The Impact of ART on Stillbirth andNeonatal Death Among HIV-positive Pregnant Women — Yunnan Province, China,2013–2022

Ailing Wang¹,Shuiling Qu², Jiarui Zheng³, Xiaoyan Wang¹,Hongqiao Zheng², Qian Wang¹, Xiaolong Gui³,Pengbin Li³, Dongxu Huang¹, Changhe Wang^1,#,Leiyu Shi^4,#

1. National Center for Women and Children’s Health, National Health Commissionof the People’s Republic of China, Beijing, China;

2. Chinese Center for Disease Control and Prevention, Beijing, China;

3. Yunnan Maternal and Child Health Care Hospital, Kunming City, YunnanProvince, China;

4. Johns Hopkins University, Baltimore, Maryland, United States.

# Corresponding authors:Changhe Wang, wangchanghe@ncwchnhc.org.cn; Leiyu Shi, lshi2@jhu.edu.

This study assessed the impactof antiretroviral therapy (ART) on stillbirth and neonatal mortality andinvestigated associated risk factors among Human immunodeficiencyvirus-positive (HIV-positive) pregnant women in Yunnan, China during 2013–2022.Data from the National Information System of Integrated Prevention ofMother-to-Child Transmission of HIV, Syphilis and Hepatitis B Programme (PMTCT)were analyzed to determine stillbirth and neonatal mortality rates. MultivariatePoisson regression was employed to identify risk factors associated withstillbirth and neonatal outcomes. Among 9,563 HIV-positive women with singletonpregnancies in Yunnan Province during 2013–2022, 9,404 (98.34%) received ARTduring pregnancy while 159 (1.66%) did not. There were 9,421 live births, 76stillbirths, and 66 neonatal deaths, yielding a stillbirth rate (SBR) of 8.07‰and neonatal mortality rate (NMR) of 7.01‰. The SBR was significantly lower inpregnancies where ART was used (P=0.033). Univariate analysis revealedthat ART (P=0.009), ethnicity (P=0.012), and antenatal care utilization(P<0.001) were associated with stillbirth and newborn survival.Multivariate Poisson regression identified that six or more antenatal carevisits as an independent predictor of survival. Stillbirth and neonatalmortality rates were elevated among mothers who did not receive ART duringpregnancy compared to those who did. These findings emphasize the importance ofART during pregnancy, particularly since several mortality risk factors areamenable to intervention.

HIV阳性孕产妇抗逆转录病毒治疗对死胎死产和新生儿死亡的影响 — 云南省，中国，2013–2022年

王爱玲¹；屈水令²；郑佳瑞³；王潇滟¹,郑洪巧²,王前¹；桂小龙³；李鹏斌³；黄东旭¹；王常合^1,#；Leiyu Shi^4,#

1.妇幼健康中心，国家卫生健康委，北京，中国；

2.中国疾病预防控制中心，北京，中国；

3.云南省妇幼保健院，昆明市，云南省，中国；

4.约翰斯·霍普金斯大学，巴尔的摩市，马里兰州，美国。

^# 通信作者:王常合，wangchanghe@ncwchnhc.org.cn；Leiyu Shi，lshi2@jhu.edu。

本研究评估了抗逆转录病毒治疗（ART）对死胎死产和新生儿死亡的影响，并探讨了 2013-2022年中国云南省人类免疫缺陷病毒（HIV）阳性孕产妇中这两种结局的风险因素。数据来自国家“预防艾滋病、梅毒和乙肝母婴传播（PMTCT）管理信息系统”，计算了死胎死产率和新生儿死亡率。本研究采用多变量泊松回归分析探讨死胎死产和新生儿结局的风险因素。2013-2022年，云南省共有9,563例HIV阳性孕产妇单胎妊娠；其中9,404例（98.34%）孕产妇孕期接受了ART，159例（1.66%）未接受。共有9,421例活产婴儿，76例死胎死产和66例新生儿死亡。死胎死产率为8.07‰，新生儿死亡率为7.01‰。孕期使用ART时死胎死产率更低（P=0.033）。在单变量分析中，抗逆转录病毒治疗方法（P=0.009）、民族（P=0.012）和产前检查次数（P<0.001）与死胎死产和新生儿存活相关。多变量泊松回归分析表明，产前检查次数6次或以上与新生儿存活独立相关。与孕期使用抗逆转录病毒治疗的母亲相比，未使用抗逆转录病毒治疗的母亲的死胎死产率和新生儿死亡率更高。因此更应关注孕期使用抗逆转录病毒治疗，控制一些影响新生儿死亡率的因素。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.042

Risk Assessment of CardiovascularDisease in HIV Infected Individuals Receiving Antiretroviral Therapy — ShanghaiMunicipality, China, 2023

XiaomengLi^1,2,&; Lin Wang^2,&; Li Liu²; ZihuiZhao^1,2; Ye Li²; Jiawei Huang²; Huiqin Yan²;Yiping Jin²; Meiyan Sun²; Jun Chen²; YingyingDing³; Renfang Zhang²; Yinzhong Shen^2,#

1.Shanghai Institute of Infectious Disease and Biosecurity, Fudan University,Shanghai, China;

2.Shanghai Public Health Clinical Center, Fudan University, Shanghai, China;

3.School of Public Health, Fudan University, Shanghai, China.

^&Joint firstauthors.

^# Corresponding author:Yinzhong Shen, shenyinzhong@shphc.org.cn.

Cardiovasculardisease (CVD) has emerged as a critical determinant of prognosis and quality oflife among individuals living with human immunodeficiency virus (HIV). The primary objective of thisstudy is to assess the CVD risk among HIV-infected individuals and determinethe proportion of high-risk individuals using multiple evaluation methods. Across-sectional study was conducted among HIV-infected individuals aged 18years and older who were receiving antiretroviral therapy between April 26,2023, and December 16, 2023. Participants were categorized into low-risk,intermediate-risk, and high-risk groups for CVD based on six risk assessmenttools. Ouranalysis revealed that the 5-year overall CVD risk estimates ranged from 2.37%to 2.50%, while the 10-year overall risk estimates spanned from 3.42% to18.35%, with significant variations observed between subgroups. The proportionof high-risk individuals in the 10-year risk assessment, identified using fivedifferent tools, ranged from 7.85% to 31.94%, demonstrating moderateconsistency across tools. The findings underscore the importance of closelymonitoring and managing CVD risk in HIV-infected individuals. Given thevariability in risk stratification methods, it is imperative to develop anassessment model tailored to the specific characteristics of the Chinesepopulation.

接受抗病毒治疗的 HIV 感染者心血管疾病风险评估 — 上海直辖市，中国， 2023年

李晓梦^1,2,&；王琳^2,&；刘莉²； 赵子辉^1,2；李晔²； 黄嘉玮²； 严慧琴²；金依萍²； 孙美艳²；陈军²；丁盈盈³；张仁芳²；沈银忠^2,#

1.上海市重大传染病和生物安全研究院，复旦大学，上海，中国；

2. 上海市公共卫生临床中心，复旦大学，上海，中国；

3. 公共卫生学院，复旦大学，上海，中国。

^& 共同第一作者

^# 通信作者：沈银忠，shenyinzhong@shphc.org.cn。

心血管疾病（CVD）已成为影响人类免疫缺陷病毒（HIV）感染者预后和生活质量的关键因素。本研究的主要目标是评估HIV感染者的CVD风险，并利用多种评估方法确定高危人群的比例。本研究为横断面研究，对2023年4月26日至2023年12月16日期间接受抗逆转录病毒治疗（ART）的18岁及以上HIV感染者进行CVD风险评估。根据六种风险评估工具，参与者被划分为低风险、中风险和高风险三个等级。我们的分析显示，HIV感染者5年总体CVD风险估计范围为2.37%至2.50%，而10年总体风险估计范围为3.42%至18.35%。不同亚组之间存在显著差异。在10年风险评估中，采用五种评估工具识别出的高危人群比例范围为7.85%至31.94%，表现出适中的一致性。研究结果强调了密切监测和管理HIV感染者CVD风险的重要性。鉴于风险分级方法存在差异，有必要开发一套针对中国人群特征的评估模型。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.043

Association Between Incorrect Use ofPre- and Post-Exposure Prophylaxis and HIV infection Among Men Who Have Sexwith Men — Shenzhen City, Guangdong Province, China, 2021–2023

ZijieYang^1,2, Jiachun Chen^1,3, Lan Wei¹, Delei Dai^1,3,Hu Tang^1,4, Yan Zhang¹, Wei Xie¹, Shaochu Liu¹,Wei Tan¹, Xiangdong Shi¹, Chenli Zheng¹,Xiaohong Yuan^1,5, Zhongliang Xu⁶, Wei Ye⁶, JinZhao^1,#

1. STD& AIDS Control and Prevention Section, Shenzhen Center for Disease Controland Prevention, Shenzhen City, Guangdong Province, China.

2.School of Public Health, Peking University, Beijing, China.

3.School of Public Health, Shantou University, Shantou City, Guangdong Province,China.

4.School of Public Health, Shanxi Medical University, Taiyuan City, ShanxiProvince, China.

5.School of Public Health Southern Medical University, Guangzhou City, GuangdongProvince, China.

6.Shenzhen Nanshan Center for Disease Control and Prevention, Shenzhen City,Guangdong Province, China.

^# Corresponding author: Jin Zhao, szcdczj@163.com.

Pre-exposureprophylaxis (PrEP) and post-exposure prophylaxis (PEP) are promisinginterventions to curb HIV transmission among men who have sex with men (MSM).However, incorrect use may elevate HIV risk. This study investigated the impactof improper PrEP/PEP use on HIV infection among MSM. A cross-sectional surveywas conducted in Shenzhen (2021–2023) using time-location sampling andrespondent-driven sampling. χ² tests and Poisson regressionwith robust error variance were employed for univariate and multivariateanalyses. Compared to PrEP/PEP non-users, MSM who incorrectly used PrEP [adjustedodds ratio (aOR)=2.17, 95% confidence interval (CI): 1.05, 4.49)and PEP (aOR=3.76, 95% CI: 1.40, 10.15) were more likely to beHIV-positive. No HIV-positive cases were reported among MSM who correctly usedPrEP. Correct PEP users showed no significant difference in HIV prevalencecompared to non-users. Correct PrEP/PEP use is an effective HIV preventionstrategy for MSM, but incorrect use may increase infection risk. Public healthefforts must prioritize interventions promoting adherence to PrEP/PEPguidelines, emphasizing that PrEP/PEP should complement — not replace — consistentcondom use.

男性同性性行为者不正确使用暴露前及暴露后预防用药与HIV感染之间的关联性分析 — 深圳市，广东省，中国，2021–2023年

杨梓杰^1,2；陈嘉淳^1,3；卫兰¹；唐虎^1,4；戴德磊^1,3，张燕¹；谢炜¹；刘少础¹；谭唯¹；石向东¹；郑陈丽¹；袁小洪^1,5；徐仲良⁶；叶薇⁶；赵锦^1,#

1. 深圳市疾病预防控制中心，深圳市，广东省，中国；

2. 公共卫生学院，北京大学，北京，中国；

3. 公共卫生学院，汕头大学，汕头市，广东省，中国；

4. 公共卫生学院，山西医科大学，太原市，山西省，中国；

5. 公共卫生学院，南方医科大学，广州市，广东省，中国；

6. 深圳市南山区疾病预防控制中心，深圳市，广东省，中国。

^# 通讯作者:赵锦,szcdczj@163.com。

为了遏制HIV在MSM中继续传播与蔓延，暴露前预防用药（pre-exposure prophylaxis, PrEP)/暴露后预防用药(post-exposureprophylaxis, PEP) 被认为是具有应用前景的干预措施之一。然而，不正确使用PrEP/PEP可能会增加MSM的HIV感染风险。因此，本研究旨在对MSM的PrEP/PEP使用进行调查，以探讨不正确使用PrEP/PEP对MSM HIV感染的影响。本研究在2021-2023年间通过使用时间场所抽样结合同伴推动抽样的方法在深圳市对MSM的PrEP/PEP使用进行调查。使用χ²分析进行单因素比较分析，使用广义线性模型的带稳健误差方差的泊松回归进行多因素回归分析。检验水准α=0.05。与未使用 PrEP/PEP 的 MSM 相比，不正确使用 PrEP（aOR=2.17，95% CI： 1.05, 4.49）和 不正确使用PEP（aOR=3.76，95%CI: 1.40, 10.15）的 MSM 更有可能报告为 HIV 阳性。此外，正确使用 PrEP 的 MSM 均未报告 HIV 阳性，而正确使用 PEP 的 MSM 和未使用 PEP 的 MSM的 HIV 感染率无显著差异。男男性行为者正确使用 PrEP/PEP 是一种很有前景的艾滋病预防策略，但不正确的使用可能会增加艾滋病感染风险。目前的当务之急是制定和实施有效的战略，促进正确使用 PrEP/PEP，同时强调这些预防性药物应补充而不是取代坚持使用安全套。

For more information:https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.044

Identification of Multiple Unique HIV-1Recombinant Forms in Newly Reported HIV-1 Infected Individuals — AnhuiProvince, China, 2023

Huan Li¹;Yi Feng¹; Qi Li¹; Jianjun Wu²; Hui Xing¹;Lingjie Liao¹; Zheng Wang^1,#

1.National Key Laboratory of Intelligent Tracking and Forecasting for InfectiousDiseases, National Center for AIDS/STD Control and Prevention, Chinese Centerfor Disease Control and Prevention, Beijing, China.

2.Anhui Provincial Center for Disease Control and Prevention, Hefei City, AnhuiProvince, China.

^# Corresponding authors: Zheng Wang, wangzheng@chinaaids.cn.

The genetic diversity of humanimmunodeficiency virus-1 (HIV-1) in China is characterized by multiplesubtypes, circulating recombinant forms (CRFs) and unique recombinant forms(URFs) across the country. Through timely molecular surveillance, over 65distinct CRFs have been identified in China to date. In this study, weidentified five novel URFs among newly infected individuals in Anhui Province,China.Near-full length HIV genome sequences were obtained usingtwo-half molecule amplification methods from five samples containing potentialURFs. The sequences were subsequently subjected to phylogenetic andrecombination analyses.Phylogenetic and recombination analyses of thefive near-full length genome sequences confirmed their classification as novelURFs. Among these, three sequences were recombinants of CRF01_AE and CRF07_BC,one sequence was a recombinant of CRF01_AE, CRF07_BC and B, and one sequenceresulted from CRF07_BC and CRF08_BC recombination.The identification ofURFs in newly infected individuals indicates ongoing transmission of multipleHIV-1 clades in Anhui Province, with superinfection occurring at notablefrequencies. These findings emphasize the importance of enhancing long-termsurveillance of circulating HIV-1 clades using near-full length sequenceanalysis in Anhui, China.

HIV-1 新发感染病例中多个HIV-1 独特重组形式的鉴定 — 安徽省，中国，2023年

李唤¹；冯毅¹；李淇¹；吴建军²；邢辉¹；廖玲洁¹；王铮^1,#

1.传染病溯源预警与智能决策全国重点实验室，性病艾滋病预防控制中心，中国疾病预防控制中心，北京，中国；

2.安徽省疾病预防控制中心，合肥市，安徽省，中国。

^# 通信作者：王铮, wangzheng@chinaaids.cn。

在中国，人类免疫缺陷病毒（humanimmunodeficiency virus, HIV） 的基因多样性表现为多种亚型的共同流行，包括流行重组形式（CRFs）和独特重组形式（URFs）。目前，得益于及时的分子监测，中国已经鉴定出了超过65种不同的流行重组形式和多种独特重组形式。在本研究中，我们从2023年安徽新发感染病例中鉴定出了5个独特重组形式。使用半分子扩增的方法从5个潜在独特重组形式的样本中提取核酸后测序得到近全长基因组，并对5个近全长基因组进行系统发育分析。5个近全长基因组的系统进化结果证明这5个样本的亚型为独特重组形式，在这5个样本中，3个是由CRF01_AE和CRF07_BC重组而成，1个由CRF01_AE，CRF07_BC和B亚型重组而成，一个由CRF07_BC和CRF08_BC重组而成。在安徽省新发感染病例中鉴定出5个独特重组形式，这证明安徽省的流行亚型呈现多样性，这可能给HIV-1的预防和控制带来挑战。

For more information:https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.046