Sino-British scientific and technological cooperation: join hands to attack the commanding heights of AIDS prevention and treatment
On November 12th, the Ministry of Health of China said that China would amend the Regulations on Entry and Exit Administration to lift the 20-year entry restriction for HIV carriers and infected people. From the blind fear of AIDS and its patients in the past to the rational acceptance now, in addition to the change in understanding, it also reveals the confidence of the China government in AIDS prevention and treatment. In recent years, the Ministry of Health has listed the reporting and monitoring of HIV-infected people and AIDS patients as the focus of AIDS prevention and control work, and the AIDS prevention and control work has shown a good trend. In September last year, the Beijing Municipal Science and Technology Commission invested 14 million yuan to launch a major scientific research project "AIDS prevention and control strategy and comprehensive prevention and control research", which consisted of seven sub-projects, which were jointly undertaken by seven units, including Beijing You ‘an Hospital, ditan hospital, Union Medical College Hospital, Beijing Center for Disease Control, 302 Hospital of the People’s Liberation Army, Beijing University of Technology and Guang ‘anmen Chinese Medicine Hospital. It is planned to establish a prevention and control strategy and scientific research center in Beijing in the next three years. According to reports, this major project has designed an interface with international cooperation from the very beginning. During the implementation of the project, through close cooperation with Oxford University in the UK, it has continuously introduced the latest international technology and mature experience in international AIDS clinical management, and achieved initial success. The essence of cooperation is to cultivate local scientific research ability For Wu Hao, the head of the AIDS project in Beijing You ‘an Hospital, the cooperation with Britain has become familiar. As early as 2003, he had a successful cooperation with Xu Xiaoning of Oxford University, the British leader of this project. Due to the high level of research on coronavirus in Britain, during the SARS epidemic, Xu Xiaoning was specially invited by Beijing Municipal Health Bureau to come to Beijing to discuss the Sino-British cooperative research on SARS. "It was a dangerous time. There were no people in the streets. Professor Xu risked his life to come to Beijing." Wu Hao said with a smile. The Sino-British SARS cooperation project kicked off. According to the agreement, the British Medical Research Council (MRC) provided technical, instrument, reagent and personnel training support to You ‘an Hospital, and the mode of Sino-British cooperation began to take shape. The project "AIDS prevention and control strategy and comprehensive prevention and control research" is another all-round cooperation between Oxford University and Beijing You ‘an Hospital after the SARS cooperation project. You ‘an Hospital is the hospital with the largest number of AIDS patients in Beijing, and has accumulated valuable experience in AIDS research and diagnosis. "Cooperation with the AIDS project of You ‘an Hospital is mainly to study the immunological mechanism of HIV after natural infection, especially how to suppress the virus in the early stage of infection, and do basic research for the production of AIDS vaccine." Xu Xiaoning said. In the past 20 years, about 200 kinds of AIDS vaccines have been developed around the world, but so far, no vaccine has been successful in large-scale human experiments. The difficulty in the development of AIDS vaccine lies in the rapid variation of HIV, so Xu Xiaoning thinks that it is better to strengthen basic research than to invest a lot of money in the development of AIDS vaccine. Only when we really understand the mechanism and know how to make the immune cross-reaction, can we choose a system that can directly stimulate cellular immunity or cross-reaction, so that the vaccine has broad spectrum. According to reports, Xu Xiaoning is pushing you ‘an Hospital to build a third-level laboratory for biosafety protection, namely P3 laboratory, and will serve as the director of the laboratory. The laboratory will undertake part of the work of vaccine development through the separation, culture and reproduction of virus samples such as SARS and AIDS. The whole laboratory is completely sealed, and the room is in a negative pressure state, so as to ensure that the virus samples will not cause harm to the experimenters and the external environment. In order to cultivate China’s local R&D capability, Xu Xiaoning did not want to just use China as a collection base for virus specimens, but provided a lot of technical and management support for this project, bringing advanced technology from abroad and training personnel for Chinese and foreign scientists to do research together. Through such cooperation, China research institutions can establish their own scientific research teams quickly. Wu Hao said: "The British side sends two or three experts to You ‘an Hospital every year to do experiments for a long time, each time for three months to six months; There are also several students from China who go to the UK to study for doctors and do experiments for one to two years, which are counted as students jointly trained by both sides. " Renewing the concept of clinical scientific research "MRC spent 300 million pounds to move a research institute to the hospital. In Britain, the Institute of Life Sciences, which studies human diseases, is within 500 meters of the hospital. " Xu Xiaoning said: "The research on human diseases must be closely integrated with hospitals, which has become a world trend." However, the current situation in China is that many institutions that study human diseases do not have corresponding hospitals, which leads to the lack of communication between clinicians and researchers, and the decoupling of clinical and scientific research. Some researchers only regard clinicians as the source of specimens, and many doctors only obtain the signatures of scientific research papers by providing virus samples, but their scientific research ability has not been improved. In fact, in this mode, researchers have no stable source of specimens, so they can’t conduct long-term systematic research, and they don’t understand the clinic, so it is difficult for scientific research results to solve clinical problems. "The purpose of our cooperation is to improve the scientific research ability of clinicians in China and break the gap between clinical and scientific research." Xu Xiaoning said. As the first clinical doctoral tutor in You ‘an Hospital, Wu Hao has two outpatient clinics every week, one for hepatitis and the other for sexually transmitted diseases. His doctoral students were also sent to Oxford University in the form of Sino-British joint training to carry out laboratory research; Three chief physicians and head nurses of AIDS wards have also received short-term training in Britain. Huang Xiaojie used to be a clinician, working in an outpatient clinic. Later, at the invitation of Xu Xiaoning, she served as the coordinator of the Sino-British AIDS project, and at the same time, she followed Wu Hao to carry out doctoral research. "Participants in the AIDS project are both basic research and clinicians. General hospital experts focus on clinical research without their own laboratories, while we have a 300-square-meter laboratory." Huang Xiaojie said proudly. "Let people who study medicine engage in scientific research, so that they can understand the basic mechanism of diseases and communicate with researchers easily. At the same time, arrange people who engage in basic research in hospitals and communicate with doctors more, so that scientific research can be targeted." Xu Xiaoning said. Get twice the result with half the effort, target high-risk groups At the end of 2006, a survey report on the health status of gay men published by the Chinese Center for Disease Control concluded that gay men are the high-risk group of HIV infection in China. For example, there are nearly 300,000 homosexuals in Beijing. Among 526 male homosexuals in Beijing, the HIV infection rate is 3%, ranking first in China. Nearly one-third of gay men have bisexual behavior and become a high-risk group for HIV infection and transmission. Only about 20% of gay men can insist on using condoms and other protective measures every time they have sex. Compared with the general population, the high-risk population has a high incidence and strong infectivity, so Beijing You ‘an Hospital locks its sub-project as screening of high-risk population. Screening for high-risk groups, we can find the law of AIDS transmission in Beijing, determine who are the high-risk groups of AIDS, in which groups AIDS is transmitted, and which groups of people will cause the incidence of AIDS in Beijing to increase. By referring to the screening data, AIDS prevention and control strategies can be adjusted in a targeted manner. "Through screening, we can also find out the HIV infection rate of high-risk groups in Beijing, find some newly infected patients who are still in the window period as soon as possible, and conduct research on the pathogenesis, treatment and immunity of acute infection to help AIDS prevention and treatment." Huang Xiaoyu said. Studies have shown that the infection rate of unprotected sexual intercourse among HIV-infected people in acute infection period is as high as 1/30, while the infection rate of patients in asymptomatic AIDS period is only 3‰. "Therefore, carrying out safety education for patients in acute period can not only save money, but also reduce the incidence of AIDS well, which will have a multiplier effect on prevention and treatment." Wu Hao said. AIDS is a public health problem, not limited to high-risk groups. "Like other infectious diseases, AIDS infection also has a critical point. When it reaches this critical point, it will spread to the general population and become an epidemic." Xu Xiaoning said. Because homosexuals are not accepted by China society, they may transmit HIV to their spouses and children after being forced to get married. Details win, humanized queue screening mode The goal of gay queue in You ‘an Hospital is to establish 800 queues, which is a very difficult task. In epidemiological research, a queue refers to a group of people who have a common experience or state. 800 gay queues will track and detect 800 homosexuals for 3 years, and the frequency is once every 2 months. Due to social discrimination, most homosexuals are reluctant to reveal their identity, and are prone to rejection of AIDS testing. For example, some follow-up people don’t leave the correct phone number, or just check it once and then stop cooperating with the return visit. Therefore, the construction of gay queues in China and even internationally has been unsatisfactory. In some domestic research institutions, the testing period may be as long as half a year, and it is actually a cross-sectional test of the follow-up, so it is difficult to obtain complete and sustainable cohort data. You ‘an Hospital draws lessons from international experience and explores a set of methods to improve the follow-up rate. For example, first train some gay backbones, and persuade gay groups to come to the hospital for AIDS testing through their distribution of condoms and free inspection cards. The hospital also promised that in case the follow-up patients were found to have sexually transmitted diseases and other infectious diseases, they would be given free treatment until they recovered. If found infected with HIV, the hospital will give full free treatment according to the national policy, and use the best drugs available in China. "All in all, we try our best to do our work from the perspective of this group." Huang Xiaoyu said. You ‘an Hospital also uses hospital resources to implement more testing and treatment projects than other institutions. Taking the gay cohort as an example, besides HIV antibody and HIV virus load, each inspection project also includes syphilis, hepatitis B and hepatitis C, which greatly enhances the willingness of follow-up. The hospital also regularly invites psychologists to do psychological training for the follow-up, promotes peer education, and organizes various cultural performances, so that the interviewees can establish a good relationship with the hospital during the activities. "In our place, queue testing is not just about leaving after one test, but establishing long-term emotional ties with the respondents." Huang Xiaoyu said. When visiting the testing room specially set up for the follow-up, Huang Xiaojie specially introduced: "In order to protect the privacy of the follow-up, we specially separated the testing room of the follow-up who has been infected with HIV from the uninfected follow-up. Because they are a special group with a small circle, many people know each other. If they can’t be isolated during testing, it may lead to contradictions between them. " This solid and meticulous work mode has been recognized by the gay people. At present, You ‘an Hospital has built 500 gay queues, and now 70% of patients who came for examination a year ago can guarantee to visit once every two months. The difficulty of gay cohort screening is that it is difficult to find acute patients, and good cohort construction is the basis and premise to overcome this difficulty. Due to the unsuccessful cohort construction in other domestic institutions, only a few acute patients have been found at present, while the cohort study in You ‘an Hospital has only been carried out for more than one year, and more than a dozen acute patients have been found. "Through Sino-British cooperation, we can not only get technical and financial guarantee, but also train our own research team and better grasp the research direction and implementation details of AIDS." Wu Hao said: "This kind of research has no worries." |