We retrospectively analysed routinely collected baseline data of 2252 patients with HIV infection registered in the National Free Antiretroviral Treatment Program in Xinjiang province, China, from 2006 to 2011 to estimate the prevalence and predictors of anaemia at the initiation of combined antiretroviral therapy. Anaemia was diagnosed using the criteria set forth by the World Health Organisation, and univariate and multivariate logistic regression analyses were performed to determine its predictors. The prevalences of mild, moderate, and severe anaemia at the initiation of combined antiretroviral therapy were 19.2%, 17.1%, and 2.6%, respectively. Overall, 38.9% of the patients were anaemic at the initiation of combined antiretroviral therapy. The multivariate logistic regression analysis indicated that Uyghur ethnicity, female gender, lower CD4 count, lower body mass index value, self-reported tuberculosis infection, and oral candidiasis were associated with a higher prevalence of anaemia, whereas higher serum alanine aminotransferase level was associated with a lower prevalence of anaemia. The results suggest that the overall prevalence of anaemia at the initiation of combined antiretroviral therapy in patients with HIV infection is high in Xinjiang, China, but severe anaemia is uncommon. Patients in China should be routinely checked for anaemia prior to combined antiretroviral therapy initiation, and healthcare providers should carefully select the appropriate first-line combined antiretroviral therapy regimens for anaemic patients.

BackgroundTuberculosis and HIV co-epidemics are problems in many parts of the world. Xinjiang is a high tuberculosis and HIV prevalence area in China. We aimed to investigate the prevalence and cure rate of tuberculosis among HIV positive patients in Xinjiang.MethodsIn a retrospective study between 2006 and 2011, clinical and laboratory data on 333 patients with HIV and tuberculosis were compared to 2668 patients with HIV only. There were 31 HIV positive patients with no data on tuberculosis.ResultsThe prevalence of tuberculosis co-infection among the HIV positive patients was 11% (95% CI 10–12%), significantly higher than the national figure in China of 2%. In most cases HIV was diagnosed late, with advanced immunodeficiency. The use of isoniazid preventive therapy was only 57.9% in patients without tuberculosis who fulfilled the criteria for receiving this prevention. The cure rate one year after diagnosis was 69.2%, which was lower than the officially reported 91.4% in all tuberculosis cases in Xinjiang in 2011. The hazard of not surviving over the five years was significantly higher in patients with HIV + tuberculosis compared to HIV only after adjusting for sex and Intravenous drug use with HR = 1.84 (95% CI 1.43-2.35; p < 0.0001).ConclusionsThe prevalence of tuberculosis among HIV positive patients in Xinjiang was higher than in China taken as a whole, and HIV was diagnosed late, with underuse of isoniazid preventive therapy. The low cure rate and reduced survival can be due to late diagnosis of HIV and no testing for antibiotic resistance, together with insufficient control of adherence to the treatment regimens for tuberculosis and HIV.

Nearly half of the HIV patients in Urumqi had markers of hepatitis. Only antiretroviral treatment is provided free, and most of the patients cannot afford the hepatitis treatment they need, which has to be addressed in the treatment programs.

In total, 679 HIV-positive patients from 4 clinics in Urumqi city were given structured questionnaires by the doctors or nurses treating them. Health-related quality of life (HRQL) was assessed using the Chinese Patient-Reported Outcome Quality of Life-HIV questionnaire versions in Mandarin and Uyghur. This tool has been used in other parts of China and several countries. Compared to France, Australia, United States, Brazil, Thailand, Cambodia, Senegal, and Central-Southern China (CS China), the HRQL was significantly lower among HIV-positive patients in Xinjiang, with regard to the dimension of treatment impact and general health score. The health concern was similar to Brazil and Cambodia but lower than other countries and CS China. Our findings showed high stigmatization: 86% of the patients were afraid to tell others they were HIV positive and 69% often felt or always felt depressed. Only 1% of the patients were on antidepressant treatment.

The present study investigated the expression of Toll-like receptor 4 (TLR4) and proteins involved in its associated signaling pathways in patients with classic Kaposi's sarcoma (KS) and acquired immune deficiency syndrome (AIDS)-associated KS (AIDS-KS) in Xinjiang Autonomous Region of China. A total of 35 patients with KS were enrolled in the present study between May 2011 and July 2013, including 26 cases of AIDS-KS and 9 cases of classic KS. Another 10 healthy subjects of the Uygur ethnic group were included in the normal control group. KS tissues were subjected to hematoxylin and eosin staining and immunohistochemical staining. To measure the expression of mRNA, reverse-transcription quantitative polymerase chain reaction was performed. To determine protein expression, western blot analysis was employed. AIDS-KS was mainly distributed in the face and limbs, while classic KS was mainly distributed in the limbs. The histopathological characteristics of AIDS-KS and classic KS tissues were different from those of normal tissues. TLR4 was mainly distributed in the dermis of KS tissues. The mRNA expression levels of TLR4 were reduced in classic KS and AIDS-KS. The protein expression levels of RAS, RAF, nuclear factor (NF)-κB P65 and P50 as well as inhibitor of NF-κB-α of the TLR4 signaling pathway in AIDS-KS and KS tissues were higher than those in normal tissues. In conclusion, the expression of TLR4 gene in KS tissues was decreased, while the expression of proteins of the TLR4 signaling pathway was upregulated in KS. Downregulation of TLR4 may be associated with the occurrence and development of AIDS-KS, while its restoration may represent a novel therapeutic approach for AIDS-KS.