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Cancer Mortality among Persons with Human Immunodeficiency Virus Infection in New York City, 2001–2015

Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S58-S58页

作者： Ramaswamy, Chitra Westheimer, Emily Braunstein, Sarah Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene Long Island City New York Bureau of HIV Prevention and Control New York City Department of Health and Mental Hygiene Queens New York Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene New York New York

Background With the prolonged life-span of persons with hiv (PWH) due to anti-retroviral therapy, their cancer burden has increased. Cancer continues to be a leading cause of death among PWH. Studying cancer mortality can inform and guide the development of cancer screening and prevention strategies for PWH. Methods We analyzed data for all persons > = 13 years who were diagnosed with hiv from 2001 to 2015 and reported to the New York City (NYC) hiv surveillance registry (HSR). Using the HSR and the underlying cause of death obtained from the NYC vital statistics registry and the National Death Index, we examined age-specific and age-standardized mortality rates from cancer and compared time trends of deaths due to hiv-related8 cancer to deaths from non-hiv-related cancers. Results There were 34,190 deaths reported among 154,688 PWH of whom nearly half ( n = 16,804; 49.1%) died due to hiv (excluding hiv-related cancers). Among all deaths, hiv was the leading cause, followed by cancer (both hiv and non-hiv-related) ( n = 5,271; 15.4%) and cardiovascular disease ( n = 3,724, 10.9%). The top three causes of non-hiv-related cancer deaths were lung cancer ( n = 1,040; 19.7%), liver cancer ( n = 552; 10.5%), and colorectal cancer ( n = 315; 5.6%). Although the mortality rate among PWH decreased over time (24.4 to 13.9 per 1,000 person-years from 2001 to 2015), the proportion of deaths attributable to all cancers increased (10.6% in 2001 to 19.9% in 2015, p < .0001). This increase was driven by non-hiv-related cancers (6.1% of all deaths in 2001 to 15.8% in 2015, p < .0001). The mean age increased from 2001 to 2015 among the dead (46 to 56 years) and among the censored (35 to 49 years). After controlling for demographic factors, transmission risk, and last CD4 count, the hazard ratio for cancer deaths was higher among people who inject drugs (HR = 1.5; 95% CI = 1.4–1.7) and those with last CD4 count < 200 (HR = 9.3; 95% CI = 8.3–10.5). Conclusion Although mortality rates a

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Prevalence and risk factors of hiv and syphilis,and knowledge and risk behaviors related to hiv/aids among men who have sex with men in Chongqing,China

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The Journal of Biomedical Research 2016年第2期30卷 101-111页

作者： Wenzhe Ma Guohui Wu Hui Zheng Wenjuan Zhang Zhihang Peng Rongbin Yu NingWang Department of Epidemiology and Biostatistics School of Public Health Nanjing Medical University Nanjing Jiangsu 211166 China Chongqing Center for Disease Control and Prevention Chongqing China National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Beijing China

High hiv prevalence and incidence burdens have been reported in men who have sex with men（MSM）in Chongqing,*** aimed to estimate the prevalence of hiv and other sexually transmitted infections（STIs）,to appraise the knowledge and risk behaviors related to hiv/aids among MSM,and to analyze the possible causes of deviation between behavior and knowledge to make better *** recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling（RDS） method in Chongqing,*** the collection of questionnaire-based data and biological testing results from all objects,we launched a crosssectional ***/SE was used for data analysis by frequency,ANOVA,rank sum test and logistic regression *** with syphilis（OR=4.16,95%CI：2.35-7.33,P〈0.0001） were more likely to be hiv *** a company employee（OR=3.64,95%CI：1.22-10.08,P〈0.0001） and having bought male for sex（OR=3.52,95%CI：1.10-11.32,P〈0.034） were associated with a higher probability of *** with younger age,higher education and greater monthly income had a higher mean knowledge *** who had hiv testing had a higher mean knowledge score than those who never ***,venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations,venues for finding sex partners and sexual *** is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of hiv interventions among MSM.

关键词： hiv/aids men who have sex with men Chongqing China

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Impact of Extended Combination Antiretroviral Therapy on the Decline of hiv Prevalence in Pregnant Women in Malawi

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Journal of the International Association of Providers of aids Care 2016年第2期15卷 172-177页

作者： Liotta, Giuseppe Chimbwandira, Frank Wouters, Kristien Nielsen-Saines, Karin Jere, Haswell Mancinelli, Sandro Ceffa, Susanna Erba, Fulvio Palombi, Leonardo Marazzi, Maria Cristina Department of Biomedicine and Prevention Università Tor Vergata Rome Italy HIV/AIDS Department Malawi Ministry of Health Lilongwe Malawi HIV/STD Division Institute of Tropical Medicine Antwerp Belgium Department of Pediatrics David Geffen UCLA School of Medicine Los Angeles CA United States DREAM Program Malawi Blantyre Malawi DREAM Program Community of sant'Egidio Rome Italy Department of Preventive Medicine LUMSA University Rome Italy

Combination antiretroviral therapy has been shown to reduce hiv transmission and incident infections. In recent years, Malawi has significantly increased the number of individuals on combination antiretroviral drugs through more inclusive treatment policies. Using a retrospective observational cohort design, records with hiv test results were reviewed for pregnant women attending a referral hospital in Malawi over a 5-year period, with viral load measurements recorded. hiv prevalence over time was determined, and results correlated with population viral load. A total of 11 052 women were included in this analysis, with 440 (4.1%) hiv infections identified. hiv prevalence rates in pregnant women in Malawi halved from 6.4% to 3.0% over 5 years. Mean viral loads of adult patients decreased from 120 000 copies/mL to less than 20 000 copies/mL. Results suggest that community viral load has an effect on hiv incidence rates in the population, which in turn correlates with reduced hiv prevalence rates in pregnant women. © The Author(s) 2014.

关键词： combination antiretroviral therapy hiv prevalence Malawi pregnant women

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Subnational mapping of hiv incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18: a modelling study

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The Lancet hiv 2021年第6期8卷 e363-e375页

作者： Sartorius, Benn VanderHeide, John D. Yang, Mingyou Goosmann, Erik A. Hon, Julia Haeuser, Emily Cork, Michael A. Perkins, Samantha Jahagirdar, Deepa Schaeffer, Lauren E. Serfes, Audrey L. LeGrand, Kate E. Abbastabar, Hedayat Abebo, Zeleke Hailemariam Abosetugn, Akine Eshete Abu-Gharbieh, Eman Accrombessi, Manfred Mario Kokou Adebayo, Oladimeji M. Adegbosin, Adeyinka Emmanuel Adekanmbi, Victor Adetokunboh, Olatunji O. Adeyinka, Daniel Adedayo Ahinkorah, Bright Opoku Ahmadi, Keivan Ahmed, Muktar Beshir Akalu, Yonas Akinyemi, Oluwaseun Oladapo Akinyemi, Rufus Olusola Aklilu, Addis Akunna, Chisom Joyqueenet Alahdab, Fares Al-Aly, Ziyad Alam, Noore Alamneh, Alehegn Aderaw Alanzi, Turki M. Alemu, Biresaw Wassihun Alhassan, Robert Kaba Ali, Tilahun Alipour, Vahid Amini, Saeed Ancuceanu, Robert Ansari, Fereshteh Anteneh, Zelalem Alamrew Anvari, Davood Anwer, Razique Appiah, Seth Christopher Yaw Arabloo, Jalal Asemahagn, Mulusew A. Asghari Jafarabadi, Mohammad Asmare, Wondwossen Niguse Atnafu, Desta Debalkie Atout, Maha Moh'd Wahbi Atreya, Alok Ausloos, Marcel Awedew, Atalel Fentahun Ayala Quintanilla, Beatriz Paulina Ayanore, Martin Amogre Aynalem, Yared Asmare Ayza, Muluken Altaye Azari, Samad Azene, Zelalem Nigussie Babar, Zaheer-Ud-Din Baig, Atif Amin Balakrishnan, Senthilkumar Banach, Maciej Bärnighausen, Till Winfried Basu, Sanjay Bayati, Mohsen Bedi, Neeraj Bekuma, Tariku Tesfaye Bezabhe, Woldesellassie M. Mequanint Bhagavathula, Akshaya Srikanth Bhardwaj, Pankaj Bhattacharyya, Krittika Bhutta, Zulfiqar A. Bibi, Sadia Bikbov, Boris Birhan, Tsegaye Adane Bitew, Zebenay Workneh Bockarie, Moses John Boloor, Archith Brady, Oliver J. Bragazzi, Nicola Luigi Briko, Andrey Nikolaevich Briko, Nikolay Ivanovich Burugina Nagaraja, Sharath Butt, Zahid A. Cárdenas, Rosario Carvalho, Felix Charan, Jaykaran Chatterjee, Souranshu Chattu, Soosanna Kumary Chattu, Vijay Kumar Chowdhury, Mohiuddin Ahsanul Kabir Chu, Dinh-Toi Cook, Aubrey J. Cormier, Natalie Maria Cowden, Richard G. Culquichicon, Carlos Dagnew, Baye Dahlawi, Saad M.A. D Centre for Tropical Medicine and Global Health Nuffield Department of Medicine University of Oxford Oxford United Kingdom Malaria Atlas Project University of Oxford Oxford United Kingdom The George Institute for Global Health University of Oxford Oxford United Kingdom Department of Health Metrics Sciences School of Medicine University of Washington Seattle WA United States Institute for Health Metrics and Evaluation University of Washington Seattle WA United States Department of Global Health University of Washington Seattle WA United States Department of Medicine University of Washington Seattle WA United States Insights Program Bill and Melinda Gates Foundation Seattle WA United States Global Programs Medical Teams International Seattle WA United States Department of Pediatric Newborn Medicine Brigham and Women's Hospital Boston MA United States Advanced Diagnostic and Interventional Radiology Research Center Tehran University of Medical Sciences Tehran Iran Multiple Sclerosis Research Center Tehran University of Medical Sciences Tehran Iran Department of Epidemiology and Biostatistics Tehran University of Medical Sciences Tehran Iran Pediatric Chronic Kidney Disease Research Center Tehran University of Medical Sciences Tehran Iran Department of Environmental Health Engineering Tehran University of Medical Sciences Tehran Iran Metabolomics and Genomics Research Center Tehran University of Medical Sciences Tehran Iran Research Center for Immunodeficiencies Tehran University of Medical Sciences Tehran Iran Department of Public Health Arba Minch University Arba Minch Ethiopia Department of Medical Laboratory Sciences Arba Minch University Arba Minch Ethiopia College of Medicine and Health Science Arba Minch University Arba Minch Ethiopia Department of Nursing Arba Minch University Arba Minch Ethiopia Department of Biomedical Sciences Arba Minch University Arba Minch Ethiopia Department of Public Health Debre Berhan University Debre Brehan

Background: High-resolution estimates of hiv burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess hiv incidence and hiv mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific hiv prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates hiv incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate hiv prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these hiv prevalence and treatment estimates to estimate hiv incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in hiv incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated hiv incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, hiv incidence ranged from 2·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and hiv mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique,

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Characterization of New hiv Infections among Adults ≥45 Years—New York City, North Carolina, San Francisco, 2011–2013

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S15-S15页

作者： Evans, Mary Patala, Anne Campbell, Ellsworth Westheimer, Emily Gay, Cynthia L Cohen, Stephanie E Switzer, William M Peters, Philip J Division of HIV and AIDS Prevention Centers for Disease Control and Prevention Atlanta Georgia Division of HIV and AIDS Prevention ICF International Atlanta Georgia Centers for Disease Control and Prevention Atlanta Georgia Bureau of HIV Prevention and Control New York City Department of Health and Mental Hygiene Queens New York North Carolina Department of Public Health Raleigh North Carolina Population Health San Francisco Department of Public Health San Francisco California

Background While hiv prevention activities are often focused on younger people, older people can also be at risk for hiv infection. We aimed to characterize hiv transmission in older adults. Methods The STOP study was a multi-site prospective study of persons with acute hiv infection (AHI) from 2011 to 2013. Older adults were defined as ≥45 years and younger persons were 13–44 years. AHI was defined by a negative rapid test but a reactive antigen/antibody or hiv RNA test. We performed bivariate analysis using Pearson’s chi-square and odds ratios to examine associations between older age and transmission characteristics. Among persons with hiv-1 polymerase ( pol) sequences, transmission linkages were inferred when the genetic distance between sequences was <1.5% and did not indicate directionality of transmission. Results Among 86,836 participants (median age, 29 years; 75.0% male; 51.8% MSM), hiv infection was diagnosed in 176 (1.46%) of 12,036 older adults compared with 1,150 (1.53%) of 74,800 younger people ( P = 0.56). Among hiv-infected persons, AHI was diagnosed in similar proportions of older and younger people (13.1% vs. 12.6%; P = 0.86). Among hiv-infected persons who participated in partner notification ( n = 1,326), older adults were less likely to report meeting a sex partner online (11.3% vs. 26.9%; OR 0.52, 95% CI = 0.35–0.78) and were less likely to name ≥2 sex partners (31.5% vs. 46.8%; OR = 0.28, 95% CI = 0.15–0.53) compared with younger people. Among hiv-infected persons with hiv-1 pol sequences ( n = 537), similar proportions of older and younger people had viruses that genetically linked with another study participant (15.9% vs. 23.5%; OR 0.62, 95% CI 0.31–1.22) (Figure). Conclusion In this study, older adults had a similar frequency of newly diagnosed hiv infection, acute infection, and genetic linkage compared with younger people, suggesting that increased hiv prevention efforts may be needed in this population. Open in a separate window Disclos

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Behavioral Risk Profile of Men Who Have Sex with Men in Beijing, China： Results from a Cross-sectional Survey with Randomized Response Techniques

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Chinese Medical Journal 2016年第5期129卷 523-529页

作者： Guo-Zhu Geng Ge Gao Yu-Hua Ruan Ming-Run Yu Yun-Hua Zhou Department of Epidemiology and Health Statistics School of Public Health Medical College of Soochow University Suzhou Jiangsu 215123 China Chinese Center for Disease Control and Prevention State Key Laboratory of Infectious Disease Prevention and Control Collaborativelnnovation Center for Diagnosis and Treatment of Infectious Diseases Beijing 102206 China Department of STD/AIDS and Dermatology Taizhou City Center for Disease Control and Prevention Taizhou Jiangsu 225300 China

Background：Human immunodeficiency virus （hiv） is spreading rapidly among men who have sex with men （MSM） in *** questionnaires or direct interviews have been frequently used to study their *** aim of the study was to describe the behavioral risk profile of the MSM in Beijing using the randomized response techniques （RRTs）.Methods：A cross-sectional survey of sexual behavior among a sample of MSM was conducted in two hiv counseling and testing clinics in *** survey was carried out with an anonymous questionnaire containing sensitive questions on sexual *** obtain the honest responses to the sensitive questions,three distinctive RRTs were used in the questionnaire：（1） Additive randomized response model for quantitative questions,（2） randomized response model for multiple choice questions,and （3） Simmons randomized response model for binomial *** for the point estimate,variance,and confidence interval （CI） were provided for each specific ***：Using RRTs in a sample of 659 participants,the mean age at first homosexual encounter was estimated to be 21.7 years （95% CI：21.2-22.2）,and each had sex with about three （2.9,95% CI：2.4-3.4） male partners on average in the past *** estimated rate for consistent condom use was 56.4% （95% CI：50.1-62.8%）.In addition,condom was estimated to be used among 80.0% （95% CI：74.1-85.9%） of the population during last anal sex with a male ***：Our study employed RRTs in a survey containing questions on sexual behavior among MSM,and the results showed that RRT might be a useful tool to obtain truthful feedback on sensitive information such as sexual behavior from the respondents,especially in traditional Chinese cultural settings.

关键词： Condom Use, Cross-sectional Survey： Men Who Have Sex with Men Randomized Response Technique, Sexual Behavior

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Screening for Comorbid Conditions Among People with hiv in Medical Care

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S210-S211页

作者： Lazar, Rachael Kersanske, Laura Braunstein, Sarah Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene Long Island City New York Massachusetts Department of Public Health Boston Massachusetts Bhiv Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene New York New York

Background A significant proportion of morbidity and mortality among people living with hiv (PLWH) is attributable to non-hiv comorbid conditions. Despite the importance of detecting and treating comorbidities among PLWH, screening rates for common comorbidities are often suboptimal and may not correspond with risk factor status. Methods Comorbidities screening and other clinical data were obtained from the 2012 New York City (NYC) Medical Monitoring Project (MMP), a multi-site surveillance project comprised of demographically representative cohorts of PLWH receiving medical care. MMP medical record abstraction data were analyzed to determine screening frequencies for potential comorbid conditions, including tuberculosis, hepatitis B and C, type 2 diabetes, and three sexually transmitted infections (STI), and to assess demographic and clinical factors associated with screening in the previous 12 months. Results In the NYC MMP cohort ( N = 439), 18% of patients were screened for hepatitis B, 26% for hepatitis C, 37% for type 2 diabetes, 38% for gonorrhea, 41% for chlamydia, 42% for tuberculosis, and 46% for syphilis in the past year. In multivariate analyses, having three or more medical visits with a CD4 count or viral load test during the year was significantly associated with STI screening (OR = 3.84, 95% CI: 1.94, 7.57) and hepatitis C screening (OR = 3.45, 95% CI: 1.65, 7.21). Hispanic PLWH were more likely to be screened for hepatitis C (OR = 1.72, 95% CI: 1.05, 2.81) and non-Hispanic Whites were less likely to be screened for type 2 diabetes (OR = 0.30, 95% CI: 0.10, 0.88), compared with non-Hispanic Blacks. Self-reported sexual risk behaviors and history of injection drug use were not associated with screening for STI and hepatitis C, respectively. Conclusion We found a range of screening frequencies for comorbid conditions among PLWH in medical care during 2012, indicating a need for improved integration of hiv care with other clinical services. More frequen

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Reporting and case management of occupational exposures to blood-borne pathogens among healthcare workers in three healthcare facilities in Tanzania

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Journal of Infection prevention 2016年第4期17卷 153-160页

作者： Lahuerta, Maria Selenic, Dejana Kassa, Getachew Mwakitosha, Goodluck Hokororo, Joseph Ngonyani, Henock Basavaraju, Sridhar V Courtenay-Quirk, Cari Liu, Yang Kazaura, Koku Simbeye, Daimon Bock, Naomi Boshe, Judith Antelman, Gretchen Mbatia, Redempta Austin, Angela Patnaik, Padmaja ICAP at Columbia University Mailman School of Public Health NY United States Department of Epidemiology Mailman School of Public Health Columbia University NY United States Divisions of Global HIV/AIDS Centers for Disease Control and Prevention (CDC) Atlanta GA United States Ministry of Health and Social Welfare Dar es Salaam Tanzania US Centers for Disease Control and Prevention (CDC) Dar es Salaam Tanzania Tanzania Health Promotion Support (THPS) Tanzania

Background: In sub-Saharan Africa, blood-borne pathogens exposure (BPE) is a serious risk to healthcare workers (HCW). Methods: We conducted a cross-sectional study assessing BPE among HCW at three public hospitals in Tanzania. From August to November 2012, HCW were surveyed using Audio-Computer Assisted Self-Interview. All HCW at risk for BPE were invited to participate. Factors associated with reporting BPE were identified using logistic regression. Findings: Of the 1102 eligible HCW, 973 (88%) completed the survey. Of these, 690 (71%) were women and 499 (52%) were nurses and nurse assistants. Of the 357 HCW who had a BPE (32%) in the previous 6 months, 120 (34%) reported it. Among these 120 reported exposures, 93 (78%) HCWs reported within 2 h of exposure, 98 (82%) received pre- and post-hiv test counselling, and 70 (58%) were offered post-exposure prophylaxis (PEP). Independent factors associated with reporting BPE were being female (adjusted odds ratio [AOR], 2.0;95% confidence interval [CI], 1.2–3.5), having ever-received BPE training (AOR, 2.0;95% CI, 1.2–3.5), knowledge that HCW receive PEP at another facility (AOR, 2.6;95% CI, 1.5–4.4), low/no perceived risk related to BPE (AOR, 4.2;95% CI, 1.9–9.4) and hiv testing within the past year (AOR, 2.3;95% CI, 1.2–4.4). Conclusion: These results highlight the importance of appropriate training on the prevention and reporting of occupational exposure to increase acceptance of hiv testing and improve access to PEP after BPE. © 2016, © The Author(s) 2016.

关键词： Africa Blood-borne pathogen exposures post-exposure prophylaxis reporting

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Clinician perspectives on delaying initiation of antiretroviral therapy for clinically eligible hiv-infected patients

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Journal of the International Association of Providers of aids Care 2015年第3期14卷 245-254页

作者： Beer, Linda Valverde, Eduardo E. Raiford, Jerris L. Weiser, John White, Becky L. Skarbinski, Jacek Division of HIV/AIDS Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA United States Division of Global HIV/AIDS Center for Global Health Centers for Disease Control and Prevention Atlanta GA United States Division of Infectious Diseases Department of Medicine University of North Carolina Chapel Hill NC United States

Objectives: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. Methods: In 2009, we surveyed a probability sample of hiv care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. Results: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. Conclusion: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.

关键词： adherence antiretroviral therapy clinical practice

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Evaluation of PIMA Point-of-care CD4 Analyzer in Yunnan, China

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Chinese Medical Journal 2015年第7期128卷 890-895页

作者： Jun Liang Song Duan Yan-Ling Ma Ji-Bao Wang Ying-Zhen Su Hui Zhang Chin-Yih Ou Ling Hao Ming-Shan Qi Marc Bulterys Larry Westerman Yan Jiang Yao Xiao Department of AIDS/STD Prevention National HIV/HCV Reference Laboratory National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Beijing 102206 China Department of Laboratory Tongzhou Blood Center Beijing 101100 China Department of AIDS/STD Prevention Dehong Prefecture Center for Disease Control and Prevention Dehong Yunnan 678400 China Department of AIDS/STD Prevention Yunnan Provincial Center for Disease Control and Prevention Kunming Yunnan 650022 China Global AIDS Program-China Office US Center for Disease Control and Prevention Beijing 100600 China International Laboratory Branch Division of Global HIV/AIDS Center for Global Health U.S. Centers for Disease Control and Prevention Atlanta GA 30329 USA

Background： CD4 count is used to determine antiretroviral therapy （ART） eligibility. In China, flow cytometers are mostly located in urban areas with limited access by patients residing in remote areas. In an attempt to address this issue, we conducted a study to validate the performance ofAlere PIMA point-of-care CD4 analyzer. Methods： Venous and finger-prick blood specimens were collected from hiv-positive participants from two voluntary counseling and testing sites in Yunnan Province. Both venous and finger-prick blood specimens were tested with the PIMA analyzer. Venous blood specimens tested with the Becton Dickinson FACSCalibur were used as a reference. Results： Venous specimens from 396 and finger-prick specimens from 387 persons were available for analysis. CD4 counts by PIMA correlated well with those from FACSCalibur with an R2 of 0.91 for venous blood and 0.81 for finger-prick blood. Compared to FACSCalibur, the PIMA analyzer yielded lower counts with a mean bias of- 47.0 cells/μl （limit of agreement, [LOA]： -204-110 cells/μl） for venous blood and -71.0 cells/μl （LOA： -295-153 cells/μl） for finger-prick blood. For a CD4 threshold of 350 cells/μl, the positive predictive value （PPV） of PIMA was 84.2% and 75.7% and the negative predictive value （NPV） was 97.6% and 95.8% for venous and finger-prick blood, respectively. For an ART threshold of 500 cells/μl, the corresponding PPV was 90.3% and 84.0% and NPV was 94.3% and 93.4%, respectively. Conclusions： CD4 counting using venous blood with PIMA analyzers is a feasible alternative to a large flow cytometer to determine ART eligibility.

关键词： CD4 Counts Finger-prick hiv Point-of-care Venous Blood

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