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Background HIV-related stigma among people living with HIV/AIDS (PLWHA) has been associated with many negative consequences, including poor adherence to therapy and undue psychological stress. However, the relative influence of specific demographic and situational factors contributing to HIV-related stigma among rural PLWHA in central China remains unknown. The aim of this study was to explore the level of HIV-related stigma among rural PLWHA across specific demographic and situational factors in central China. Methods A cross-sectional study was conducted among PLWHA receiving care through the Chinese Centers for Disease Control of Zhenping county in Henan Province, China. Participants completed a 55-item questionnaire which included demographic and disease-related factors, HIV-related stigma was measured utilizing the validated Berger HIV Stigma Scale which has good psychometric characteristics in Chinese PLWHA. Results A total of 239 PLWHA completed the survey. The mean total HIV-related stigma score was 105.92 (SD = 12.35, 95% CI: 104.34, 107.49). Multivariable linear regression analysis revealed a higher level of HIV-related stigma in younger PLWHA (β = − 0.57, 95% CI = − 0.78,-0.35, p<0.001) and those who self-reported opportunistic infections (β = 6.26, 95% CI = 1.26, 11.26, p < 0.05). Conclusions The findings in the current study suggest that rural PLWHA in central China suffer from the burden of HIV-related stigma at a moderate to high level. Younger PLWHA and PLWHA that have opportunistic infections tend to perceive a higher level of HIV stigma.

Background Osteoporosis has emerged as an important comorbidity for people living with HIV (PLWH) as life expectancy for this population has increased in the anti-retroviral therapy era. In countries lacking a robust primary care system such as China, chronic co-morbidities of HIV such as osteoporosis and fractures may be particularly under-recognized. Understanding barriers and opportunities for integration of bone health promotion strategies into current HIV care settings can aid in bone health program development and may provide a model of primary/secondary preventive care that is currently lacking. Methods Adopting grounded theory approach, we conducted a qualitative research study between April-July 2021. In-depth interviews were carried out with 13 HIV care providers, including physicians and nurses involved in both clinical care and coordination of HIV care services, from four cities across China. Two independent coders applied the constant comparison method for transcript analysis on providers’ current knowledge and practices on bone health in HIV, as well as opportunities and barriers to future program development. Results Interviewed providers recognized osteoporosis as a topic of increasing importance in long-term HIV care yet conceded that bone health received less priority than other aging-related comorbidities in routine HIV care. They reported receiving little formalized training on managing osteoporosis and limited access to education on this topic due to financial and human resources constraints. However, providers saw significant potential for program development in three key areas: creation and adoption of population-specific guidelines for osteoporosis prevention, screening, and management practices; increased access to training regarding osteoporosis screening, interpretation of results, and management algorithms; and development of structured interdisciplinary care services and referral networks. Conclusions Osteoporosis is an issue of increasing importance for the comprehensive care of PLWH. Population-specific recommendations on prevention, screening and management of osteoporosis, targeted education programs and tools, and innovative interdisciplinary expansion of current HIV care networks were identified by HIV care providers as key strategies for osteoporosis and fracture prevention and broader promoting bone health among Chinese PLWH.

Background Patients with rheumatoid arthritis (RA) are at increased risk of fractures. Although their decline in bone mineral density (BMD) is well-established, data regarding the alterations in bone microarchitecture are limited. In this study, we aimed to evaluate bone microarchitecture, geometry, and volumetric BMD among patients with RA in mainland China using high-resolution peripheral quantitative computed tomography (HRpQCT). Methods In this cross-sectional study, patients with RA were recruited from the Peking Union Medical College Hospital site of the Chinese Registry of rhEumatoiD arthrITis (CREDIT). Each participant underwent HRpQCT scanning (Scanco XtremeCT II), thoracolumbar X-ray and dual-energy X-ray absorptiometry. The primary outcomes were HRpQCT-related measures at distal radius and tibia. Data regarding demographic features, RA-related characteristics, and history of fragility fractures were collected. Correlation between HRpQCT parameters and potentially related factors were analyzed using linear regression analysis. A group of age- and sex-matched healthy controls was included for comparison. Results A total of 81 patients with RA [69 women, aged 57.9 ± 8.7 years, disease duration 5.7 (IQR 1.4–11.2) years] and 81 matched healthy controls were included. Compared with controls, patients with RA had significantly larger bone area and lower total and trabecular vBMD at both the distal radius and tibia. Lower cortical bone thickness was also shown at the distal tibia. Among patients with RA, advanced age, low BMI, female sex, disease duration, and activity were associated with decreased vBMD and impaired bone microstructure. Female reproductive factors including menopause, late menarche, breast feeding, and early childbirth also showed negative correlation with these parameters. Compared to patients with RA without fractures, patients with fragility fractures ( n  = 11) showed lower trabecular and cortical vBMD, thinner cortical bone, impaired trabecular microstructure, and a trend of declined bone strength. Current glucocorticoid intake was related to decreased vBMD, trabecular number, increased trabecular separation, and inhomogeneity. Conclusions In this study, we observed alterations in bone mineral density, geometry, and microarchitecture among patients with RA compared to healthy individuals, which may impair bone strength and lead to increased risk of fractures. Both traditional risk factors for osteoporosis and RA-associated factors need to be considered in the assessment of the bone quality.

Introduction With the global scale-up of antiretroviral therapy (ART) and improved life expectancy, people living with HIV (PLWH) increasingly face non-infectious comorbidities, and metabolic syndrome (MetS) is one of the most prevalent. MetS is associated with unfavorable health outcomes, including cardiovascular disease, chronic kidney disease, and metabolic dysfunction-associated fatty liver disease. However, data on the prevalence and risk factors of MetS among treatment-naïve PLWH in China are limited. The aim was to investigate the prevalence and risk factors of MetS and to understand its association with multi-organ damage. Methods Data on sociodemographic, physical, and clinical characteristics were collected from a completed multicenter, prospective cohort study in China. MetS was diagnosed according to criteria proposed by the China Diabetes Society. Univariate and multivariable logistic regression were applied to identify associated risk factors for MetS. The relationship with organ damage, including kidney, liver, heart, and bone health, were also been assessed. Results Among the 449 participants (median age 30 years; 92.9% male), 16.9% met the criteria for MetS. Patients met MetS criteria in our study presented with low HDL-C concentration (49.8%), hypertriglyceridemia (26.1%), hypertension (23.1%), hyperglycemia (15.4%), and abdominal obesity (8.0%). Risk factors significantly associated with MetS included older age (OR 1.08; 95% CI 1.02–1.15) and alcohol consumption (OR 3.63; 95% CI 1.13–11.67). PLWH with MetS exhibited higher level of organ involvement, including reduced kidney function, elevated liver enzymes, and increased risks for cardiovascular events. Among them, 162 participants (36.0%) were classified as being at moderate or high risk using pooled cohort equations (PCEs). It is worth noting that in the MetS group, the dropped bone mineral density (BMD) in the spine decreased more significantly than that of the non-MetS group ( P  = 0.007). Conclusion The incidence of MetS in ART-naïve PLWH in China is relatively high. Older age and alcohol consumption are associated with higher risk of MetS. Multiple organ damage may occur accompanied with MetS. Early identification and intervention are critical in managing MetS in PLWH.

Studies have shown that women aging with HIV have significantly lower health-related quality of life (HRQoL) compared to women without HIV. However, no studies have examined this issue in Latin America and the Caribbean. We aimed to explore HRQoL measured by the 36-Item Short Form Health Survey (SF-36) among women aging with and without HIV in Peru. We conducted a cross-sectional study at a large HIV-clinic in Peru. Outcomes of the SF-36 were evaluated, exploring the relationship between physical activity (International Physical Activity Questionnaire), sociodemographic factors (ethnicity, alcohol/tobacco use, age, BMI) and clinical data (AIDS progression, treatment duration, CD4+ cell count and viral load, years since HIV diagnosis) with HRQoL using regression analysis. Statistical significance was set with a two-tailed p-value <0.05. We enrolled 427 women (175 HIV-infected) with mean age of 54±8 years. From the SF-36 individual domains: physical functioning, role limitations due to physical and emotional health, and emotional wellbeing were significantly lower for HIV-infected women. Summary component scores were lower for the HIV-subset for both physical (45.8 vs 47.3) and mental (45.1 vs 45.8) components, although they did not achieve statistical significance. Regression analysis of the HIV-infected women revealed that the physical component score was significantly associated with physical activity, ethnicity, and chronic comorbidities while the mental component was significantly associated with physical activity, employment, and CD4+ cell count. In our study, HIV-infected women scored lower in both physical and mental component scores. Important determinants for each component included CD4+ cell count as an assessment of HIV severity for the mental component, and ethnicity, reflecting socio-cultural factors, for the physical component. These results reveal the importance of a holistic approach to addressing HRQoL in this population. Better understanding of these factors will help shape future policies and interventions to improve HRQoL of women aging with HIV.

Autosomal dominant hypophosphatemic rickets (ADHR) is a rare hereditary disorder characterized by variant onset ages and diverse phenotypes. Our aim is to explore the genotype–phenotype correlations between ADHR patients with R176 and R179 mutations in FGF23 gene. Clinical manifestations, laboratory examinations, and genetic analyses were collected from 20 patients in six Chinese ADHR kindreds in our hospital. Previously published ADHR literatures were reviewed. Among 20 Chinese ADHR mutation carriers, 11 patients revealed overt symptoms. 10/11 (90.9%) of which were females. Patients with R179 mutations presented with earlier onset than those with R176 mutation [1.3 (1.0, 37.0) years vs. 28.5 (19.0, 44.0) years]. More patients with R179 mutations had a history of rickets with lower extremity deformity [3/4 (75%) vs. 1/7 (14.3%), p < 0.05]. The serum phosphate, i-FGF23 and c-FGF23 levels of patients with R179 and R176 mutations were 0.47 ± 0.14 mmol/L versus 0.57 ± 0.17 mmol/L, 79.6 ± 87.0 pg/mL versus 79.9 ± 107.4 pg/mL, and 33.4 ± 3.0 RU/mL versus 121.3 ± 177.6 RU/mL, respectively. 7/11 of patients had iron deficiency at onset of disease. When combined with previously reported seven ADHR families, difference was observed in the age of onset among symptomatic patients with R179 and R176 mutations [1.0 (0.9, 37.0) years vs. 24.5 (1.2, 57.0) years, p < 0.05]. Patients with R179 mutation were more likely to have rickets than R176 mutation (11/13, 84.6% vs. 5/20, 25.0%, p < 0.01) and lower extremity deformity (10/13, 76.9% vs. 6/19, 31.6%, p < 0.01). ADHR patients with R179 mutations had earlier onset age and more rickets compared to those with mutations in R176, which partially explained the clinical heterogeneity of ADHR.

Background Cardiovascular disease (CVD) is an important cause of mortality among HIV-infected patients, however little is known about the burden of CVD among this population in Asia. We sought to quantify prevalence of CVD risk factors, 10-year CVD risk, and patterns of CVD risk factor treatment in a group of individuals with HIV in China. Methods We retrospectively analyzed baseline data from treatment-naïve HIV-infected adults enrolled in two multicenter clinical trials in China. Data regarding CVD risk factors such as smoking, hypertension, diabetes, dyslipidemia and obesity were assessed. The Framingham Risk Score (FRS) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk scores were calculated to estimate 10-year CVD risk. The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score was used to identify individuals meeting criteria for lipid-lowering therapy. Results In total, 973 patients were included in the analysis. Mean age was 36.0 ± 10.2 years and 74.2% were men. The most common CVD risk factors were dyslipidemia (51.7%) and smoking (23.7%). Prevalence of hypertension, diabetes and obesity were 8.4%, 4.6% and 1.0%, respectively. Over 65% of patients had at least one CVD risk factor. The prevalence of 10-year risk of CVD ≥10% was 4.5% based upon FRS and was 3.3% based upon D:A:D risk score. Few patients with dyslipidemia, hypertension or diabetes were on treatment. Conclusions CVD risk factors are common but under-treated among Chinese treatment-naïve individuals with HIV. Future interventions should focus on training HIV providers to appropriately recognize and manage CVD risk factors during routine clinical assessments.

Background Life expectancy among persons living with HIV (PLWH) has improved with increasing access to antiretroviral therapy (ART), however incidence of chronic comorbidities has simultaneously increased. No data are available regarding the incidence of hypertension among Chinese PLWH. Methods We analyzed data collected from patients enrolled in two prospective longitudinal multicenter studies of PLWH initiating ART in China. Incidence rate of hypertension per 100 person-years (PYs) among PLWH was calculated, and Cox proportional hazards models was used to evaluate the association between incident hypertension and traditional and HIV-associated risk factors. Results Of 1078 patients included in this analysis, 984 ART-naïve patients were hypertension-free at baseline, and contributed 2337.7 PYs of follow up, with a median follow-up period of 1.8 years (range: 1.2–3.2) after initiation of ART. Incidence of hypertension was 7.6 [95% confidence interval (CI): 6.5–8.7] per 100 PYs. In the Cox regression analysis, incidence of hypertension was positively associated with body mass index [adjusted hazard ratio (aHR) 1.07 (1.01,1.13), p  = 0.02] and recent viral load (aHR 1.28, 95% CI:1.08–1.51, p  < 0.01), and negatively associated with recent CD4+/CD8+ ratio (aHR 0.14, 95% CI:0.06–0.31, p  < 0.001), zidovudine exposure (aHR 0.15, 95% CI: 0.10–0.24, p  < 0.001) and tenofovir disoproxil fumarate exposure (aHR 0.13, 95% CI: 0.08–0.21, p < 0.001). Conclusions The incidence of hypertension was relatively high among Chinese PLWH initiating ART. Recent low CD4+/CD8+ ratio and detectable HIV viremia were associated with incident hypertension, whereas receipt of ART was associated with reduced risk. Hypertension may be mitigated, in part, by excellent HIV care, including viral suppression with ART. Trial registration ClinicalTrials.gov Identifier: NCT00872417 registered on 31 March, 2009, and NCT01844297 registered on 1 May, 2013.

Background The impact of HIV-1 subtype (CRF01_AE and non-CRF01_AE) on HIV-1 DNA levels in HIV-1 chronically infected patients with suppressive antiretroviral therapy (ART) remains poorly understood. To evaluate the correlation of HIV-1 subtype with DNA level, and identify baseline predictors of HIV-1 DNA decay. Methods ART-naïve HIV-1-infected patients from two large multi-center studies in China were classified into CRF01_AE and non-CRF01_AE subtype groups. Peripheral blood samples were collected at baseline and week 12, 24, 48 and 96 after ART initiation and total HIV-1 DNA levels were quantified by real-time PCR. HIV-1 DNA levels at week 96 were categorized into high, moderate, and low levels, reflecting HIV-1 DNA ≥ 3, 2–3, ≤ 2 log 10 copies/10 6 PBMCs, respectively, and the corresponding proportion of CRF01_AE and non-CRF01_AE subtype were compared. The baseline predictors of low HIV-1 total DNA levels (≤ 2 log 10 copies/10 6 PBMCs) at week 96 were evaluated using a logistic regression model. Results Compared to the non-CRF01_AE subtypes ( n  = 185), patients with CRF01_AE subtype ( n  = 188) harboured a higher level of HIV-1 DNA (median: 3.19 vs. 2.95 log 10 copies/10 6 PBMCs, P  < 0.001) prior to treatment. After 96 weeks of ART, HIV-1 DNA levels remained higher in the CRF01_AE subtype group (median: 2.63 vs. 2.39 log 10 copies/10 6 PBMCs, P  = 0.002). There was no significant difference in the proportion of patients achieving high (22.3% vs. 14.6%, P  = 0.054), moderate (59.6% vs. 60.5%, P  = 0.849) and low levels (18.1% vs 24.9%, P  = 0.111) between CRF01_AE and non-CRF01_AE groups. In the multivariable analysis, baseline HIV-1 DNA level and CD4 + T cell count but not the subtype were independent risk factors for achieving HIV-1 DNA level ≤ 2 log 10 copies/10 6 PBMCs. Conclusion HIV-1 CRF01_AE subtype is neither correlated with HIV-1 DNA reservoir decline nor a prognostic factor for achieving lower HIV-1 DNA levels (≤ 2 log 10 copies/10 6 PBMCs) after ART. However, higher HIV-1 DNA level in HIV-1 CRF01_AE patients should be aroused much attention and strengthen surveillance during ART.

Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings. We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda. Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes. Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities. Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients' social support networks.