Study On Epidemiological Characteristics Of 371 HIV Infected Men Who Have Sex With Men And Influencing Factors Of CD4/CD8 Ratio In Guangxi

Objective:To understand the main epidemiological characteristics of HIV-infected men who have sex with men（MSM）in Guangxi,and investigate the distribution of their genotype;To understand the status of antiviral treatment of MSM HIV-infected people,and to analyze the factors that affect the change in the CD4/CD8 ratio after treatment,so as to provide reference for future prevention and control measures in MSM population.Methods:From March to July 2018,MSM patients diagnosed with HIV/AIDS and treated in the outpatient care clinic of the Guangxi Center for Disease Prevention and Control were recruited as subjects for questionnaire survey and follow-up.Using some self-designed questionnaires,combined with the information available in the National AIDS Comprehensive Prevention Information System,the demographic characteristics,behavioral characteristics,sexually associated HIV infection,reasons for HIV detection,time of HIV/AIDS diagnosis,date of antiviral treatment,age of treatment,CD4 cell,CD8 cell,viral load and treatment plan of the subjects were collected.Results:1.Epidemiological characteristics:A total of 371 cases of HIV infected with male sex were collected.The majority of MSM HIV infected persons were rural registered permanent residence（55.26%）,Han nationality（58.76%）,unmarried（85.98%）,college degree or above（62.45%）.Among the occupations distributed,mainly working in enterprises or companies（35.86%）.90.03%find sexual partners through online dating software,and 71.97%had three or more male sexual partners;52.83%had no spouse or permanent partner;the proportion of spouses or fixed sexual partners who are HIV positive is10.78%.The proportions of using condoms each time when having behaviors with spouse/female fixed sexual partners,male regular partners,and male temporary sexual partners were 38.14%,46.39%,and 42.27%.Among them,14.82%（55/371）had used some drugs or aphrodisiac drugs in the past,and85.45%（47/55）of them had used nitrite drugs.28.03%of the patients were found to be infected with HIV through high-risk behaviors,and 26.42%through voluntary testing and counseling.2.Genotype:Among the blood samples of 371 MSM HIV/AIDS patients,192 samples（51.75%）were successfully typed based on the extraction,amplification,sequencing,successful splicing and phylogenetic tree judgment.Seven subtypes were detected,which were CRF01＿AE（40.63%）,CRF07＿BC（40.63%）,CRF55＿01B（6.77%）,URFS（29.69%）,B（1.56%）CRF68＿01B（0.52%）and C（0.52%）;Among them,CRF01＿AE is the most common subtype.There was significant difference in the distribution of HIV genotype who had used drugs or aphrodisiac drugs in the past（χ²=8.623,P=0.029）.3.Antiviral treatment:The median age of MSM HIV/AIDS patients starting antiviral therapy was 26 years（P25～P75:22～31）,mainly 21～30 years（58.92%）.The median time from diagnosis to treatment was 2.57 weeks（P25～P75:1.43～8.64）,and 63.51%could be treated within 4 weeks after diagnosis.The median number of CD4 cells before treatment was 360 cells/μL（P25～P75:267.50～463.25）;and the median CD4/CD8 ratio before treatment was 0.29（P25～P75:0.21～0.42）.The median duration of treatment was 55.00months（P25～P75:40.00～72.00）,and 164 cases（44.93%）were treated for 5years or more.The proportion of virological failure was 1.37%（5/365）,and the proportion of immunological failure was 6.85%（25/365）.4.CD4 cells and CD4/CD8 ratio Changes:CD4 cells and CD4/CD8 ratio has increased to varying degrees,and the rate of increase was relatively fast within 6 to 11 months of treatment,but relatively slow after 12 months.The median increase of CD4 cells was 249.00 cells/μL（P25～P75:127.00～411.00）,and the median increase of CD4/CD8 ratio was 0.45（P25～P75:0.28～0.65）.The proportion of CD4 cells≥500 cells/μL increased from 20.77%to 70.16%(χ²_trend=173.864,P<0.05);the proportion of CD4/CD8 ratio≥0.61 increased from 7.89%to 74.10%(χ²_trend=329.197,P<0.05);the proportion of CD4/CD8ratio≥1 increased from 0.56%to 29.18%(χ²_trend=132.548,P<0.05).After treatment,the CD4/CD8 ratio of different CD4 cell levels increased to varying degrees,and the ratio of CD4 cells<200 cells/μL increased slowly before treatment.During the follow-up,the proportion of CD4 cells≥500 cells/μL was68.77%（251/365）;the proportion of CD4/CD8 ratio≥1 was 26.85%（98/365）,and the proportion of CD4/CD8 ratio returning to normal was 35.45%（89/251）in patients with CD4 cells≥500 cells/μL.5.Multivariate analysis results:The protective factors for recovery of CD4/CD8 ratio were age≥41 years old（OR=0.180,95%CI:0.038～0.841）,and CD4 cells before treatment were 350～499 cells/μL（OR=0.199,95%CI:0.043～0.935）,CD4 cells≥500 cells/μL before treatment（OR=0.082,95%CI:0.014～0.478）,CD4/CD8 ratio≥0.61 before treatment（OR=0.112,95%CI:0.018～0.679）,treatment time of 60～71 months（OR=0.279,95%CI:0.092～0.874）and treatment time of≥72 months（OR=0.232,95%CI:0.080～0.879）.The risk factors for CD4/CD8 ratio recovery were:CD8 cells≥1150 cells/μL before treatment（OR=3.934,95%CI:1.217～12.725）.Conclusion:1.The main characteristics of MSM HIV/AIDS patients are young,Han nationality,unmarried,college degree or above,and wide occupation distribution;the main way to find sexual partners is online dating software;more than half of the infected people have no spouses or regular sexual partners;weak security measures were taken when the behavior occurred.2.The HIV genotype of MSM patients treated at the Guangxi Center for Disease Prevention and Control was predominantly CRF01＿AE,followed by CRF07＿BC and URFs.3.More than half of MSM HIV/AIDS patients can be treated as early as possible;CD4 cell count and CD4/CD8 ratio increased to varying degrees after antiviral treatment,and the CD4/CD8 ratio increased slowly in patients with less than 200 CD4 cells/μL before treatment.The ratio of CD4 cell count≥500cells/μL and CD4/CD8 ratio≥1 showed an increasing trend;most MSM patients can return to normal CD4 cell counts,and a small number of MSM HIV/AIDS patients can return to normal CD4/CD8 ratios.Although the CD4/CD8 ratio of most patients increased,it still did not return to normal.4.The factors that promote the recovery of the CD4/CD8 ratio in MSM HIV/AIDS patients were treatment age≥41 years,CD4 cells≥350 cells/μL before treatment,CD4/CD8 ratio≥0.61 before treatment and treatment time≥60months;the risk factor for CD4/CD8 ratio recovery was CD8 cells≥1150cells/μL before treatment.