| Objective:To study the characteristics of behavior,psychology and neutralizing antibody activity of HIV infected long term non-progressors(LTNP)in Yunnan Province based on Bio-Psycho-Social medical model,and to analyze the influencing factors of HIV infected LTNP,and to provide a theoretical basis forlengthening the survival time and improving the quality of life of HIV infected patients.Methods:A 1:1 matched case-control study and HIV-1 fake virus neutralization test method were used.The all HIV infected who course long-term non-progressors(great than or equal to 10 years),could follow-up face-to-face,and voluntarily participated in the study were selected as the research object in YunnanProvince.HIV infectedLTNP in the case groupand the course of disease progression in the control group.The case data had been downloadedfrom the China disease prevention and control information system.The cases were qualitative interviewed face to face,and were assessed the mental health status by SCL-90.At the same time,10ml venous blood of HIV infectedLTNP were gained after obtaining the informed consent totestthe CD4+T count and HIV-1 false virus neutralization test.The influencing factors of HIV infectedLTNP were discussed from behavior,psychology,molecular epidemiology,and so on,through case control study,mental health status assessment,and neutralization studies.Using Epidata3.1 to establish the database,and use SPSS19.0 for data processingand statistical analysis.Result:1.General Characteristics1.1 The total cases are 240.120 cases were collected in to case group.Male accounted for90.00%(108/120),and female account for 10.00%(12/120),the sex ratio was 9:1.The average age was(39.37±4.21).Unmarried was majority,accounting for 59.17%(71/120).Majority educational background was junior middle school,accounting for 49.17%(59/120).Farmers were the main professional,accounting for 50.00%(60/120).91.67%(110/120)of the samples were the Han nationality.Most regional distribution in DeHong,accounting for 26.67%(32/120).Sample mainly comes from compulsory drug addiction rehabilitation personnel HIV test,accounting for 45.00%(54/120).120 cases were collected in to control group.Male accounted for84.17%(101/120),and female account for 15.83%(19/120),the sex ratio was 5:1.The average age was(39.98±4.61).Married was majority,accounting for 46.67%(56/120).Majority educational background was junior middle school,accounting for 57.50%(69/120).Farmers were the main professional,accounting for 45.83%(55/120).81.67%(98/120)of the samples were the Han nationality.Most regional distribution in DeHong,accounting for 30.00%(36/120).The basic information of the case group and control group have a good balance(P>0.05).1.2 Sexual behavior and condom useThe sexual behavior incidence and the rate of condom use of the case groupin the past 3 months respectively were 52.50%(63/120),95.23%(60/63).The sexual behavior incidence and the rate of condom use of the control groupin the past 3 months respectively were 73.33%(88/120),98.86%(89/88).The incidence of sexual behavior in the case group and the control group was statistically different(x2 =12.982,P=0.002).1.3 Injecting drug use and methadone maintenance treatment.The rate of injection drug users of the case group was32.50%(39/120)in the past 3 months,and the rate of injection drug users of the control group was 40.00%(48/120),the difference was not statistically significant(P>0.05).The case group and the control group wereneither have shared syringe injection drug use behavior.The rate of accept the community methadone maintenance treatment of the control group was 87.50%(105/120),and the control group was 1.67%(2/120),the difference was statistically significant(x2 =178.916,P<0.01)1.4 Single factor analysis Pearson chi-square test showed that the five factors with HIV infectedLTNP have statistical significance(P<0.05)as follows:route of infection(x2=12.963,P =12.963),CD4+T cell count of the first time(x2=169.133,P<169.133),the current infection status of spouse/Steady partners(x2=14.744,P =0.005),having sex in the past three months(x2=12.982,P =0.002),community methadone maintenance treatment(x2=178.916,P<178.916).1.5 Multivariate Cox regression model fitting 1:1 matching logistic analysis Multivariate Cox regression analysis showed that infected by injecting drug using(OR=0.152,P=0.036,95%CI:0.020-0.381),CD4+T cell count of the first time<350(OR=0.007,P?0.01,95%CI:0.000-0.099),not receiving methadone maintenance treatment(OR=0.002,P<0.01,95%CI:0.000-0.020)were promoting factors of HIV infected progression(OR<1).2.Psychological Characteristics2.1 The case group and the control group compared with the adult norm in SCL-90 scoreHaving multivariate analysis of variance,homogeneity of variance(P>0.05).Results showed that the case group,the control group and the adult norm in the total score(F=13.098,P<0.01),the total split score(F=10.407,P =0.001)and 10 factors score difference had statistical significance(P<0.05)as follows:summarizations(F=9.302,P=0.006),forced symptoms(F=5.137,P=0.033),the sensitive interpersonal relationship(F=11.083,P<0.01),depression(F=8.761,P =0.009),anxiety(F=9.450,P=0.021),hostility(F=6.103,P=0.030),the terrorist(F=10.452,P=0.002),paranoid(F=6.446,P=0.043),psychotic(F=12.303,P<0.01),and additional factors(F=5.322,P=0.029),which showed that the case group,the control group and the national adult norm have difference in the mental health.2.2 LSD-t test on the case group,the control group compared with the adult norm in SCL-90 scoreLSD-t test showed that the SCL-90 score of the case group and the control group higher than the national adult norm in the total score,the total splitscore and 10 factors score as follows:somatization,force symptom,the sensitive interpersonal sensitivity,depression,anxiety,hostility,terror,paranoia,psychosis,and additional factors,the difference have statistically significant(P<0.05).This showed that HIV infected had more serious psychological problems compared with the adult norm.At the same time,the SCL-90 score of the case group lowerthan the control groupin the total score,the total splitscore and 6 factors score as follows:somatization,the sensitive interpersonal sensitivity,depression,anxiety,terror,and psychosis,the difference have statistically significant(P<0.05).This showed thatHIV infected LTNPmuch less psychological problems than HIV infected progression.3.Biological factors:characteristics of serum neutralizing antibody3.1 IC50 to pseudovirus CNE5,CNE11,CNE15,JRFL,SF162 in long-term non-progressors group were 490.07±898.369,493.27±1362.026,440.9±1803.604,315.75±962.3,839.5±679.975;IC50 to pseudovirus CNE5,CNE11,CNE15,JRFL,SF162 in progressors group were 40.15±82.919,162.42±342.806,223.91±374.784,185.92±537.171,305.2±386.507?3.2 Compared the neutralization effect for 5 different pseudoviruses between long-term non-progressors group and preogressors group.IC50 in long-term non-progressors group was higher than in progressors,and the difference was statistically significant(P<0.05).3.3 According to IC50 values,neutralization effect was divided into very strong effect(IC50>540),strong effect(IC50181-540),medium effect(IC5061?180),weak effect(IC5021?60)and no effect(IC50?20).The amount of cases of very strong and strong effect to pseudovirus were 45,44,37,37,107 in long-term non-progressors group and 3,16,39,20,73 in progressors group.To pseudovirus CNE5?CNE11.JRFL?SF162,cases in long-term non-progressors group were more than in progressors group,and the difference was statistically significant(P<0.05).3.4 In long-term non-progressors group,case 89?83?54?46?94?103?71?61?62?78?88 had very strong effect to more than 3 pseudoviruses.Conclusion:HIV infected long term non-progressorsin Yunnan Province are influenced by many factors,which could introducethe mode of "biology-psychology-social medicine".1.Social factors:infected by injecting drug using but not receiving methadone maintenance treatment were promoting factors of HIV infected progression.2.Psychological factors:compared with the adult norm,HIV infected LTNP and typical progress are serious mental health problems.HIV infected LTNP in mental health is better than typical progress,there was mainly manifested in these areas:somatization,interpersonal sensitivity,depression,anxiety,terror,psychotic.3.Biological factors:3.1 High level of CD4+ T cell count of the first time was a protective factor for non-progressor.3.2 The neutralization effect was stronger and neutralization width was wider in long-term non-progressors than progressors.Neutralizing antibody was a very important protective factor for non-progress.Neutralization effect was very strong to different pseudoviruses in several LTNP cases which means presence of broadly neutralizing antibody. |
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