青少年人类免疫缺陷病毒感染的影响因素

获得性免疫缺陷综合征(AIDS),即艾滋病,是由人类免疫缺陷病毒(HIV)感染引起的一种严重的传染病.目前,HIV感染呈低龄化流行趋势,青少年已成为HIV的易感群体.静脉注射吸毒和性行为是青少年感染HIV的主要途径.吸毒和性行为的发生受多种个人及环境因素的影响.文章就青少年HIV感染现状及影响因素进行综述.     

保山市隆阳区吸毒人群性传播疾病和丙型肝炎病毒感染分析

吸毒人群是我国艾滋病感染和传播的重要人群,经哨点监测资料显示,近年来云南省保山市隆阳区注射吸毒人群的人类免疫缺陷病毒（HIV）抗体阳性率在4％左右。同样,丙型肝炎病毒（HCV）作为一种血源性传染病毒,在我国吸毒人群中特别是注射吸毒人群中呈现高的感染率,为了解隆阳区注射吸毒人群中HCV、HIV以及梅毒感染率,本研究针对隆阳区吸毒人群中HIV与HCV的感染的流行特点及其相互作用产生的危害做一分析。     

吸毒人群高危行为与相关血源病原感染相关研究

目的 了解四川省凉山彝族自治州地区吸毒人群共用注射器具静脉吸毒方式和性行为与HCV、HIV和梅毒感染的关系。方法于2004年5～7月，从社区中招募吸毒人群调查其社会人口学特征、近3个月直接和间接共用注射器具静脉吸毒方式和近6个月性行为情况。采集血样进行HIV、HCV和梅毒抗体检测。结果在调查的451名吸毒人群中HCV和HIV感染率分别为64．1％（289／451）和15．1％（68／451），HIV和HCV混合感染率为14．4％（65／451）。口吸吸毒者和静脉吸毒者HCV感染率分别为17．3％（14／81）和74．3％（275／370）；多因素Logistic回归分析结果显示，与HCV感染关系有统计学意义的变量为近3个月内共用针头或注射器静脉吸毒（OR值为2．27；95％CI为1．41-3．66）和未结婚或同居（OR值为2、21；95％CI为1．45～3．36）。未见性行为因素对吸毒人群HCV感染的影响。结论四川省凉山彝族自治州吸毒人群HCV和HIV感染率高，应加强对共用注射器具静脉吸毒行为的干预。     

岳阳市吸毒人群四种血液传染病感染的流行病学调查

目的了解岳阳市吸毒人群中艾滋病、丙型肝炎、乙型肝炎和梅毒等四种血液传染病的感染状况及其影响因素。为做好综合防治提供依据。方法对岳阳市强制戒毒所吸毒人员进行问卷调查，并采用常规方法检测Anti—HIV、Anti—HCV、HBsAg和梅毒抗体并作统计分析。结果277名吸毒人员中HIV感染率4．69％，HCV感染率81．95％，HBV感染率（HBsAg阳性率）14．08％，梅毒感染率2．53％，13名HIV感染者均合并感染HCV。结论本市吸毒人群中HIV、HCV感染率较高，静脉吸毒和共用针具吸毒是HIV和HCV传播的高危因素，不洁性行为增加了HIV、HCV、梅毒、乙肝由吸毒人员向其它人群传播的危险性。     

乌鲁木齐市某区吸毒人群HIV、HCV、梅毒感染状况及行为学调查

目的：了解乌鲁木齐市吸毒人员对艾滋病知识的知晓情况、危险行为及 HIV、HCV、梅毒感染状况,为制定预防措施提供科学依据。方法调取2012年4-6月乌鲁木齐某区 CDC艾滋病哨点监测数据,对360名吸毒人员的人口学基本特征、艾滋病防治知识知晓情况、性行为及安全套使用、吸毒行为、商业性性行为、就医行为、艾滋病干预服务情况进行调查,并检测 HIV、HCV和梅毒感染情况。结果360名吸毒人员艾滋病知识的知晓率达97．9％,文化程度越高其艾滋病知晓率越高（χ趋势^2＝4．794,P ＝0．029）。曾经有注射吸毒史者占76．9％,共用针具吸毒者占40．8％（113/277）。有效应答者中13．1％（47/358）承认有过性交易,其中每次性交易都使用安全套者占57．4％。360名吸毒人员 HIV感染率为16．1％,HCV感染率为67．5％,梅毒感染率为2．2％。有注射吸毒史者感染 HIV和 HCV的危险分别是未注射吸毒者的5．5（1．8,17．1）倍和2．3（1．7,3．1）倍（P ＜0．01）;共用注射针具者感染 HIV的危险是不共用注射针具者的2．2（1．3,3．5）倍（P ＜0．01）。结论吸毒人员艾滋病知晓率高,但危险行为的发生率并未下降,“知信行脱节”是吸毒人群中 HIV、HCV、梅毒感染状况严重的重要原因。     

四川省西昌市静脉吸毒人群HIV感染情况研究

目的了解四川省西昌市静脉吸毒人群HIV感染情况及其影响因素。方法于2005年10月至11月在西昌市对静脉吸毒人群进行问卷调查，调查内容包括社会人口学、毒品使用、共用注射器具静脉吸毒以及性行为情况等，同时采集血样进行HIV抗体检测。结果在招募的325名静脉吸毒者中，HIV感染率为15．7％（51／325）。多因素Logistic回归模型分析结果显示，彝族（OR，2．71；95％CI，1．34～5．46）和近3个月使用他人用过的针头或注射器（0R，3．53；95％CI，1．72～7．24）与静脉吸毒人群HIV感染间差异有统计学意义。结论四川省西昌市静脉吸毒人群中HIV感染率仍在升高，应该在该地区进一步加大HIV干预的力度以控制HIV的传播。     

信宜市吸毒人员HIV感染及合并肺结核的调查

目的了解信宜吸毒人员人类免疫缺陷病毒（HIV）感染及合并肺结核的情况,探索防治对策。方法对信宜戒毒所的吸毒人员及到信宜市慢病站就诊有吸毒史的人员全部免费进行HIV抗体初筛和X线胸部透视。HIV抗体初筛阳性者送广东省疾病预防控制中心进行确认,对胸部透视发现肺结核病可疑者,结合胸片、痰涂片、结核抗体（含PPD试验）及临床表现进行肺结核的确诊。结果共检查531例,HIV感染者25例（其中男22例,女3例）,患病率4.71%;合并肺结核8例,占HIV感染者的32.0%。结论信宜吸毒人员HIV感染疫情严峻,且有向一般人群传播的趋势,合并肺结核也相当严重,应引起有关部门的关注,HIV感染者或有静脉吸毒史者宜及时作胸部X线检查和PPD试验,对肺结核患者也应作HIV抗体初筛,利于早期诊断与防控。     

广西荔浦县2001～2007年吸毒人员艾滋病监测结果分析

目的了解荔浦县吸毒人群艾滋病病毒（HIV）感染情况，为制定艾滋病预防控制措施提供科学依据。方法对2001—2007年在荔浦县强制戒毒所戒毒的吸毒者进行血清HIV抗体检测，并对吸毒者吸毒方式及性行为进行分析。结果2001—2007年共监测222名吸毒者，吸毒者年龄以20—39岁男性为主，占90．99％，吸毒方式以静脉吸毒多见，占85．14％，性行为中有性乱行为占77．03％。共检出HIV阳性34人，平均感染率为15．32％。结论荔浦县吸毒人群HIV感染率较高，不仅存在因静脉吸毒经血传播HIV的危险，还存在因性乱行为传播的危险因素，当前工作重点应在吸毒人群开展艾滋病宣传教育及行为干预措施。     

2000例吸毒者HIV感染情况的检测分析

目的了解吸毒人群中HIV感染情况，吸毒行为与HIV感染的关系。方法对我所新收容的2000例吸毒劳教人员进行HIV抗体检测，并采用“吸毒方式调查表”进行问卷调查。结果2000例吸毒人员中HIV阳性者372例，检出率18．6％。2000例吸毒人员中静脉注射吸毒1860例中HIV感染370例，烫吸吸毒140例中HIV感染2例；1860例静脉注射吸毒者中共用注射器1302例，其中HIV感染360例（HIV感染率28．42％），非共用注射器558例，其中HIV感染10例（HIV感染率1．43％）。二者差异有显著性（χ^2=163．89，P〈0．001）。结论广东省部分地区静脉吸毒者HIV感染率高，共用注射器是引起HIV传播的主要原因，应当采取措施予以干预。     

美沙酮维持治疗吸毒人员感染人类免疫缺陷病毒调查研究

目的 调查美沙酮维持治疗吸毒人员感染人类免疫缺陷病毒（HIV）的状况,并分析导致吸毒人员感染HIV的高危因素.方法 选择2009年5月至2012年5月来宾市美沙酮维持治疗门诊收治的230例接受美沙酮维持治疗的药物依赖者为研究对象,通过问卷调查、采集血样检测HIV抗体等方式收集相关数据,并进行统计学分析.结果 HIV抗体阳性27例,感染率为11.74％,共用注射器者32例,有输血、血制品史4例,有不良性接触史20例.共用注射器与非共用注射器HIV感染率比较差异有统计学意义（x2=136.570,P=0.000）;有、无输血液、血制品史HIV感染率比较差异无统计学意义（x2=0.517,P=0.472）;有、无不良性接触史HIV感染率比较差异有统计学意义（x2=9.112,P=0.002）.结论 共用注射器静脉吸毒及不良性接触是吸毒人群感染HIV的高危因素,采取必要的手段阻断此途径是防止HIV在人群中传播的重要措施.     

人类免疫缺陷病毒感染早期启动抗逆转录病毒治疗的意义

人类免疫缺陷病毒（HIV）感染者如在感染早期未及时诊断和治疗,HIV将在体内持续复制,损害免疫系统。目前,越来越多的指南建议HIV感染者应尽早启动抗逆转录病毒治疗（ART）,尤其是急性HIV感染者。早发现并在感染早期开始ART可以限制病毒储存库的规模,改善免疫细胞功能。从社会层面而言,感染早期的患者通过启动ART达到病毒抑制状态,可以减少HIV的传播机会,降低获得性免疫缺陷综合征（AIDS）的发病率,进而减少与AIDS相关的卫生支出。但HIV感染早期诊断及治疗存在个人因素和社会因素等方面的问题,阻碍了早期治疗的实施和开展。尽早启动ART,联合其他治疗策略,有可能真正实现功能性治愈。     

某市2013～2015年男男性行为人群人类免疫缺陷病毒新发感染研究

目的了解淮安市男男性行为（MSM）人群中人类免疫缺陷病毒（HIV）新发感染情况及其影响因素。方法2013～2015 年通过网络招募MSM,进行问卷调查以及实验室检测;检出的HIV 阳性样本再应用BED HIV IgG 捕获酶免疫法（BED-CEIA）检出其中的新发感染样本,计算新发感染率。以HIV 阴性为对照,采用Logistic 回归分析探讨其影响因素。结果2013～2015 年共招募1 202 名调查对象,新发感染率分别为1.81%、1.89%和3.18%,3年间差异无统计学意义（P >0.05）。多因素分析显示在本地居住时间和梅毒感染是HIV感染的主要危险因素。结论淮安市MSM人群HIV 新发感染率较其他地区低,但仍在不断增长,影响新发感染的主要因素为本地居住时间和梅毒感染,应加强MSM 人群的干预力度,同时开展多种疾病联合监测,遏制疾病扩散。     

Human immunodeficiency virus infection in disadvantaged adolescents. Findings from the US Job Corps

OBJECTIVE--To describe the human immunodeficiency virus (HIV) epidemic among socially and educationally disadvantaged young persons in the United States. DESIGN.-We analyzed demographic and geographic findings from the screening of Job Corps students for antibody to HIV. SETTING--The Job Corps is a federal training program for disadvantaged, out-of-school youth. POPULATION SCREENED--Residential students aged 16 to 21 years who entered the Job Corps from October 1987 through February 1990. MAIN OUTCOME MEASURE--Rates of observed HIV infection in entering students, stratified by demographic and geographic features. RESULTS--Of 137,209 Job Corps students screened, 488 were HIV seropositive (3.6 per 1000), a seroprevalence rate higher than that among military applicants of the same age. Overall seroprevalence was slightly higher in male (3.7 per 1000) than in female (3.2 per 1000) Job Corps students, but among those students aged 16 and 17 years, seroprevalence was higher among females (2.3 per 1000) than among males (1.5 per 1000) (P less than .05). For students aged 16 to 21 years, seroprevalence increased with year of age: 1.8 per 1000 per year for males and 0.7 per 1000 per year for females. Among those aged 21 years, HIV prevalence was 8.9 per 1000. For black and Hispanic students from large Northeastern cities, seroprevalence increased by 4.3 per 1000 per year of age and reached 24.8 per 1000 (one of 40) in students aged 21 years. However, among students from rural areas and small towns, HIV seroprevalence was disproportionately high in the Southeast. Compared with recently described US patients with the acquired immunodeficiency syndrome, HIV-infected students who entered the Job Corps were much more likely to be female. CONCLUSIONS--These findings show that disadvantaged, out-of-school adolescents are at high risk for HIV infection. The screening results identified surprisingly high seroprevalence in the southeastern United States and demonstrated a marked shift in the HIV epidemic to young women. Controlling the HIV epidemic among teenagers must include interventions that will reach adolescents early and outside of the formal educational system.     

异性性接触途径传播HIV的风险及相关因素研究

目的：了解经异性性接触途径感染人类免疫缺陷病毒(HIV)/获得性免疫缺乏综合征(AIDS)的患者作为艾滋病传染源传播HIV情况,为艾滋病防治决策提供依据。方法：对250名HIV阳性人员进行问卷调查,了解其社会人口学特征、异性性行为等有关情况,同时溯源调查与其性行为密切接触的易感人群,检测、了解其艾滋病感染情况,计算续发率和增长率。采用病例对照分析方法探讨传染源继续传播HIV的相关因素。结果：250名传染源的431名易感接触者有59人HIV阳性,续发率为13.7%(59/431),增长率为23.6%(59/250)。传染源继续传播HIV的相关因素为：艾滋病防治知识知晓情况、知晓感染后心理反映、与配偶/固定性伴安全套使用情况、与非固定性伴安全套使用情况。结论：HIV 异性性接触者的续发率和增长率较高;加强艾滋病防治知识宣传,对传染源及时提供心理和医学服务,促进安全套使用可以降低高危行为和控制HIV的进一步传播。     

HIV infections in otolaryngology

HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer.     

Estimates of the number of motherless youth orphaned by AIDS in the United States.

OBJECTIVE--To estimate the number of youth in the United States who have been or will be left motherless by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, in order to project the need for family supports, age-appropriate foster and congregate care, and mental health and social services. DESIGN--Orphans are defined as youth whose mothers (the usual caregiving parent) die of HIV/AIDS-related causes. A mathematical model was constructed to estimate the number of such motherless youth. Cumulative fertility rates were applied to the number of reported AIDS deaths (1981 through 1990) and projected deaths (1991 through 1995) of adult women less than 50 years old. The results were adjusted for underreporting of HIV/AIDS-related mortality, pediatric AIDS deaths, infant mortality, ethnic and racial variation in fertility, and decreased fertility associated with late-stage HIV disease. Estimates were made for the number who were children (less than 13 years of age), adolescents (13 to 17 years of age), or young adults (18 years of age or older) at the time of their mothers' death. RESULTS--By the end of 1995, maternal deaths caused by the HIV/AIDS epidemic will have orphaned an estimated 24,600 children and 21,000 adolescents in the United States; unless the course of the epidemic changes dramatically, by the year 2000, the overall number of motherless children and adolescents will exceed 80,000. In 1991, an estimated 13% of US children and 9% of adolescents whose mothers died of all causes were children of women who died of HIV/AIDS-related diseases. These proportions will surpass 17% and 12%, respectively, by 1995. The vast majority of these motherless youth will come from poor communities of color. CONCLUSIONS--A large and rapidly growing number of American youth are being orphaned by the HIV/AIDS epidemic. Unless increased attention and resources are devoted to this vulnerable population, a social catastrophe is unavoidable.     

Serosurvey of human immunodeficiency virus infection in parturients. Implications for human immunodeficiency virus testing programs of pregnant women

Although perinatal transmission of the human immunodeficiency virus (HIV) is well documented, seroprevalence rates of HIV in populations of women of reproductive age have not yet been reported. To determine the seroprevalence of HIV in childbearing women from a population with a high incidence of acquired immunodeficiency syndrome, cord blood samples were collected from 602 infants delivered at an inner-city municipal hospital in New York. Demographic and HIV risk factor information was also collected from mothers of these infants. Twelve (2%) of 602 samples (95% confidence interval, 1% to 4%) were positive for HIV on enzyme-linked immunosorbent assay and Western blot analysis. In interviews, seven of 12 seropositive women had risk factors as defined by the Centers for Disease Control, Atlanta; the remaining five seropositive women had no self-identified risk factors. The HIV seroprevalence rate in our hospital (2.0%) is several times higher than that of many other diseases for which screening is already routine. This serosurvey indicates that HIV infection of inner-city parturients is a significant problem that warrants broadly implemented health strategies. Furthermore, the data also suggest that if risk factor information elicited by physicians is used to initiate HIV antibody counseling and testing of pregnant women, a significant number of seropositive parturients is missed. In areas with significant seroprevalence rates of HIV infection, a broader counseling and testing program may be needed.     

HIV/AIDS致病机理研究进展

目的：对近年来获得性免疫缺陷综合征（Acquired Immunodeficiency Syndrome,AIDS）的致病机理研究进展进行综述。方法：参阅新近公开发表的中外文献阐述了AIDS是由人类免疫缺陷病毒（Human Immunodeficiency Virus,Hiv）引起的一种严重的免疫缺陷性疾病。结果：HIV属于逆转录病毒,由双链RNA、病毒核心蛋白及包膜组成,分为两种类型（HIV-1,HIV-2）,绝大多数感染人体的是HIV-1。HIV通过病毒糖蛋白gP^120／gP^41与在被感染细胞的细胞膜表面同时表达的CD4和辅助受体进行识别,从而侵入细胞并损伤宿主的免疫系统,而宿主的免疫应答又不能清除HIV,最终发展成AIDS。结论：HIV感染最终导致机体的免疫功能的损伤,进而发展成AIDS。本文就AIDS致病机理的研究进展做一简要的综述。     

Human immunodeficiency virus infection in urban Rwanda. Demographic and behavioral correlates in a representative sample of childbearing women

OBJECTIVE.--To determine behavioral and demographic risk factors for human immunodeficiency virus (HIV) infection in central Africa. DESIGN.--Cross-sectional survey. SETTING.--Kigali, Rwanda. PARTICIPANTS.--A representative sample of 1458 childbearing women aged 19 to 37 years who were recruited from outpatient prenatal and pediatric clinics at the only community hospital in the city. MAIN OUTCOME MEASURE.--Antibodies to HIV assessed by enzyme immunoassay and confirmed by Western blot or indirect immunofluorescence. RESULTS.--The HIV seroprevalence was 32% overall. Infection rates were higher in women who were single, in those in steady relationships that began after 1981, and in the 33% of women reporting more than one lifetime sexual partner. Women in legal marriages or monogamous partnerships had lower rates of infection, but even low-risk women had prevalences on the order of 20%. History of venereal disease in the past 5 years, although the strongest risk factor in a multiple logistic analysis (odds ratio, 2.7; 95% confidence interval, 2.0 to 3.7), was reported by only 30% of those infected. Having a male sexual partner who drank alcohol or who had higher income were significant risk factors for HIV infection in the multivariate analysis, but use of oral contraceptives and having an uncircumcised partner were not. CONCLUSIONS.--The epidemic of the acquired immunodeficiency syndrome in Rwanda has spread beyond high-risk groups to the general population of women without known risk factors. For most of these women, a steady male partner is the source of their HIV risk and therefore a vital target for intervention efforts.