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Background Tianjin, a major hub in northern China, faces rising HIV-1 infections dominated by CRF01_AE and CRF07_BC. This study elucidated their divergent transmission patterns and drug resistance dynamics to guide targeted interventions. Methods This study included samples identified as CRF01_AE and CRF07_BC subtypes through various methods between 2013 and 2022. BEAST software was used to examine the spatiotemporal transmission patterns of these subtypes in Tianjin. By integrating HIV-TRACE, we constructed high-risk transmission clusters and identified drug resistance mutations (DRMs) based on the Stanford HIV Drug Resistance Database. Finally, the birth–death skyline serial (BDSKY) model was employed to dynamically assess the effective reproductive number (Re) of both subtypes to predict future transmission dynamics. Results CRF01_AE might be introduced in 1988 from Henan and Zhejiang, forming multiple small clusters (< 10 nodes) and spreading through both heterosexual and men who have sex with men (MSM) in Tianjin, while CRF07_BC from Chongqing and Guizhou, et al. in 2004, experiencing explosive local transmission and forming a large cluster of 170 nodes primarily among MSM under 30 years old ( P  < 0.05). Phylogenetic analysis indicated that CRF01_AE has a significantly higher evolutionary rate (2.08 × 10⁻ 3 vs. 1.48 × 10⁻ 3 substitutions/site/year, P  < 0.05), while CRF07_BC demonstrates a greater cluster formation capacity (56.6% vs. 37.1%, P  < 0.05). CRF01_AE showed a higher mutation occurrence rate (5.18% vs. 2.49%, P < 0.05), particularly with non-nucleoside reverse transcriptase inhibitor (NNRTI) associated mutations (e.g., K101E). Although CRF07_BC had a lower resistance burden, the emergence of K103E mutations suggests a need for vigilance regarding potential decreases in sensitivity to newer NNRTIs. BDSKY modeling revealed that the Re for CRF01_AE dropped below 1 after 2016, whereas CRF07_BC’s Re remains above 1, indicating that the risk of transmission still exists. Conclusion Subtype-specific strategies are critical: intensified resistance monitoring for CRF01_AE and cluster-focused interventions for CRF07_BC, particularly among young MSM.

Tianjin, a major hub in northern China, faces rising HIV-1 infections dominated by CRF01_(A)E and CRF07_(B)C. This study elucidated their divergent transmission patterns and drug resistance dynamics to guide targeted interventions. This study included samples identified as CRF01_(A)E and CRF07_(B)C subtypes through various methods between 2013 and 2022. BEAST software was used to examine the spatiotemporal transmission patterns of these subtypes in Tianjin. By integrating HIV-TRACE, we constructed high-risk transmission clusters and identified drug resistance mutations (DRMs) based on the Stanford HIV Drug Resistance Database. Finally, the birth-death skyline serial (BDSKY) model was employed to dynamically assess the effective reproductive number (Re) of both subtypes to predict future transmission dynamics. CRF01_(A)E might be introduced in 1988 from Henan and Zhejiang, forming multiple small clusters (< 10 nodes) and spreading through both heterosexual and men who have sex with men (MSM) in Tianjin, while CRF07_(B)C from Chongqing and Guizhou, et al. in 2004, experiencing explosive local transmission and forming a large cluster of 170 nodes primarily among MSM under 30 years old (P < 0.05). Phylogenetic analysis indicated that CRF01_(A)E has a significantly higher evolutionary rate (2.08 × 10â».sup.3 vs. 1.48 × 10â».sup.3 substitutions/site/year, P < 0.05), while CRF07_(B)C demonstrates a greater cluster formation capacity (56.6% vs. 37.1%, P < 0.05). CRF01_(A)E showed a higher mutation occurrence rate (5.18% vs. 2.49%, P < 0.05), particularly with non-nucleoside reverse transcriptase inhibitor (NNRTI) associated mutations (e.g., K101E). Although CRF07_(B)C had a lower resistance burden, the emergence of K103E mutations suggests a need for vigilance regarding potential decreases in sensitivity to newer NNRTIs. BDSKY modeling revealed that the Re for CRF01_(A)E dropped below 1 after 2016, whereas CRF07_(B)C's Re remains above 1, indicating that the risk of transmission still exists. Subtype-specific strategies are critical: intensified resistance monitoring for CRF01_(A)E and cluster-focused interventions for CRF07_(B)C, particularly among young MSM.

Introduction Few studies focused on the Pre-Exposure Prophylaxis (PrEP) -related aspects, and the applicability of prior evidence to young men who have sex with men (YMSM) students was unknown. This study aimed to assess the awareness, willingness, uptake, and adherence (AWUA) to PrEP among YMSM students in China and to explore the associated factors with these stages. Methods A cross-sectional survey with a sizable sample of 1151 was conducted among YMSM students aged 16 and above, who self-identified as men who have sex with men(MSM) and resided in mainland China between October 20 and December 20, 2021. The chi-square test and Fisher’s exact test were used for univariate analysis, followed by multivariable logistic regression analysis of influencing factors at all levels. Results According to the cascade analysis approach, 88.71% of the participants were aware of PrEP, among which 66.7% expressed willingness to use it. Among those who were willing to use PrEP, only 13.80% took it, and of those who took it, 44.68% adhered to it. The students taking PrEP were those with higher education (OR = 4.239, 95% CI: 1.334–13.467), residence in pilot cities (OR = 2.791, 95% CI: 1.498–5.198), residence in high-risk areas (OR = 5.082, 95% CI: 2.224–11.612), engagement in multi-person sexual behavior (OR = 2.186, 95% CI: 1.236–3.867), and substance use (OR = 1.908, 95% CI: 1.167–3.118). Furtherly, students with higher adherence to PrEP were likely to have receptive sexual behaviors (OR = 8.702, 95% CI: 2.070-36.592), absence of substance use (OR = 4.468, 95% CI: 1.371–14.561), and uptake of PrEP through daily oral route. (OR = 7.065, 95% CI: 1.699–29.371). Conclusion YMSM students exhibit distinct patterns of “high awareness, low willingness, low uptake, and low adherence” to PrEP. Strategies for reduction in the acquisition of HIV prioritizing the current features of utilizing PrEP were urgently warranted.

Objective HIV infection rises rapidly in YMSM (young men who have sex with men). Despite extensive promotion of risk-reduction measures, existing research lacks categorical analysis of multidimensional prevention combinations, limiting precise interventions. This study uses latent class analysis (LCA) to identify prevention behavior patterns, analyze influencing factors, and evaluate association with HIV. Methods From January 2021 to December 2024, 2,685 YMSM aged 15–24 in Tianjin were recruited through online and offline methods. 13 HIV-prevention indicators (one cognitive, twelve behavioral) were classified using LCA. Multinomial logistic regression analyzed associations between latent classes and demographics/intervention services factors, while differences in HIV infection across prevention behavior patterns were compared. Results Four distinct HIV prevention classes emerged: “High-Risk Perception with Biomedical Reliance” (Class 1; 16.61%), “Low-Risk Perception with Condom Reliance” (Class 2; 16.72%), “Low-Risk Perception with Low Protection” (Class 3; 29.39%), and “High-Risk Perception with Partner & Barrier Strategy” (Class 4; 37.28%). Multinomial logistic regression showed that students were less likely to be classified into Class 1 (aOR = 0.56, 95%CI: 0.42–0.76) and Class 2 (aOR = 0.75, 95%CI: 0.57–0.97), and more likely to belong to Class 3. Online partner-seekers were less likely to fall into Class 2 (aOR = 0.58, 95%CI: 0.37–0.90) and Class 4 (aOR = 0.24, 95%CI: 0.17–0.36), and more prone to Class 3. For intervention services, those who received condom promotion or HIV counseling and testing were more likely to be categorized into Class 1 (aOR = 6.78, 95%CI: 4.20–10.95), Class 2 (aOR = 2.65, 95%CI: 1.86–3.77), and Class 4 (aOR = 10.64, 95%CI: 7.65–14.80), whereas peer education was negatively associated with Class 2 (aOR = 0.63, 95% CI: 0.44–0.91) and Class 4 (aOR = 0.34, 95% CI: 0.25–0.47). HIV analysis revealed Class 3 had the highest HIV positivity rate (6.60%, 95% CI: 5.08–8.77), followed by Class 1 (2.26%, 95% CI: 1.11–4.54) and Class 4 (2.20%, 95% CI: 1.20–3.32), with Class 2 showing the lowest rate (0.83%, 95% CI: 0.28–2.45). Conclusion Among YMSM, HIV prevention behavior is highly heterogeneous. The highest-risk subgroup—“Low-Risk Perception with Low Protection”—should be prioritized, particularly among students and online partner-seekers. Peer education programs may require further optimization, while integrated prevention strategies should combine condom use, biomedical tools, and both online and offline delivery channels.

Background Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy in preventing HIV infection among men who have sex with men (MSM). However, improper use can lead to breakthrough infections and diagnostic challenges. Case presentation We report the case of a 30-year-old MSM who was prescribed on-demand PrEP with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) via telemedicine, following baseline assessments that included a negative HIV antibody test and an undetectable pooled (10-sample) HIV-1 nucleic acid testing (NAT). Five months after initiating PrEP treatment, pooled NAT reported a positive result, while the HIV antibody test remained negative. In the subsequent month, HIV antibody seroconversion was observed; however, the viral load remained at a low level (< 1,000 copies/mL), and Western blot (WB) results were indeterminate. Genotypic testing identified a transient K70KR mutation. Four months after the first positive NAT, WB positive seroconversion occurred, accompanied by an increased viral load (14,064 copies/mL). Subsequently, the patient initiated treatment with Bictegravir/Emtricitabine/Tenofovir Alafenamide and achieved viral suppression within three months. Conclusions Improper and irregular use of PrEP led to HIV infection in this case. Telemedicine providers should conduct thorough assessments before starting PrEP and offer ongoing adherence support to maximize its effectiveness. This case highlights the importance of using NAT for early HIV detection in PrEP users and suggests including NAT in follow-up assessments to catch PrEP failures early. There is no need for excessive concern regarding the transient drug resistance mutations that may arise following PrEP failure, as these mutations do not compromise the efficacy of HIV treatment.

s Background In recent years, HIV testing has become one of the effective strategies to reduce the risk of the infection. Frequent quarterly HIV testing can be cost effective. Therefore, an in-depth study of factors related to the testing behavior of men who have sex with men (MSM) were analyzed to optimize intervention strategies. Methods From March 2011 to October 2018, the project was implemented in a Tianjin (China) bathhouse, and 5165 MSM were surveyed using snowball sampling. Factors related to HIV testing behavior were analyzed by ordinal logistic regression analysis after grouping according to testing frequency, and comprehensive analysis was performed. Results The multivariate logistic analysis showed that 6 variables including young MSM (OR = 0.67, 95% CI: 0.49–0.92, p  = 0.01), low-educated MSM (OR = 0.60, 95% CI: 0.48–0.77, p  < 0.0001), low HIV/AIDS knowledge (95% CI: 0.57–0.83, p  < 0.0001), marital status (OR = 1.30, 95% CI: 1.07–1.57, p  = 0.007), acceptance of condom promotion and distribution (OR = 14.52, 95% CI: 12.04–17.51, p <  0.0001), and frequency of condom use ( p  < 0.05) could link to HIV testing behaviors. Conclusions In order to achieve the 95–95-95 goal, target publicity, HIV/AIDS education and promotion of HIV self-testing kits should be carried out to encourage frequent HIV testing among MSM who are young (especially students), married to women, poorly educated and who are reluctant to always use condoms.

This study compared the immunogenicity of inactivated SARS-CoV-2 vaccines between people living with HIV (PLWH) and HIV-negative individuals. We recruited 120 PLWH and 53 HIV-negative individuals aged 18–59 years who had received an inactivated SARS-CoV-2 vaccine in two Chinese cities between April and June 2021. Blood samples were tested for immunogenicity of the inactivated SARS-CoV-2 vaccines. The prevalence and severity of adverse events associated with SARS-CoV-2 vaccines were similar between PLWH and HIV-negative individuals. The seropositivity of neutralizing activity against authentic SARS-CoV-2, of the total amount of antibody (total antibody) and of S-IgG were 71.3%, 81.9%, and 92.6%, respectively, among fully vaccinated PLWH. Among all participants, PLWH had lower neutralizing activity, total antibody, S-IgG, and T-cell-specific immune response levels, compared to HIV-negative individuals, after controlling for types of vaccine, time interval between first and second dose, time after receiving the second dose, and sociodemographic factors. PLWH with a longer interval since HIV diagnosis, who received their second dose 15–28 days prior to study commencement, and who had an interval of ≥21 days between first and second dose had higher neutralizing activity levels. The immunogenicity of the inactivated SARS-CoV-2 vaccines was lower among PLWH as compared to HIV-negative individuals. Vaccination guideline specific for PLWH should be developed.

Background Several studies have demonstrated the population-level effectiveness of oral PrEP in reducing the risk of HIV infection. However, oral PrEP utilization among MSM in China remains below 1%. While existing literature has primarily focused on oral PrEP preference and willingness, there is limited exploration of the underlying factors contributing to oral PrEP cessation in China. This study aims to fill this gap by investigating the factors associated with oral PrEP cessation among MSM in China. Methods Assisted by MSM community organizations, we collected 6,535 electronic questionnaires from 31 regions across China, excluding Taiwan, Hong Kong, and Macau. The questionnaire focused on investigating MSM's awareness, willingness, usage, and cessation of oral PrEP. Additionally, 40 participants were randomly chosen for key informant interviews. These qualitative interviews aimed to explore the reasons influencing MSM discontinuing oral PrEP. Results We eventually enrolled 6535 participants. Among the 685 participants who had used oral PrEP, 19.70% (135/685) ceased oral PrEP. The results indicated that individuals spending > ¥1000 on a bottle of PrEP ( aOR  = 2.999, 95% CI: 1.886–4.771) were more likely to cease oral PrEP compared to those spending ≤ ¥1000. Conversely, individuals opting for on-demand PrEP ( aOR  = 0.307, 95% CI: 0.194–0.485) and those using both daily and on-demand PrEP ( aOR  = 0.114, 95% CI: 0.058–0.226) were less likely to cease PrEP compared to those using daily PrEP. The qualitative analysis uncovered eight themes influencing oral PrEP cessation: (i) High cost and low adherence; (ii) Sexual inactivity; (iii) Lack of knowledge about PrEP; (iv) Trust in current prevention strategies; (v) Poor quality of medical service and counseling; (vi) PrEP stigma; (vii) Partner and relationship factors; (viii) Access challenges. Conclusions The cessation of oral PrEP among MSM in China is associated with various factors, including the cost of oral PrEP medication, regimens, individual perception of HIV risk, stigma, and the quality of medical services. It is recommended to provide appropriate regimens for eligible MSM and develop tailored combinations of strategies to enhance PrEP awareness and acceptance among individuals, medical staff, and the MSM community. The findings from this study can support the refinement of HIV interventions among MSM in China, contributing to efforts to reduce the burden of HIV in this population.

Background Although men who have sex with men (MSM) and male sex workers (MSWs) both represent the high-risk groups for the transmission of HIV/AIDS and syphilis, the comparison between them have not yet been well studied in China. We aimed to evaluate the prevalence of HIV among MSM and MSW, and then identify the difference of risk factors of HIV infection. Methods A snowball sampling was employed to recruit patrons attending the Tianjin bathhouse from March 2011 to October 2018. A questionnaire covering sociodemographic characteristics, sexual behaviors, HIV-related and HIV awareness was completed by 5166 patrons from all parts of China. Bivariate analyses were done using the Chi-square test to investigate the association between factors and HIV infection among MSM and MSWs. Subsequently, we studied the different impact of risk factors on HIV infections among the two groups using multiple logistic regression with the adjusted odds ratio (aOR) being derived. Results From 2011 to 2018, 235 MSWs and 4931 MSM were included into our study. HIV prevalence among the MSWs was 17.8% (95%CI: 13.2% ~ 23.4%) while 6.5% (95%CI: 5.8% ~ 7.2%) for MSM ( P  < 0.01). MSWs tends to be younger (26.50% in MSWs vs. 8.64% in MSM, P  < 0.05), live alone (84.68% in MSWs vs. 47.98 in MSM, P  < 0.05), get poor education (41.28% in MSWs vs. 28.45 in MSM, P  < 0.05), use drug (8.09% in MSWs vs. 0.89% in MSM, P  < 0.05), have more proportion of always use condom during anal sex (56.50% in MSWs vs. 41.95% in MSM, P  < 0.05) but less proportion during commercial sex (81.28% in MSWs vs. 98.48% in MSM, P  < 0.05), access HIV-related health services (65.96% in MSWs vs. 47.80% in MSM, P  < 0.05) and have a HIV test last year(60.85% in MSWs vs. 41.27% in MSM, P  < 0.05). The significant associations between risk factors with HIV infection in MSM were not observed in MSWs and vice versa. Conclusions High HIV prevalence needs urgent intervention targeting MSWs as a higher susceptible to HIV in comparison to MSM owing to their unique characteristics. The discrepancies of profiles and risk factors between MSM and MSWs should be consider in design and development of strategies.

Background Men who have sex with men (MSM) face a disproportionately high HIV risk globally. Biomedical prevention strategies, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), reduce HIV transmission, but their combined impact on sexual risk behaviors remains uncertain, raising concerns about risk compensation. Methods From 2018 to 2024, MSM in Tianjin, China were recruited through snowball sampling and followed within a longitudinal cohort linked to routine HIV testing services. HIV testing frequency and HIV incidence were analyzed using Poisson regression and Cox proportional hazards models, respectively. Unprotected anal intercourse (UAI) risk scores were constructed from sexual behavior indicators. Mixed-effects models and trajectory modeling assessed the associations between biomedical intervention use and UAI risk. Results Among 8790 repeat-testing MSM, 1858 (21.14%) used biomedical interventions. Intervention users had lower HIV incidence (0.40 vs. 0.62 per 100 person-years; HR = 0.53, 95% CI 0.35–0.80), more frequent testing (IRR = 1.30, 95% CI 1.27–1.33), higher risk scores (β = 0.191, 95% CI 0.162–0.219), more anal intercourse, and lower condom use at last sex and consistently. Trajectory analysis indicated users were more likely in high-risk group. Risk compensation effects tended to be greater among older MSM and those living in suburban areas. Conclusion Biomedical interventions are associated with increased HIV testing and reduced incidence but may elevate UAI risk, especially in older and suburban MSM. Integrating behavioral support into biomedical prevention is essential to mitigate risk compensation and address the prevention paradox in key subgroups.