A Noninvasive Prediction Model for Hepatitis B Virus Disease in Patients with HIV: Based on the Population of Jiangsu, China

Objective. To establish a machine learning model for identifying patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through two sexual transmission routes in Jiangsu, China. Methods. A total of 14197 HIV cases transmitted by homosexual and heterosexual routes were recruited. After data processing, 12469 cases (HIV and HBV, 1033; HIV, 11436) were left for further analysis, including 7849 cases with homosexual transmission and 4620 cases with heterosexual transmission. Univariate logistic regression was used to select variables with significant P value and odds ratio for multivariable analysis. In homosexual transmission and heterosexual transmission groups, 10 and 6 variables were selected, respectively. For identifying HIV individuals coinfected with HBV, a machine learning model was constructed with four algorithms, including Decision Tree, Random Forest, AdaBoost with decision tree (AdaBoost), and extreme gradient boosting decision tree (XGBoost). The detective value of each variable was calculated using the optimal machine learning algorithm. Results. AdaBoost algorithm showed the highest efficiency in both transmission groups (homosexual transmission group: accuracy = 0.928 , precision = 0.915 , recall = 0.944 , F − 1 = 0.930 , and AUC = 0.96 ; heterosexual transmission group: accuracy = 0.892 , precision = 0.881 , recall = 0.905 , F − 1 = 0.893 , and AUC = 0.98 ). Calculated by AdaBoost algorithm, the detective value of PLA was the highest in homosexual transmission group, followed by CR, AST, HB, ALT, TBIL, leucocyte, age, marital status, and treatment condition; in the heterosexual transmission group, the detective value of PLA was the highest (consistent with the condition in the homosexual group), followed by ALT, AST, TBIL, leucocyte, and symptom severity. Conclusions. The univariate logistics regression combined with the AdaBoost algorithm could accurately screen the risk factors of HBV in HIV coinfection without invasive testing. Further studies are needed to evaluate the utility and feasibility of this model in various settings.

Analysis on the Trend of AIDS Incidence in Zhejiang, China Based on the Age-Period-Cohort Model from 2004 to 2018

Background: To predict the trend of acquired immune deficiency syndrome(AIDS) in specific age groups and to determine the objective population for AIDS screening, we explored the three transmission routes (homosexual transmission, heterosexual transmission, drug injection and others) and characterized each patients group using the Age-Period-Cohort(APC) model based on the whole, local and immigrant populations in Zhejiang, China.Methods: The data recruited in this paper was obtained from the national "Comprehensive AIDS Prevention and Control Information System - Antiviral Therapy Management" database and the Chinese Disease Prevention and Control Information System and the Statistical Yearbook of Zhejiang, China. An APC model was used to estimate the impact of age, period and cohort on the incidence rate of AIDS, and to predict the AIDS incidence rate in specific age groups based on sexes and transmission routes.Results: The AIDS incidence rate peaked in males between 20 and 35 years old; the incidence rate of males was higher than that of females due to the impact of period; obvious cohort effect was observed among the immigrants. In the whole and local populations, the incidence rates of males in all age groups and females in both the 35-year-old group and the whole age group were predicted to increase sharply in five years. In the immigrant population, the AIDS incidence rates of males and females in all age groups were expected to increase significantly in five years; influenced by age, the incidence of AIDS through homosexual transmission peaked between 20 and 35 years old in the whole and local populations; under the influence of period, the incidence of AIDS via homosexual transmission in the whole and local populations increased and remained stable after 2015, and the incidence of AIDS transmitted by homosexual and heterosexual routes in the immigrants also showed an increasing trend. As a result of the cohort effect, the incidence of AIDS transmitted through homosexual route among the whole and local populations peaked in 1990; the incidence of AIDS in all age groups through different transmission routes would show an upward trend over the next five years.Conclusions: The results elucidate that there are sex differences in AIDS incidence rate, and the incidence of AIDS through various transmission routes in all groups is predicted to exhibit an upward trend in the five years to come. Effective intervention strategies should be developed and implemented by the public health departments in Zhejiang to control the epidemic of AIDS.

Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk

Background: It is important to understand how HIV infection is transmitted in the population in order to guide prevention activities and properly allocate limited resources. In Ukraine and other countries where injecting drug use and homosexuality are stigmatized, the information about mode of transmission in case registration systems is often biased.Methods: We conducted a cross-sectional survey in a random sample of patients registered at HIV clinics in seven regions of Ukraine in 2013-2015. The survey assessed behavioral risk factors and serological markers of viral hepatitis B and C. We analyzed the discrepancies between the registered mode of transmission and the survey data, and evaluated trends over three years.Results: Of 2,285 participants, 1,032 (45.2%) were females. The proportion of new HIV cases likely caused by injecting drug use based on the survey data was 59.7% compared to 33.2% in official reporting, and proportion of cases likely acquired through homosexual transmission was 3.8% compared to 2.8%. We found a significant decrease from 63.2% to 57.5% in the proportion of injecting drug use-related cases and a steep increase from 2.5 to 5.2% in homosexual transmission over three years. Conclusions: The study confirmed the significant degree of misclassification of HIV mode of transmission among registered cases. The role of injecting drug use in HIV transmission is gradually decreasing, but remains high. The proportion of cases related to homosexual transmission is relatively modest, but is rapidly increasing, especially in younger men. Improvements in ascertaining the risk factor information are essential to monitor the epidemic and to guide programmatic response.

Prevalence of HIV Infection Among Foreign Applicant to Residency in Shanghai, China, 2005-2016

Background: Shanghai is an international city which has high proportion of entry travelers from all over the world. The HIV infection status of this population can reflect the global trend of HIV prevalence. Thus, a retrospective epidemic investigation was conducted to clarify the prevalence and characteristics of HIV infection among entry travelers who apply to residency in Shanghai. Methods: Totally 50830 entry travelers who applied to residency in Shanghai（2005-2016）were included. The HIV infection rate was confirmed based on the detection of HIV-1 antibody. Results: Among all the recruited entry travelers, 245 persons were determined HIV positive with infection rate of 0.48%. The detection rate of HIV in male was significantly higher than that in female (χ2=62.584, P<0.0001). Those aged 18-30 years, 31-40 years and >40years accounted for 34.3%, 39.6% and 26.1% of the infected population. There was no increase in trend of HIV prevalence rates among the sampling years (Cochran-Armitage Z=2.543, P=0.111). Proportions of individuals infected through homosexual transmission increased over the study period (Cochran-Armitage Z=5.41, P<0.001), while the proportion infected through heterosexual declined over time (Cochran-Armitage Z=3.38, P =0.001). Conclusion: The characteristics of HIV infection among foreign applicant to residency in Shanghai were clarified. The results would provide the necessary epidemiological data for monitoring the HIV epidemic among entry international travelers and contribute to the establishment of relevant policies and regulations for HIV control and prevention.

Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk

Background: It is important to understand how HIV infection is transmitted in the population in order to guide prevention activities and properly allocate limited resources. In Ukraine and other countries where injecting drug use and homosexuality are stigmatized, the information about mode of transmission in case registration systems is often biased.Methods: We conducted a cross-sectional survey in a random sample of patients registered at HIV clinics in seven regions of Ukraine in 2013-2015. The survey assessed behavioral risk factors and serological markers of viral hepatitis B and C. We analyzed the discrepancies between the registered mode of transmission and the survey data, and evaluated trends over three years.Results: Of 2,285 participants, 1,032 (45.2%) were females. The proportion of new HIV cases likely caused by injecting drug use based on the survey data was 59.7% compared to 33.2% in official reporting, and proportion of cases likely acquired through homosexual transmission was 3.8% compared to 2.8%. We found a significant decrease from 63.2% to 57.5% in the proportion of injecting drug use-related cases and a steep increase from 2.5 to 5.2% in homosexual transmission over three years. Conclusions: The study confirmed the significant degree of misclassification of HIV mode of transmission among registered cases. The role of injecting drug use in HIV transmission is gradually decreasing, but remains high. The proportion of cases related to homosexual transmission is relatively modest, but is rapidly increasing, especially in younger men. Improvements in ascertaining the risk factor information are essential to monitor the epidemic and to guide programmatic response.

Prevalence of HIV infection among foreign applicant to residency in Shanghai, China, 2005-2016

Background Shanghai is an international city which has high proportion of entry travelers from all over the world. The HIV(human immunodeficiency virus)infection status of this population can reflect the global trend of HIV prevalence. Thus, a retrospective epidemic investigation was conducted to clarify the prevalence and characteristics of HIV infection among entry travelers who apply to residency in Shanghai. Methods Totally 50830 entry travelers who applied to residency in Shanghai(2005-2016)were included. The HIV infection rate was confirmed based on the detection of HIV-1 antibody. Results Among all the recruited entry travelers, 245 persons were determined HIV positive with infection rate of 0.48%. The detection rate of HIV in male was significantly higher than that in female (χ 2 =62.584, P <0.0001). Those aged 18-30 years, 31-40 years and >40years accounted for 34.3%, 39.6% and 26.1% of the infected population. There was no increase in trend of HIV prevalence rates among the sampling years (Cochran-Armitage Z=2.543, P=0.111). Proportions of individuals infected through homosexual transmission increased over the study period (Cochran-Armitage Z=5.41, P<0.001), while the proportion infected through heterosexual declined over time (Cochran-Armitage Z=3.38, P =0.001). Conclusion The rate and characteristics of HIV infection among foreign applicant to residency in Shanghai were clarified in the study. The results would have provided the necessary epidemiological data for monitoring the HIV epidemic among entry international travelers and to further contribute to the establishment of relevant policies and regulations for HIV control and prevention.

Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk

Background It is important to understand how HIV infection is transmitted in the population in order to guide prevention activities and properly allocate limited resources. In Ukraine and other countries where injecting drug use and homosexuality are stigmatized, the information about mode of transmission in case registration systems is often biased. Methods We conducted a cross-sectional survey in a random sample of patients registered at HIV clinics in seven regions of Ukraine in 2013-2015. The survey assessed behavioral risk factors and serological markers of viral hepatitis B and C. We analyzed the discrepancies between the registered mode of transmission and the survey data, and evaluated trends over three years. Results Of 2,285 participants, 1,032 (45.2%) were females. The proportion of new HIV cases likely caused by injecting drug use based on the survey data was 59.7% compared to 33.2% in official reporting, and proportion of cases likely acquired through homosexual transmission was 3.8% compared to 2.8%. We found a significant decrease from 63.2% to 57.5% in the proportion of injecting drug use-related cases and a steep increase from 2.5 to 5.2% in homosexual transmission over three years. Conclusions The study confirmed the significant degree of misclassification of HIV mode of transmission among registered cases. The role of injecting drug use in HIV transmission is gradually decreasing, but remains high. The proportion of cases related to homosexual transmission is relatively modest, but is rapidly increasing, especially in younger men. Improvements in ascertaining the risk factor information are essential to monitor the epidemic and to guide programmatic response.

Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk

Background: It is important to understand how HIV infection is transmitted in the population in order to guide prevention activities and properly allocate limited resources. In Ukraine and other countries where injecting drug use and homosexuality are stigmatized, the information about mode of transmission among newly registered patients is often biased. Methods: We conducted a cross-sectional survey in a random sample of patients registered at HIV clinics in seven regions of Ukraine in 2015-2017. The survey assessed behavioral risk factors and serological markers of viral hepatitis B and C. We analyzed the discrepancies between the registered mode of transmission and the survey data, and evaluated trends over three years. Results: Of 2,285 participants, 1,032 (45.2%) were females. The proportion of new HIV cases likely caused by injecting drug use based on the survey data was 59.7% compared to 33.2% in official reporting, and proportion of cases likely acquired through homosexual transmission was 3.8% compared to 2.8%. We found a significant decrease from 63.2% to 57.5% in the proportion of injecting drug use-related cases and a steep increase from 2.5 to 5.2% in homosexual transmission over three years. Conclusions: The study confirmed the significant degree of misclassification of HIV mode of transmission among newly registered cases. The role of injecting drug use in HIV transmission is gradually decreasing, but remains high. The proportion of cases related to homosexual transmission is relatively modest, but is rapidly increasing, especially in younger men. Improvements in ascertaining the risk factor information are essential to monitor the epidemic and to guide programmatic response.

Epidemiological features and risk factors for acquiring Hepatitis B, Hepatitis C and syphilis in HIV-infected patients in Shaanxi Province, northwest China

Background HIV-infected patients are at higher risk for co-infection with Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Treponema pallidum (TP), the agent causing syphilis, than the general population. The prevalence of HBV, HCV, and syphilis had geographic differences and varied from region to region among HIV-infected patients. The aim of this study was to investigate the epidemiological features and risk factors of HBV, HCV, and syphilis infection in HIV-infected individuals in Shaanxi Province, northwest China. Methods A retrospective study was conducted with HIV-infected patients from June 2011 to June 2016 in Shaanxi Province. Sociodemographic data was captured from the national HIV/AIDS information system in China. Serological tests and analysis of CD4+ T-cell count levels were performed using standard procedures. Besides, the HIV infection time and age were presumed by CD4+ T-cell count levels. Results The average time from HIV infection to diagnosis was (4.7±2.4) years, and the HIV infection time ≥3 years accounted for 66.8%. Of the discovery routes, voluntary counseling & testing (VCT) only accounted for 20.7%. Among 1018 HIV-infected patients, the prevalence of HBV, HCV, and syphilis was 11.0%, 11.1%, and 26.0%, respectively. HBV-HCV, HCV-syphilis, HBV-syphilis, and HBV-HCV-syphilis co-infection was 1.7%, 2.2%, 2.6%, and 0.1%, respectively. The rate of ineffective vaccination against HBV was as high as 30.2% in HIV-infected patients. Ethnicity (OR=29.257, 95%CI: 11.243-76.133) and HIV transmission routes (OR=149.368, 95%CI: 16.590-1 344.861) were the risk factors of HCV infection in HIV-infected patients. In the HIV-infected patients with the antibody of Treponema pallidum, the rate of homosexual transmission was so higher but heterosexual transmission is lower (OR=0.548 95% CI: 0.382-0.786), suggesting that homosexual transmission might be a risk factor for HIV-syphilis co-infection. Conclusion The HIV-infected patients in Shaanxi Province had the characteristics of low active detection rate and late diagnosis. In addition, a high prevalence of HBV, HCV, and syphilis co-infection could be observed, and like HIV infection, they might not understand their HBV, HCV and syphilis infection status. At last, the high rate of ineffective vaccination against HBV suggests a need for improved vaccination services.

Epidemiological features and risk factors for acquiring Hepatitis B, Hepatitis C and syphilis in HIV-infected patients in Shaanxi Province, northwest China

Background HIV-infected patients are at higher risk for co-infection with Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Treponema pallidum (TP), the agent causing syphilis, than the general population. The prevalence of HBV, HCV, and syphilis had geographic differences and varied from region to region among HIV-infected patients. The aim of this study was to investigate the epidemiological features and risk factors of HBV, HCV, and syphilis infection in HIV-infected individuals in Shaanxi Province, northwest China. Methods A retrospective study was conducted with HIV-infected patients from June 2011 to June 2016 in Shaanxi Province. Sociodemographic data was captured from the national HIV/AIDS information system in China. Serological tests and analysis of CD4+ T-cell count levels were performed using standard procedures. Besides, the HIV infection time and age were presumed by CD4+ T-cell count levels. Results The average time from HIV infection to diagnosis was (4.7±2.4) years, and the HIV infection time ≥3 years accounted for 66.8%. Of the discovery routes, voluntary counseling & testing (VCT) only accounted for 20.7%. Among 1018 HIV-infected patients, the prevalence of HBV, HCV, and syphilis was 11.0%, 11.1%, and 26.0%, respectively. HBV-HCV, HCV-syphilis, HBV-syphilis, and HBV-HCV-syphilis co-infection was 1.7%, 2.2%, 2.6%, and 0.1%, respectively. The rate of ineffective vaccination against HBV was as high as 30.2% in HIV-infected patients. Ethnicity (OR=29.257, 95%CI: 11.243-76.133) and HIV transmission routes (OR=149.368, 95%CI: 16.590-1 344.861) were the risk factors of HCV infection in HIV-infected patients. In the HIV-infected patients with the antibody of Treponema pallidum, the rate of homosexual transmission was so higher but heterosexual transmission is lower (OR=0.548 95% CI: 0.382-0.786), suggesting that homosexual transmission might be a risk factor for HIV-syphilis co-infection. Conclusion The HIV-infected patients in Shaanxi Province had the characteristics of low active detection rate and late diagnosis. In addition, a high prevalence of HBV, HCV, and syphilis co-infection could be observed, and like HIV infection, they might not understand their HBV, HCV and syphilis infection status. At last, the high rate of ineffective vaccination against HBV suggests a need for improved vaccination services.