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Current HIV/AIDS Reports
Published in: Current HIV/AIDS Reports 1/2020

Open Access 01-02-2020 | Care | The Global Epidemic (SH Vermund, Section Editor)

Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges

Authors: Wei Cao, Evelyn Hsieh, Taisheng Li

Published in: Current HIV/AIDS Reports | Issue 1/2020

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Abstract

Purpose of Review

The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years.

Recent Findings

Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART.

Summary

Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.
Literature
1.
Hong Y, Zhou D. Clinical pathological conference: fever, cough and progressive dyspnea. Chin J Internal Med. 1986;25(7):436–9.
2.
National Health Commission of the People's Republic of China: Regular press conference: Progress in the prevention and treatment of AIDS in China. http://​ncaidschinacdccn​/​xxgx/​yqxx/​201811/​t20181123_​197488.​htm Acessed at Aug 23rd, 2019.
3.
Zhang FJ, Pan J, Yu L, Wen Y, Zhao Y. Current progress of China’s free ART program. Cell Res. 2005;15(11–12):877–82.PubMed
4.
Zhang F, Haberer JE, Wang Y, Zhao Y, Ma Y, Zhao D, et al. The Chinese free antiretroviral treatment program: challenges and responses. Aids. 2007;21(Suppl 8(1473–5571 (Electronic))):S143–8.PubMed
5.
Li T, Dai Y, Kuang J, Jiang J, Han Y, Qiu Z, et al. Three generic nevirapine-based antiretroviral treatments in Chinese HIV/AIDS patients: multicentric observation cohort. PLoS One. 2008;3(12):e3918.PubMedPubMedCentral
6.
Zhang C, Wang W, Zhou M, Han Y, Xie J, Qiu Z, et al. The interaction of CD4 T-cell count and nevirapine hepatotoxicity in China: a change in national treatment guidelines may be warranted. J Acquir Immune Defic Syndr. 2013;15(62):540–5.
7.
AIDS Professional Group. Society of Infectious Diseases Chinese Medical Association: guidelines for diagnosis and treatment of HIV/AIDS in China (2011). ZHONGHUA CHUAN RAN BING ZA ZHI. 2011;29(10):629–40.
8.
Li T, Guo F, Li Y, Zhang C, Han Y, Lye W, et al. An antiretroviral regimen containing 6 months of stavudine followed by long-term zidovudine for first-line HIV therapy is optimal in resource-limited settings: a prospective, multicenter study in China. Chin Med J. 2014;127(1):59–65.PubMed
9.
ENCORE1 Study Group: Efficacy of 400 mg efavirenz versus standard 600 mg dose in HIV-infected, antiretroviral-naive adults. (ENCORE1): a randomised, double-blind, placebo-controlled, non-inferiority trial. Lancet. 2014;383(9927):1474–82.
10.
Carey D, Puls R, Amin J, Losso M, Phanupak P, Foulkes S, et al. Efficacy and safety of efavirenz 400 mg daily versus 600 mg daily: 96-week data from the randomised, double-blind, placebo-controlled, non-inferiority ENCORE1 study. Lancet Infect Dis. 2015;15(7):793–802.PubMed
11.
Guo F, Cheng X, Hsieh E, Du X, Fu Q, Peng W, et al. Prospective plasma efavirenz concentration assessment in Chinese HIV-infected adults enrolled in a large multicentre study. HIV Med. 2018;19:440–50.
12.
AIDS and Hepatitis C Professional Group. Society of Infectious Diseases Chinese Medical Association, Chinese Center for Disease Control and Prevention: [Chinese guidelines for diagnosis and treatment of HIV/AIDS (2018)]. Zhonghua Nei Ke Za Zhi. 2018;57(12):867–84.
13.
Chinese Medical Association, and Chinese Center for Disease Control and Prevention: Guidelines for diagnosis and treatment of HIV/AIDS in China (2005). Chin Med J. 2006;119(19):1589–608.
14.
AIDS Professional Group. Society of Infectious Diseases, Chinese Medical Association: third edition of the guidelines for diagnosis and treatment of HIV/AIDS (2015). Chin J Clin Infect Dis. 2015;8(5):385–401.
15.
Lundgren J, Babiker A, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807.PubMed
16.
He X, Xing H, Ruan Y, Hong K, Cheng C, Hu Y, et al. A comprehensive mapping of HIV-1 genotypes in various risk groups and regions across China based on a nationwide molecular epidemiologic survey. PLoS One. 2012;7(10):e47289.PubMedPubMedCentral
17.
Li Y, Han Y, Xie J, Gu L, Li W, Wang H, et al. CRF01_AE subtype is associated with X4 tropism and fast HIV progression in Chinese patients infected through sexual transmission. Aids. 2014;28(4):521–30.PubMed
18.
Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med. 2017;18(4):256–66.PubMed
19.
Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614–22.PubMedPubMedCentral
20.
Luo L, Zeng Y, Li T, Lv W, Wang H, Guo F, et al. Prospective echocardiographic assessment of cardiac structure and function in Chinese persons living with HIV. Clin Infect Dis. 2014;58(10):1459–66.PubMed
21.
Rosenberg AZ, Naicker S, Winkler CA, Kopp JB. HIV-associated nephropathies: epidemiology, pathology, mechanisms and treatment. Nat Rev Nephrol. 2015;11(3):150–60.PubMed
22.
Cao Y, Gong M, Han Y, Xie J, Li X, Zhang L, et al. Prevalence and risk factors for chronic kidney disease among HIV-infected antiretroviral therapy-naive patients in mainland China: a multicenter cross-sectional study. Nephrology(Carlton). 2013;18(4):307–12.
23.
Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. Aids. 2006;20(17):2165–74.PubMed
24.
Ye Y, Zeng Y, Li X, Zhang S, Fang Q, Luo L, et al. HIV infection: an independent risk factor of peripheral arterial disease. J Acquir Immune Defic Syndr. 2010;53(2):276–8.PubMed
25.
Li H, Zhang F, Lu H, Cai W, Wu H, Sun Y, et al. Expert consensus on management of HIV infection combined with chronic renal diseases. Chin J AIDS&STD. 2017;165(6):578–81.
26.
AIDS Professional Group. Society of Infectious Diseases Chinese Medical Association, Society of Tropical Diseases and Parasitology of Chinese Medical Association: expert consensus on diagnosis and treatment of HIV infection combined with mycobacterium tuberculosis infection. Chin J Clin Infect Dis. 2017;10(2):81–90.
27.
Society of Tropical Diseases and Parasitology of Chinese Medical Association. Expert consensus on diagnosis and treatment of HIV infection combined with nontuberculosis mycobacterium infection. Chin J Infect Dis. 2019;37(3):129–38.
28.
Zhang F, Zhu H, Wu Y, Dou Z, Zhang Y, Kleinman N, et al. HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study. Lancet Infect Dis. 2014;14(11):1065–72.PubMedPubMedCentral
29.
Xie J, Han Y, Qiu Z, Li Y, Li Y, Song X, et al. Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study. J Int AIDS Soc. 2016;19(1):20659.PubMedPubMedCentral
30.
Wang H, Li Y, Zhang C, Han Y, Zhang X, Zhu T, et al. Immunological and virological responses to cART in HIV/HBV co-infected patients from a multicenter cohort. Aids. 2012;26(14):1755–63.PubMed
31.
Li Y, Xie J, Han Y, Wang H, Zhu T, Wang N, et al. Lamivudine Monotherapy-Based cART Is Efficacious for HBV Treatment in HIV/HBV Coinfection When Baseline HBV DNA <20,000 IU/mL. J Acquir Immune Defic Syndr. 2016;72(1):39–45.PubMedPubMedCentral
32.
Tang H, Mao Y, Tang W, Han J, Xu J, Li J. "Late for testing, early for antiretroviral therapy, less likely to die": results from a large HIV cohort study in China, 2006-2014. BMC Infect Dis. 2018;18(1):272.PubMedPubMedCentral
33.
Xie J, Hsieh E, Sun M, Wang H, Lv W, Fan H, et al. Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China. PLoS One. 2017;12(8):e0182335.PubMedPubMedCentral
34.
Cao W, Song X, Li Y, Qiu Z, Xie J, Han Y, et al. Zhou B et al: [Clinical characteristics of 297 newly diagnosed Chinese HIV/AIDS patients]. Zhonghua Nei Ke Za Zhi. 2014;53(7):537–41.PubMed
35.
Li HP, Chang SA, Han Y, Zhuang DM, Li L, Liu YJ, et al. The prevalence of drug resistance among treatment-naive HIV-1-infected individuals in China during pre- and post-2004. BMC Infect Dis. 2016;16(1):605.PubMedPubMedCentral
36.
Zhao S, Feng Y, Hu J, Li Y, Zuo Z, Yan J, et al. Prevalence of transmitted HIV drug resistance in antiretroviral treatment naive newly diagnosed individuals in China. Sci Rep. 2018;8(1):12273.PubMedPubMedCentral
37.
Zhang FD, Liu L, Sun MY, Sun JJ, Lu HZ. An analysis of drug resistance among people living with HIV/AIDS in Shanghai, China. PLoS One. 2017;12(2):e0165110.PubMedPubMedCentral
38.
Xu Y, Peng X, Peng X, Ji S, Chen B, Wang L, et al. Characterization of HIV-1 subtypes and transmitted drug resistance among treatment-naive HIV-infected individuals in Zhejiang, China, 2014-2017. Arch Virol. 2018;163(8):2233–7.PubMed
39.
Ma Y, Zhao D, Yu L, Bulterys M, Robinson ML, Zhao Y, et al. Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China. Clin Infect Dis. 2010;50(2):264–71.PubMedPubMedCentral
40.
Wu J, Norris J, Liu HX, Li Z, Su YY, Zhu L, et al. The prevalence of HIV drug resistance among treatment-failure individuals and treatment-naive individuals in China: a meta-analysis. Biomed Environ Sci. 2014;27(11):838–71.
41.
Klatt NR, Chomont N, Douek DC, Deeks SG. Immune activation and HIV persistence: implications for curative approaches to HIV infection. Immunol Rev. 2013;254(1):326–42.PubMedPubMedCentral
42.
Li T, Wu N, Dai Y, Qiu Z, Han Y, Xie J, et al. Reduced thymic output is a major mechanism of immune reconstitution failure in HIV-infected patients after long-term antiretroviral therapy. Clin Infect Dis. 2011;53(9):944–51.PubMed
43.
Massanella M, Fromentin R, Chomont N. Residual inflammation and viral reservoirs: alliance against an HIV cure. Curr Opin HIV AIDS. 2016;11(2):234–41.PubMedPubMedCentral
44.
Routy JP, Angel J, Patel M, Kanagaratham C, Radzioch D, Kema I, et al. Assessment of chloroquine as a modulator of immune activation to improve CD4 recovery in immune nonresponding HIV-infected patients receiving antiretroviral therapy. HIV Med. 2015;16(1):48–56.PubMed
45.
Tao X, Younger J, Fan FZ, Wang B, Lipsky PE. Benefit of an extract of Tripterygium Wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study. Arthritis Rheum. 2002;46(7):1735–43.PubMed
46.
Lv QW, Zhang W, Shi Q, Zheng WJ, Li X, Chen H, et al. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Ann Rheum Dis. 2015;74(6):1078–86.PubMed
47.
Goldbach-Mansky R, Wilson M, Fleischmann R, Olsen N, Silverfield J, Kempf P, et al. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial. Ann Intern Med. 2009;151(4):229–40 W249-251.PubMedPubMedCentral
48.
Li T, Xie J, Li Y, Routy JP, Li Y, Han Y, et al. Tripterygium wilfordii Hook F extract in cART-treated HIV patients with poor immune response: a pilot study to assess its immunomodulatory effects and safety. HIV Clin Trials. 2015;16(2):49–56.PubMed
49.
Kusunoki N, Yamazaki R, Kitasato H, Beppu M, Aoki H, Kawai S. Triptolide, an active compound identified in a traditional Chinese herb, induces apoptosis of rheumatoid synovial fibroblasts. BMC Pharmacol. 2004;4(1471–2210 (Electronic)):2.PubMedPubMedCentral
Metadata
Title
Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges
Authors
Wei Cao
Evelyn Hsieh
Taisheng Li
Publication date
01-02-2020
Publisher
Springer US
Published in
Current HIV/AIDS Reports / Issue 1/2020
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-019-00478-x

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