Synthesis, X-ray crystallographic analysis and antitumor activity of 3,6-bis(substituted phenyl)-1,4-bis(substitutedphenylsulfonyl)-1,4-dihydro-1,2, 4,5-tetrazine

Article abstract of DOI:10.1258/095646206776790105

Seven compounds (3a-g) of 3,6-bis(substitutedphenyl)-1,4- bis(substitutedphenylsulfonyl)-1,4-dihydro-1,2,4,5-tetrazine were synthesised via reaction of N-arylsulfonyl-α-chloro-substituted phenyl hydrazone and triethyl amine. Their structures were confirme

Full text of DOI:10.1258/095646206776790105

International Journal of STD & AIDS 2006; 17: 324–328
ORIGINAL RESEARCH ARTICLE
Epidemiological characteristics of HIV/AIDS
in west China
1
1
1
2
Zhi Hu MD , Xia Qin MS , Min-Zhen Zhu MS , Sen Yang MD
2
and Xue-Jun Zhang MD PhD
1School of Health Administration, Anhui Medical University, 81 Meishan Road, Hefei,
Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China
2
Summary: China is facing a major crisis because of the increasing epidemic of
HIV/AIDS, especially in the western areas. The purpose of this paper is to enhance
understanding of the crisis by analysing the published literature on the
epidemiology, demographic features, routes of infection, and risk factors of HIV/
AIDS infection in the 12 provinces in the west of China. HIV/AIDS has increased
rapidly in recent years. The situation is urgent and requires comprehensive action.
China’s health care system is decentralized and under-funded, and access to
treatment by the poor is seriously limited. There is a lack of knowledge about HIV/
AIDS in the general public and health care workers. The HIV/AIDS epidemic
emerged initially in western areas of the country by means of intravenous drug use,
but sexual risk behaviour and mother-to-child transmissions in the west of China
are becoming important for HIV transmission.
Keywords: HIV/AIDS, epidemiological characters, incidence, west of China
and unpublished studies on HIV/AIDS in China.
Introduction
Second, we examined references in the retrieved
literature to identify additional studies. Third,
we examined Oscar Grusky et al.’s review of the
literature and other articles for additional English
and Chinese publications.2,8 The key words used
initially included HIV/AIDS, the names of the
western 12 provinces, infectious routes, risk factors,
health care services and China. Later we did an
additional search for articles on intravenous drug
use, blood safety and sexual risk taking. Mean-
while, we collected all published data of the HIV
sentinel surveillance from the 12 western pro-
vinces. Selected newspaper reports and new
information about AIDS, especially about the
government policies in China on the Internet were
also added. Finally, we selected those studies
carried out in the 12 western provinces.
The distribution of HIV/AIDS in China shows
strong local character; the west of China is both
the starting place and the most affected area today
in China. West China consists of 12 provinces/
municipalities or autonomous regions including
Chongqing, Sichuan, Guizhou, Yunnan, Tibet,
Shanxi, Gansu, Qinghai, Ningxia, Xinjiang, Inner
Mongolia and Guangxi. They cover 6,850,000
square kilometers, adding up to about 71.4% of
China’s territory. The population of the west is
364,000,000, accounting for 28.6% of the nation’s
total population. And the majority of China’s
ethnic groups live in these areas. From the report
of HIV/AIDS prevention and treatment of China
released at the end of 2003, we learn that the most
severe areas of HIV infection are Yunnan, Tibet,
Guangxi, Guandong, and Sichuan, respectively,
and four of these belong to the west.1
Findings and discussion
Severity and incidence trend of HIV/AIDS in
west China
Methods
A literature search was undertaken that involved
the following steps. First, many electronic data-
bases, such as WANFANG DATA, China National
Knowledge Infrastructure (CNKI), VIP DATA,
and Medline were searched to find published
The first AIDS case in China was discovered in
1985. But China did not report any HIV-infected
case until October 1989, which was found in the
remote Yunnan province, and caused by drug
use. Before 1993, the reported HIV-infected cases
focused mainly in Yunnan province.2,3 But a report
from Liangshan Yi county in Sichuan in 1995
revealed that 35% of drug users were HIV-positive,
Correspondence to: Professor Xue-Jun Zhang, Institute of Dermatology,
Anhui Medical University, No. 81, Meishan Road, Hefei, Anhui 230032,
PR China
Email: ayzxj@mail.hf.ah.cn
324
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Hu et al. Epidemiological characteristics of HIV/AIDS
325
surveillance result from 1996 to 2000 in Yining
Xinjiang revealed that the ratio of male to female
was as high as 27.5:1, and the 20–40 age group
taking up 93.3%.12,13 Also, the surveillance data
from Yunnan, Guangxi, and Guizhou revealed that
the 20–40 aged male group was the main group
infected with HIV.14–16 The occupations of these
patients were mostly farmers and unemployed as
reflected in a report from Shanxi that the majority of
patients (68%) were farmers, followed by unem-
ployed.6 The HIV-infected farmers in Yunnan in
1990 numbered 93.8%,8 and though the figure has
dropped gradually, it was still 40%, and unem-
ployed 37%, in 2001 as revealed by Zhang et al.;17
the situation was the same in Sichuan in 2001.12
2000
1997
1994
1991
1988
1985
Year
Figure 1 The time of the first AIDS case discovered in the 12
provinces in the west of China (Source: the chronicle surveillance
report of HIV/AIDS in the 12 provinces of the west)
1600
1400
1200
1000
AIDS transmission routes in different provinces
in the west of China
AIDS
The main transmission routes of AIDS were found
to be through blood, followed by sex. Besides, there
were reports in Yunnan, Sichuan, Shanxi, and
Guizhou that mother-to-child transmission is also
a transmission route.16,18–20 Blood collection and
intravenous drug use are the main causes of HIV
spread in nine areas in the west. In China, a drug
user sentinel surveillance report from 1995 to 1998
revealed that the infection rate rose from 0 to 28.8%
in the four years in Wulumuqi, and from 1% in
1997 to 12.8% in 1998 in Guangxi. The highest
infection rate, 82.2%,10 was from the drug user
sentinel in Yining Xinjiang. A further example was
from Qinghai where three out of four infected cases
discovered in 2000 were former intravenous drug
users.11 A surveillance report from Chongqing
released in 2001 showed that the majority of
patients who were infected had a history of
intravenous drug use. Eighty percent had both
sexual and intravenous drugs use as risk factors,
12% had only sexual risk factors (Figure 3).21
800
600
400
200
0
Year
Figure 2 The number of HIV-infected reported recently in the
west of China (Source: the chronicle surveillance report of HIV/
AIDS in the 12 provinces of the west)
followed by reports of HIV-positive cases from
Chongqing, Shanxi, and Tibet4–7 (Figure 1).
The number of HIV cases have increased since
the first HIV case was reported. For example, in
Yunnan province, the most affected area, the
reported cases increased from 148 to 5868, from
1989 to 1998;8 in Tibet, HIV sero-prevalence rate
derived by sentinel surveillance rose from 8% in
1996 to 20.8% in 1997,9 and in Guangxi from 1% in
1997 to 12.8%10 in 1998. Qinghai province is the last
to have an HIV-positive diagnosis where two cases
of HIV were discovered in 1998, one in 1999 and
four in 200011 (Figure 2).
Xinjiang
Neimeng
Ningxia
Qinghai
Character of AIDS population in different
provinces of the west
Gansu
Shanxi
Tibet
Among the infected in the west of China, males out-
number females. From the chronicle document
released by the Ministry of Health, the ratio of
adult male HIV population to female was 4:1 until
the end of 2002. The population of HIV-infected
persons in China until 2003 was 840,000, of which
50% were young adults aged 20–29. The ratio of
male to female in Sichuan province from the
surveillance result in 2001 was 7:1. A five-year
Sichuan
Chongqing
Guizhou
Guangxi
Yunnan
Figure 3 Sketch map of the west of China (Source origin: http://
xb8.com/html/2003/08/20030810212849-1.htm)
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326
International Journal of STD & AIDS Volume 17 May 2006
mission, showed that the proportion of rural
residents who knew about HIV was very small.
Nearly 20% people had never heard of AIDS, and
people were not conscious of self-protection and
the coming of the HIV/AIDS crisis. Only 22.7%
knew that it is a virus acquired from the people
who have HIV.36 In 2003, an investigation by Wang
revealed that rural residents generally lack knowl-
edge of HIV/AIDS. About 50% of people did not
know the transmission routes of AIDS.37 Another
investigation, by Yan, which targets rural women,
revealed that rural women were not clear about the
transmission routes of HIV/AIDS.38 The investiga-
tion into drug users in Yuxi Yunnan showed that
many people still did not know that needle-sharing
can spread HIV/AIDS. Among those investigated
78.5% had shared needles.39
Risk factor of HIV epidemic in the west of China
Social-economic-environmental factor The west
is an area with vast land, 71.4% of total, but
scarce population, approximately 28.6% of total,
and an area that is economically under-developed
from where a large amount of rural residents
are pouring into cities to earn a living. It has
already been proven that mobile population is
the main factor causing the spread of HIV/
AIDS.22–24 Poverty is also an important factor
causing needle-sharing among the drug users. An
investigation revealed that the proportion of
needle-sharing among drug users in the rich
areas was significantly lower than that in the
deprived areas.25 Infection caused by illegal blood
collection was also connected with a poor financial
situation, as revealed by a study in Guizhou
showing that the majority of the infected are
farmers, who were all infected through plasma
donation.26,27 As for Yunnan, the first and most
severe province of HIV infection, can be attributed
to its geological location boarding Burma in the
west and southwest and Laos and Vietnam in the
south. These areas are well known for drug
trafficking and drugs smuggled into China must
first go through Yunnan.28
Public health system The spread of HIV/AIDS in
the west of China is closely related to problems in
the public health system. A refined health system
must have adequate health service resources and
good management. But in the current system
response is slow, insensitive and decentralized
with regard to prevention and treatment, and there
is lack of cooperation among different depart-
ments.28,40,41 The coverage of surveillance sentinels
is limited with under-reporting or no reporting
of HIV.
An investigation of no reporting cases in Gansu
showed the rate to be 80.11%, and the ratio of
reported cases to detected cases was about 1:5.42
From the nationwide perspective, experts predict
that the number of the accumulated HIV-positive
patients could reach 1,000,000. But only 40,000
cases were reported, that is to say, 95% of the
patients were unknown to us. Furthermore, the
health resources in the west are not adequate,
particularly in the remote rural areas and minority
ethnic groups. Special funding for the health
systeming is lacking. Nationally, though there
was increased capital input into the prevention
and treatment of HIV/AIDS from government
from as early as 1993,1 the input is still too small.
Twenty thousand RMB is needed for the treatment
of an AIDS patient yearly, so very considerable
funds will be needed each year. The fact is that a
large number of HIV/AIDS patients from rural
China do not have medical insurance and are in
need of medicine and physicians. They live in
extreme poverty.43 Health personnel are seriously
High-risk sex behaviour among high-risk popu-
lation Drug users ranked first among the infected
in the west, the majority of them inject drugs and
share needles; in Yili Xinjiang, nearly all the drug
users had shared needles. The 2000 Guangxi
surveillance showed that 87% of the injecting drug
users had shared needles.29 Extra-marital and pre-
marital sex was more serious among drug users.
In addition, most of them do not use condoms
and most female drug users had traded sex for
drugs. These would easily cause the outbreak of
HIV/AIDS among the drug users and casual sex
workers.27,30 An investigation of the drug users in
1999 in a reformatory in Ningxia showed that
as high as 96.8% of them had never used a
condom.31 The 2003 study in Gansu revealed that
over half of the drug users had multiple previous
sexual partners, and female drug users who
had multiple partners had a history of casual sex
work.32 Furthermore, mobile population is another
high-risk population whose high-risk behaviour
can also cause the spread of HIV/AIDS.33,34
Public’s knowledge about HIV/AIDS Due to the lacking in the west, too.43 Many township heath
economic-cultural situation and isolated geological centres have no special STD doctors, and the
location of the west, the residents know little available doctors are inadequately trained in
about drugs and HIV/AIDS. Among both the HIV/AIDS and STD-related knowledge. Thus they
high-risk and the general population, there was a can provide limited services.44,45 An evaluative
lack of HIV knowledge due to inadequate HIV report released by a UN work team claimed HIV in
education.35
China is a ‘huge risk’, and appealed to the Chinese
The 2001 baseline investigation of AIDS know- government to strengthen its work on HIV control
ledge, propaganda and education, programme, and to put more personnel and capital into the
launched by the National Family Planning Com- field.46
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Hu et al. Epidemiological characteristics of HIV/AIDS
327
Government policies on HIV/AIDS The ability
Several trends typify the HIV/AIDS epidemic:
and willingness of the government to confront the
HIV/AIDS epidemic is a key factor influencing (1) The trend of HIV epidemic in the west will
its impact. From 1985, when the first AIDS case
was reported, the Chinese government has made
great efforts in the prevention and treatment of
HIV/AIDS. An HIV/AIDS coordination committee
under state government was formed in 1995.
Coordination meetings have been held annually.
continue. The area of high prevalence will
confront exaggerated morbidity and mortality.
The area of low prevalence will witness the
increase of infection rate based on the analysis
of every risk factor and refinement of surveil-
lance institution.51
And the programme of HIV/AIDS prevention and (2) The transmission route is mainly through
treatment has been put into national economic
and social development plan. The former state
commissioner, Pengpeiyun once stressed in an
AIDS meeting held in 1996 that: ‘we should take
work in AIDS as nation salvation’.47 In the late
1990s, State Council formed a ‘Long Term Plan of
HIV/AIDS Prevention and Treatment in China’
and ‘Action Plan of Control and Treat HIV/AIDS
in China’.47 At the September 2003 UN high-level
AIDS meeting, our government made five com-
mitments. In 2003 world AIDS day, Chinese
premier Wen, on behalf of the party Central
Committee and state council, went to Beijing
Ditan Hospital and visited AIDS patients and
medical staff there. He stressed that government
at every level should assume full responsibility
to the people, further promote the work of HIV
prevention and treatment, increase the input,
provide free antiretroviral treatment, free anony-
mous testing, free mother-to-child prevention, and
free education for orphans of AIDS families.48 At
the end of 2003, Vice Premier Wuyi visited Henan
for AIDS prevention and treatment work and
posed a clear work demand. In 2004, on 26th
February, AIDS Treatment and Prevention Work
Committee was formed. An AIDS meeting was
held again by State Council and declared the
strengthening of AIDS prevention and treatment,
which is a big event of the public health field, and
the milestone of AIDS work in China.49 At the
15th AIDS meeting held on the 12th July this year,
Vice Minister of Health Wang said that the
Chinese government would consolidate the forces
of whole society, NGO in particular, to effectively
prevent and control the spread of HIV/AIDS in
China.50 All the above-mentioned show the con-
cern of our government towards people’s health
and the determination of the central party
committee and State Council to control the spread
of HIV/AIDS.
blood. Sexual and mother-to-child transmis-
sion will go up. Prediction from experts is that
the number of actual drug users is 5–10 times
that registered. No definite data can be
obtained concerning the number of casual
sexual workers. The infection rate among drug
users, casual sexual workers will increase
continually. In women who are already
married and have a child there will be a
potential problem of mother-to-child trans-
mission.51,52
(3) The proportion of females being infected is
increasing. Due to physiological and social
factors, females are more vulnerable to HIV
than males. In addition, the high rate of birth
canal infection among rural women can also
contribute to the vulnerability of HIV infec-
tion.53
(4) The number of AIDS orphans is increasing as
a direct consequence of the advance of disease
and death of AIDS patients. Meanwhile, many
AIDS orphans themselves are the victims of
HIV infection.54
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