Background: Maintaining plasma HIV RNA suppression below the limit of quantification is the goal of antiretroviral therapy (ART). When viral loads (VL) remain in low-level viremia (LLV), or between 201 and 999 copies/mL, the clinical consequences are still not clear. We investigated the occurrence of LLV with drug resistance and its effect on CD4 cell counts in a large Chinese cohort. Methods: We analysed data of 6,530 ART-experienced patients (42.1 ± 10.9 years; 37.3% female) from the China’s national HIV drug resistance (HIVDR) surveillance database. Participants were followed up for 32.9 (IQR 16.7–50.5) months. LLV was defined as the occurrence of at least one viral load (VL) measurement of 50–200 copies/mL during ART. Outcomes were drug resistance associated mutations (DRAM) and CD4 cell counts levels. Results: Among 6530 patients, 58.0% patients achieved VL less than 50 copies/mL, 27.8% with VL between 50 and 999 copies/mL (8.6% experienced LLV), and 14.2% had a VL ≥ 1000 copies/mL. Of 1818 patients with VL 50–999 copies/mL, 182 (10.0%) experienced HIVDR, the most common DRAM were M184I/V 28.6%, K103N 19.2%, and V181C/I/V 10.4% (multidrug resistance: 27.5%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 3.8, 95% CI 2.6–5.5, p < 0.01) comparing with those without HIVDR. Of 925 patients with VL ≥ 1000 copies/mL, 495 (53.5%) acquired HIVDR, the most common DRAM were K103N 43.8%, M184I/V 43.2%, M41L 19.0%, D67N/G 16.4%, V181C/I/V 14.5%, G190A/S 13.9% and K101E 13.7% (multidrug resistance: 75.8%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 5.8, 95% CI 4.6–7.4, p < 0.01) comparing with those without HIVDR. Conclusion: Persistent with VL 50–999 copies/mL on ART is associated with emerging DRAM for all drug classes, and patients in this setting were at increased risk of CD4 cell counts < 200 cells/μL, which suggest resistance monitoring and ART optimization be earlier considered.

Background This study investigated the importance of obesity and lifestyle behaviors in affecting dyslipidemia among adults aged 45 and older in China. The strength of our study is in using the decision tree model to clearly rank the importance of those key factors affecting dyslipidemia.Methods Data were taken from the China Health and Retirement Longitudinal Study. A total of 9,038 adults were included in the study. Logistic regression was used to examine the associations between obesity, lifestyle behaviors and dyslipidemia. Decision tree was built to select the best scheme on prevention of dyslipidemia.Results Based on body mass index (BMI), 33.98% of Chinese age ≥ 45 years old were overweight and a further 12.73% were obese. Logistic regression analysis showed that participants who were obese (AOR 6.82, 95% CI 3.67–12.37, P<0.0001), with hypertension stage 2 (1.53, 1.23–1.90, P=0.0001) and lived in main city zone (2.68, 2.22–3.22, P<0.0001) were more likely to have dyslipidemia; Participants who usually took part in vigorous activity (0.66, 0.54–0.80, P<0.0001) or did moderate/light activity more than 2 hours one day (moderate: 0.66, 0.53–0.84, P=0.0005; light: 0.79, 0.65–0.97, P=0.0231) were less likely to have dyslipidemia. Decision tree analysis showed that enhancing physical activity could effectively reduce the rate of dyslipidemia among people with overweight or obesity.Conclusions Overweight and obesity are rapidly growing threats in China. Regular physical activity could positively affect dyslipidemia and produce desirable health status. This will be beneficial evidence for educating those who do not or cannot perform regular and substantial physical activities.