云南省德宏州美沙酮维持治疗者HIV新发感染率研究

目的 了解云南省德宏州美沙酮维持治疗(MMT)就诊者中HIV新发感染率及其危险因素.方法 将德宏州2005年6月至2011年6月间所有入组MMT且HIV检测阴性的海洛因成瘾者作为研究对象纳入队列观察其HIV阳转情况,计算HIV新发感染率并运用Cox比例风险回归模型分析其影响因素.结果 共有3154名对象符合队列纳入标准,截至2011年6月,共有1023人(32.4％)入组MMT后从未接受过HIV随访检测,属于“失访”;另有2131人(67.6％)接受过至少一次HIV随访检测,累计随访观察4615.86人年,期间22人发生HIV抗体阳转,HIV新发感染率为0.48/100人年.无业、无婚史、自认入组前有注射毒品史者以及入组时HCV检测阳性者的HIV新发感染率较高,随访期间尿检结果均为阴性者中无一例HIV新发感染.运用Cox比例风险模型多因素分析显示,在控制混杂因素的影响后,入组前无注射毒品史者的HIV感染风险显著低于入组前有注射毒品史者(HR=0.29,95％CI:0.11～ 0.76).结论 德宏州MMT在减少HIV经吸毒途径传播中初显成效,需重点关注入组MMT前有静脉注射毒品行为以及治疗期间偷吸海洛因的MMT就诊者中HIV新发感染,加强随访和HIV检测力度.

Study on incidence of HIV infection among heroin addicts receiving methadone maintenance treatment in Dehong prefecture, Yunnan province

Objective To determine the incidence and risk factors of HIV infection among heroin addicts receiving methadone maintenance treatment(MMT)in Dehong prefecture,Yunnan province.Methods All heroin addicts who were HIV negative at the initiation of MMT in June 2005 and through June 2011,in Dehong prefecture were included in the cohort analysis.HIV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.Results A total of 3154 MMT clinic attendants were qualified for this cohort study.By June 2011,1023(32.4％)of them had never received any follow-up HIV testing so were thus referred as loss to follow-up.The other 2131(67.6％)members had received at least one follow-up HIV testing and were observed for a total of 4615.86 person-years.During the period,22 new HIV infections or seroconverters were identified,making the overall HIV incidence as 0.48/100 person-years.The HIV incidence was higher among those who were unemployed,never married,self-reported being injecting drug users(IDUs)and HCV positive at entry into the MMT program.None of those who were always negative on follow-up-urine-testing of morphine was discovered as HIV newly infected during the follow-up period.Data from multiple regression analysis under Cox proportional hazard model indicated that after controlling for confounding variables,non-IDUs at the entry point for the MMT program,were less likely to be HIV newly-infected or seroconverted than IDUs(HR=0.29,95％CI:0.11-0.76).Conclusion MMT prograqm in Dehong prefecture was demonstrated to be fairly effective in reducing HIV transmission through drug use.Those HIV negative attendants at the MMT clinic who were IDUs or keep using drugs during the treatment,were at higher risk of HIV seroconvertion.More efforts were needed to improve the follow-up and HIV testing programs for the MMT clinic attendants.