RESUMO
BACKGROUND: While hepatitis B virus (HBV) infection in children has declined dramatically in China due to the vaccination strategy for newborns, HBV infection in high-risk adults is receiving an increasing attention. The number of people who use drugs (PWUD) in China is huge, but their status of HBV infection and vaccination is less reported, especially from large samples. The related knowledge can help decision makers develop the further strategy of HBV prevention and control. METHODS: A seroepidemiological survey was conducted in all four compulsory isolated detoxification centers (CIDCs) and all eight methadone maintenance treatment (MMT) clinics located in Xi'an, China. All PWUD who were undergoing detoxification or treatment in these settings were included. A questionnaire was designed to obtain the information of HBV vaccination history of participants, and sociodemographic and behavioral data of participants were obtained from the registration records of their respective CIDCs or MMT clinics. RESULTS: A total of 4705 PWUD participated in the survey. Positive rates of HBsAg (current infection) and HBsAg or anti-HBc (current/past infection) were 5.50% and 58.02%, notably higher than those reported for the general adult population in the same province during the same period. As age increased, the anti-HBc positive rate increased with statistically significant trend. The all-negative for HBsAg, anti-HBc, and anti-HBs accounted for 28.82%. Only 18.49% were identified by the questionnaire as having received HBV vaccine. The logistic regression found that compared with identified vaccinated PWUD, those unsure if having been vaccinated and those identified non-vaccinated had a significantly higher HBV current/past infection rate, with an increasing trend. CONCLUSION: PWUD are a high-risk adult group of HBV infection in China. Of them, more than half have not received HBV vaccine, and a significant portion are susceptible to HBV. Catch-up vaccination is need for this population to prevent and control HBV transmission.
Assuntos
Vacinas contra Hepatite B , Hepatite B , Vacinação , Humanos , China/epidemiologia , Hepatite B/prevenção & controle , Hepatite B/epidemiologia , Masculino , Adulto , Feminino , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/imunologia , Pessoa de Meia-Idade , Vacinação/estatística & dados numéricos , Adulto Jovem , Estudos Soroepidemiológicos , Anticorpos Anti-Hepatite B/sangue , Anticorpos Anti-Hepatite B/imunologia , Inquéritos e Questionários , Adolescente , Antígenos de Superfície da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Usuários de Drogas/estatística & dados numéricos , Vírus da Hepatite B/imunologiaRESUMO
Estrogen signaling exerts a decisive role in female sex determination and differentiation in chicken and fish. Aromatase encoded by Cyp19a1 is the key enzyme that catalyzes the conversion of androgen to estrogen. Correlative analyses implicate the potential involvement of aromatase in reptilian sexual development, however, the direct genetic evidence is lacking. Herein, we found that Cyp19a1 exhibited temperature-dependent sexually dimorphic expression, and located in the medullary somatic cells in early female embryos of the red-eared slider turtle (Trachemys scripta elegans), before the gonad is distinct. To determine the functional role of Cyp19a1 in turtle ovarian determination, we established loss- and gain-of-function models through in ovo lentivirus-mediated genetic manipulation. At female-producing temperature, inhibition of aromatase or knockdown of Cyp19a1 in turtle embryos resulted in female-to-male sex reversal, with the formation of a testis-like structure and a male distribution pattern of germ cells, as well as ectopic expression of male-specific markers (SOX9 and AMH) and disappearance of ovarian regulator FOXL2. On the contrary, overexpression of Cyp19a1 at male-producing temperature led to male-to-female sex reversal. In conclusion, our results suggest that Cyp19a1 is both necessary and sufficient for ovarian determination in the red-eared slider turtle, establishing causality and a direct genetic link between aromatase and reptilian sex determination and differentiation.
Assuntos
Tartarugas , Animais , Feminino , Masculino , Tartarugas/genética , Aromatase/genética , Aromatase/metabolismo , Processos de Determinação Sexual/genética , Mutação com Ganho de Função , Estrogênios/metabolismo , Temperatura , Diferenciação Sexual/genéticaRESUMO
BACKGROUND: Timely diagnosis and treatment are crucial for reducing HIV transmission;therefore, estimating the time from HIV infection to antiretroviral therapy (ART) initiation becomes particularly important for people living with HIV. METHODS: We used a well-characterised CD4 depletion model to estimate the time from HIV infection to initiation of ART and the rate of delayed HIV diagnosis (infection to diagnosis >1year) and treatment initiation (diagnosis to treatment >1year), based on HIV notification data for adults (aged ≥18years) in Xi'an city, China, during 2008-19. RESULTS: Overall, 7402 reported HIV diagnoses were included. We estimated more than two-thirds of HIV infections remained undiagnosed (66.1%, 9489/14 345). The estimated proportion of HIV diagnoses that were delayed (>1year) was 80.3% (5941/7402) during 2008-19, and it increased from 72.7% (32/44) in 2008 to 83.5% (908/1088) in 2019. In contrast, the proportion of cases with delayed treatment (>1year) was 13.1% (971/7402) during 2008-19, and it reduced from 75.0% (33/44) in 2008 to 1.5% (16/1088) in 2019. The estimated median time from HIV infection to diagnosis increased from 5.05 (IQR, 0.27-8.15) years to 5.81 (IQR, 2.31-10.28) years, whereas the time from diagnosis to ART initiation reduced from 3.06 (IQR, 1.01-5.20) years in 2008 to 0.07 (IQR, 0.04-0.12) year in 2019. CONCLUSIONS: Early treatment after diagnosis has significantly improved, but timely diagnosis of HIV infections may still require further improvement. The estimated proportion of undiagnosed HIV cases remains high in 2019 in Xi'an city and is likely to impede effective control.
Assuntos
Infecções por HIV , Humanos , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Tempo para o Tratamento , China/epidemiologiaRESUMO
BACKGROUND: The World Health Organization (WHO) requires reduction in the prevalence of hepatitis B virus (HBV) surface antigen (HBsAg) in children to 0.1% by 2030, a key indicator for eliminating viral hepatitis as a major public health threat. Whether and how China can achieve this target remains unknown, although great achievements have been made. We aimed to predict the decline of HBsAg prevalence in China and identify key developments needed to achieve the target. METHODS: An age- and time-dependent dynamic compartmental model was constructed based on the natural history of HBV infection and the national history and current status of hepatitis B control. The model was run from 2006 to 2040 to predict the decline of HBsAg prevalence under three scenarios including maintaining current interventions (status quo), status quo + peripartum antiviral prophylaxis (PAP, recommended by WHO in 2020), and scaling up current interventions + PAP. RESULTS: Under the status quo, HBsAg prevalence would decrease steadily in all age groups, but the WHO's target of 0.1% prevalence in children aged < 5 years would not be achieved until 2037. The results are robust according to sensitivity analyses. Under the status quo + PAP, the HBsAg prevalence of children aged < 5 years would significantly decrease with the introduction of PAP, and the higher the successful interruption coverage is achieved by PAP, the more significant the decline. However, even if the successful interruption coverage reaches 90% by 2030, the 0.1% prevalence target would not be met until 2031. Under the scaling up current interventions + PAP, combined with scale-up of current interventions, the WHO's 0.1% target would be achieved on time or one year in advance if PAP is introduced and the successful interruption coverage is scaled up to 80% or 90% by 2030, respectively. CONCLUSIONS: It is difficult for China to achieve the WHO's target of 0.1% HBsAg prevalence in children by 2030 by maintaining current interventions. PAP may play an important role to shorten the time to achieve the target. A comprehensive scale-up of available interventions including PAP will ensure that China achieves the target on schedule.