge and difficulties such as HIV epidemic controlling and vaccine research.     

Strategy for AIDS prevention and treatment

HIV/AIDS has been circulating in China for over 25 year. While making progress and achievements on HIV/AIDS prevention, there still are great challenge and difficulties such as HIV epidemic controlling and vaccine research.      

Development and Challenge of HIV/AIDS Testing Laboratory Network and Quality Assurance System in China

This paper describes the development and challenge of HIV/AIDS testing laboratory network and quality assurance system in China. At present,the HIV/AIDS testing laboratories includes three classes,the National AIDS Reference Laboratory,HIV/AIDS confirmatory laboratories and HIV/AIDS screening laboratories. All of them are accredited by the health authorities,and each class of laboratories take charge of their function strictly according to the "National Management of HIV/AIDS Detection (2006)". A complete quality assurance and quality control system for HIV/AIDS testing has been developed,which includes technical training,strict laboratory monitoring and approval,examination or proficiency testing on HIV/AIDS detection,and quality evaluation and supervision of HIV/AIDS diagnostic kits. Besides conduct the routine anti-HIV antibody test,more and more laboratories began to conduct other tests,such as CD4 T lymphocyte cell counting,HIV viral load,HIV DNA PCR,genotyping,drug resistance,and HIV-1 recent infection test. The primary challenges faced by the HIV/AIDS testing laboratory network are in the areas of laboratory management and quality control. For example,the provincial PT program is inefficient,the internal quality control is conducted perfunctorily,personnel training can not met the needs of the workplace,which need to be improved.     

CD4＋CD25＋FoxP3＋调节性T细胞与黑龙江省HIV／AIDS患者病情相关性的研究

目的：比较黑龙江省H1V／AIDS患者与健康对照者（healthy controls,HCs）外周血cD4＋CD25＋F0xP3＋调节性T细胞数量、免疫抑制功能的变化,探讨CD4＋CD25＋FoxP3＋调节性T细胞在HIV／AIDS感染过程中的作用。方法：采用流式细胞仪检测21例HIV／AIDS患者及20例健康对照组的外周血CD4＋CD25＋FoxP3＋调节性T细胞数量的百分比及绝对数量;采用共同培养方法检测HIV／AIDS患者外周血cD4℃D25十FoxP3＋调节性T细胞免疫抑制功能的变化;实时荧光定量聚合酶链反应（RT-FQ-PCR）检测HIV／AIDS患者外周血CD4＋CD25＋FoxP3＋调节性T细胞中FoxP3mRNA的表达。结果：黑龙江省HIV／AIDS患者外周血CD4＋CD25下oxP3＋调节性T细胞比率明显高于HCs（P〈O．01）,而CD4-CD25＋FoxP3＋调节性T细胞的绝对计数显著下降,且与CD4＋T细胞绝对计数成反比;混合淋巴细胞共同培养结果显示,HIV／AIDS患者外周血CD4＋CD25＋FoxP3＋调节性T细胞的抑制功能无明显变化;HIV／AIDS患者外周血CD4＋CD25＋FoxP3＋调节性T细胞的FoxP3mRNA相对表达量无显著变化。结论：黑龙江省HIV／AIDS患者cD4℃D25＋FoxP3＋调节性T细胞的数量变化与病情相关。     

CD4+CD25+FoxP3+ 调节性T 细胞与黑龙江省HIV/AIDS 患者病情 相关性的研究

目的:比较黑龙江省HIV/AIDS患者与健康对照者(healthy controls,HCs)外周血CD4+CD25+FoxP3+调节性T细胞数量、免疫抑制功能的变化,探讨CD4+CD25+FoxP3+调节性T细胞在HIV/AIDS感染过程中的作用。方法:采用流式细胞仪检测21例HIV/AIDS患者及20例健康对照组的外周血CD4+CD25+FoxP3+调节性T细胞数量的百分比及绝对数量;采用共同培养方法检测HIV/AIDS患者外周血CD4+CD25+FoxP3+调节性T细胞免疫抑制功能的变化;实时荧光定量聚合酶链反应(RT-FQ-PCR)检测HIV/AIDS患者外周血CD4+CD25+FoxP3+调节性T细胞中FoxP3mRNA的表达。结果:黑龙江省HIV/AIDS患者外周血CD4+CD25+FoxP3+调节性T细胞比率明显高于HCs(P<0.01),而CD4+CD25+FoxP3+调节性T细胞的绝对计数显著下降,且与CD4+T细胞绝对计数成反比;混合淋巴细胞共同培养结果显示,HIV/AIDS患者外周血CD4+CD25+FoxP3+调节性T细胞的抑制功能无明显变化;HIV/AIDS患者外周血CD4+CD25+FoxP3+调节性T细胞的FoxP3 mRNA相对表达量无显著变化。结论:黑龙江省HIV/AIDS患者CD4+CD25+FoxP3+调节性T细胞的数量变化与病情相关。     

Development and challenge of HIV/AIDS testing laboratory network and quality assurance system in China

This paper describes the development and challenge of HIV/AIDS testing laboratory network and quality assurance system in China. At present, the HIV/AIDS testing laboratories includes three classes, the National AIDS Reference Laboratory, HIV/AIDS confirmatory laboratories and HIV/AIDS screening laboratories. All of them are accredited by the health authorities, and each class of laboratories take charge of their function strictly according to the “National Management of HIV/AIDS Detection (2006)”. A complete quality assurance and quality control system for HIV/AIDS testing has been developed, which includes technical training, strict laboratory monitoring and approval, examination or proficiency testing on HIV/AIDS detection, and quality evaluation and supervision of HIV/AIDS diagnostic kits. Besides conduct the routine anti-HIV antibody test, more and more laboratories began to conduct other tests, such as CD4⁺T lymphocyte cell counting, HIV viral load, HIV DNA PCR, genotyping, drug resistance, and HIV-1 recent infection test. The primary challenges faced by the HIV/AIDS testing laboratory network are in the areas of laboratory management and quality control. For example, the provincial PT program is inefficient, the internal quality control is conducted perfunctorily, personnel training can not met the needs of the workplace, which need to be improved. Foundation item: MOH Program on Applied Research in the Prevention and Treatment of AIDS (WA 2003-17)     

AIDS and evidence: interrogating [corrected] some Ugandan myths

Uganda is invoked as a metaphor for a host of arguments and insights about HIV/AIDS. However, much of what has been asserted about the country is not based on the available evidence. This paper reviews findings by epidemiologists and anthropologists, and draws on the author's experiences of researching in the country since the early 1980s. It comments on various myths about HIV/AIDS in Uganda, including myths about the origin and dissemination of the disease, about the links between HIV/AIDS and war, and about declining rates of infection. It shows that much less is known about Uganda than is commonly supposed, and it offers some alternative hypotheses for interpreting HIV prevalence and incidence data. In particular it draws attention to the importance of mechanisms for social compliance. It concludes by raising concerns about the current enthusiasm for provision of anti-retroviral drugs.     

Mandela restores morale of AIDS conference

During the 13th international AIDS conference in Durban, former president Nelson Mandela pulled the morale of the conference highlighting the need to confront the needs and concerns of those suffering and dying of HIV/AIDS in South Africa, mostly in sub-Saharan. He also stated that to challenge the grave threat posed by HIV and AIDS, efforts should be combined to save the people. This concluding remark was in direct contrast to the opening words of South Africa's current president, Thabo Mbeki, who failed to deal with the impression he has created internationally that he has doubts about the etiology of AIDS. In addition, the need to focus on the accessibility and affordability of treatment for HIV/AIDS or the opportunistic infections associated with it was highlighted. The conference focused on this issue with the help of AIDS activists, who emphasized that pharmaceutical companies needed to address how their drugs could reach those who most need them.     

HIV/AIDS epidemic in Eastern Europe: Recent developments in the Russian Federation and Ukraine among women

Background: The Russian Federation and the Ukraine are among the Eastern European countries with the fastest growing number of cases of HIV. According to data from the Joint United Nations Program on HIV/AIDS, nearly 90% of newly reported HIV diagnoses in Eastern Europe in 2006 were from the Russian Federation (66%) and the Ukraine (21%). A growing number of women are infected with HIV. The impact of gender on HIV/AIDS is an important factor in understanding the development and evolution of the HIV/AIDS epidemic in Eastern Europe.Objective: The aim of this study was to assess the importance of integrating gender consideration into the creation of HIV programs and to examine the effect of gender on HIV/AIDS.Methods: Reported HIV/AIDS cases from the official epidemiological register of the Ukrainian Centre for AIDS Prevention alongside data from the Russian Federal AIDS Center were analyzed. Joint United Nations Program on HIV/AIDS country fact sheets were reviewed and analyzed, and this information was supplemented with published HIV prevalence and sexually transmitted disease case reporting information, unpublished reports, and expert evaluations.Results: Of the newly registered cases of HIV, the proportion of women rose from 13.0% in 1995 to 44.0% in 2006 in the Russian Federation, and from 37.2% in 1995 to 41.9% in 2006 in the Ukraine. There has also been a considerable increase in mother-to-child transmission of HIV since 1995. Between 1987 and 1994, the proportion of children among the people newly infected with HIV in the Ukraine was 2.2%; in 2006 it was 17.6%. In 2006, 16,078 new HIV cases were registered in the Ukraine and 39,652 new HIV cases in the Russian Federation. Large increases in the number of HIV-infected women were reported from both countries.Conclusions: The data examined in this study suggest subregional differences in the magnitude of the HIV/AIDS epidemic in the Russian Federation and the Ukraine and the importance of the impact of gender on the rapid spread of the HIV/AIDS epidemic among women and women of child-bearing age. To protect women from HIV infection, it is important to find ways to empower them by implementing policies and specific prevention measures that increase their access to knowledge about HIV/AIDS; the empowerment of women is vital to reversing the HIV/AIDS epidemic.     

Drug companies cut HIV drug prices in the developing world

The UN has reported that five multinational pharmaceutical companies would cut down HIV drug prices in the developing world. One of these drug companies is GlaxoWellcome, which has promised to reduce the price of zidovudine and lamivudine to US$2 in the poorest nations, a fifth of its price in the US. Although Peter Piot, director of the UN Program on HIV/AIDS, welcomed the companies' promises, he warned that price cuts alone will not curb the epidemic. He stated that this initiative is only one critical factor in what must become a much broader and more urgent effort to help people living with HIV/AIDS. Moreover, health and development agencies expressed concern that AIDS drugs will still be unaffordable for the vast majority of those in need in developing countries. In addition, poor countries lack the infrastructure to deliver these drugs safely and effectively. During the time of the UN announcement, US President Bill Clinton also signed an executive order allowing sub-Saharan Africa to adopt legal measures to obtain cheap HIV drugs. Meanwhile, South Africa's reaction to the offer to cut antiretroviral drug prices has been lukewarm.     

The Progress on the Studies of HIV/AIDS Vaccine

人类控制HIV感染长远的目标是发展安全、有效、廉价的HIV AIDS疫苗。但经 2 0多年的努力 ,人类探索HIV AIDS疫苗之路仍在继续。分析了疫苗研究的复杂性和发展HIV AIDS疫苗过程中所面临的挑战 ,并对发展HIV AIDS疫苗的可能性从实验和临床方面进行了阐述。同时结合HIV感染的免疫应答原理对现有的各种HIV AIDS疫苗研究策略作一综述 ,并根据以往HIV AIDS疫苗研究的经验和教训提出未来疫苗的发展思路及展望。     

Challenges and Opportunities： the Expanded Government-led HIV/AIDS Programs in China

HIV/AIDS has posed an increasingly serious issue in China. In recent years,Chinese government has taken further intensified efforts to combat HIV/AIDS with high-level political commitment,supportive policy development,increased financial allocation,large-scale of government-led initiatives,expanded international cooperation and great involvement of non-governmental organizations. Meanwhile gaps and challenges coexist impacting the implementation and the results of national HIV/AIDS programs. Thus,further government efforts are needed to improve and tailor the actions to meet the requirement of HIV/AIDS control in China.     

Non-Chinese Immigrants: Challenge Faced by Yunnan of China to Achieve the 90–90–90 Goals

正China’s AIDS epidemic started among people who inject drugs(PWID)in Ruili county-level city,a China–Myanmar border city of Yunnan Province,in 1989(Fig.1).Since then HIV has spread rapidly across the country(He and Detels 2005).China launched a‘‘Four Frees and One Care’’policy in 2003 to fight against HIV/AIDS.As one of     

Age and Sex Structured Model for Assessing the Demographic Impact of Mother-to-Child Transmission of HIV/AIDS

Age and sex structured HIV/AIDS model with explicit incubation period is proposed as a system of delay differential equations. The model consists of two age groups that are children (0–14 years) and adults (15–49 years). Thus, the model considers both mother-to-child transmission (MTCT) and heterosexual transmission of HIV in a community. MTCT can occur prenatally, at labour and delivery or postnatally through breastfeeding. In the model, we consider the children age group as a one-sex formulation and divide the adult age group into a two-sex structure consisting of females and males. The important mathematical features of the model are analysed. The disease-free and endemic equilibria are found and their stabilities investigated. We use the Lyapunov functional approach to show the local stability of the endemic equilibrium. Qualitative analysis of the model including positivity and boundedness of solutions, and persistence are also presented. The basic reproductive number (ℛ₀) for the model shows that the adult population is responsible for the spread HIV/AIDS epidemic, thus up-to-date developed HIV/AIDS models to assess intervention strategies have focused much on heterosexual transmission by the adult population and the children population has received little attention. We numerically analyse the HIV/AIDS model to assess the community benefits of using antiretroviral drugs in reducing MTCT and the effects of breastfeeding in settings with high HIV/AIDS prevalence ratio using demographic and epidemiological parameters for Zimbabwe.     

Aids, Policy and Bioethics: Ethical Dilemmas Facing China in HIV Prevention

The present situation of the HIV/AIDS epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/AIDS cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle.     

AIDS, policy and bioethics: ethical dilemmas facing China in HIV prevention: a report from China

The present situation of the HIV/AIDS epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/AIDS cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle.     

Epidemiology of HIV infection and AIDS in Croatia--an overview

This article presents an overview of HIV/AIDS epidemiology and surveillance in Croatia 20 years after the first documented case of AIDS in the country. Here we describe strategies employed for HIV/AIDS surveillance in Croatia as well as preliminary results of HIV seroprevalence among most-at-risk populations (MARPs) research conducted by the Infectious Diseases Epidemiology Service at the Croatian National Institute of Public Health (CNIPH). Croatia has a low incidence and prevalence of HIV and AIDS. At the end of 2005, there were 553 documented cases of HIV infection, 239 of which progressed to AIDS. In Croatia, AIDS is being registered within MARPs only and dominantly among men who have sex with men (MSM). AIDS patients and HIV infected persons are found in all parts of the country. Crude prevalence of HIV among MARPs was found to be 0.9%. It is necessary to continue with current prevention and control measures in the country, and to create a culture of awareness and precaution, a strategy that has proven effective in reducing risk of HIV infection.     

Apoptotic cell death and cytokine dysregulation in human immunodeficiency virus infection: pivotal factors in disease progression

The progressive loss of CD4 T lymphocyte is patognomonic of Human Immunodeficiency Virus (HIV) infection and results in immunodeficiency and the appearance of acquired immunodeficiency syndrome (AIDS)-defining pathologies. Although a percentage of CD4 T lymphocytes is destroyed directly by HIV infection, a much higher proportion of lymphocytes remains uninfected and therefore must be destroyed by mechanisms not directly involving viral infection. One such mechanism is apoptotic T cell death (ATCD). ATCD in HIV infection has been shown to be: 1) secondary to cross-linking of CD4 by viral proteins; 2) mediated by both APO-1/Fas and lymphotoxin (LT); and 3) differentially modulated by type 1 and type 2 cytokines. We will briefly analyze the experimental evidences suggesting that ATCD contributes significantly to the immunopathogenesis of HIV/AIDS via depletion of CD4+ T cells.     

Through a glass, darkly: data and uncertainty in the AIDS debate

The HIV/AIDS epidemic is the greatest threat to development in much of Africa. It is already the main cause of death in many countries, especially those in Southern Africa. However there is an absence of solid data on the scale and scope of the disease and how it is evolving. In this article we discuss the data on the epidemic – where it comes from and how it is presented. We note the limitations of the use of antenatal clinic surveys – which provide the bulk of our information.
We then turn to the evidence of impact. The paper shows that the long incubation period between infection and illness means that it takes time for HIV infections to turn into AIDS cases, and AIDS cases to translate into deaths with all the consequences of orphaning, poverty and changing population structures. Furthermore it means that once the HIV prevalence has peaked, AIDS impact will take years to work through – this epidemic is a 'long-wave' event.
The paper is premised on the view that HIV causes AIDS and AIDS causes death. It notes that insufficient and/or unreliable data have allowed leaderships to deny the scope and scale of the problem and that this is unacceptable. However it is incumbent on all to accept the moral responsibility for and the moral consequences of their work, and this includes those who gather, interpret and use the data.     

Assessing the effects of drug misuse on HIV/AIDS prevalence

Drug misuse (injecting drug users-IDU) has been recognized to have a significant effect on the spread of HIV/AIDS epidemic. A deterministic model to assess the contribution of drug misuse and sex in the spread of HIV/AIDS is investigated. The threshold parameters of the model are determined and stabilities are analysed. Analysis of the reproduction number has shown that increase in drug misuse results in an increase in HIV infections. Furthermore, numerical simulations of the model show that drug misuse enhances HIV transmission and progression to AIDS. Thus, in a population with intravenous drug users, advocating for safe sex alone will not be enough to control the HIV/AIDS epidemic.