我国社区美沙酮维持治疗吸毒人员HIV新发感染研究

目的分析我国参加社区美沙酮维持治疗吸毒人员艾滋病病毒(HIV)新发感染情况,探讨与感染相关的因素。方法建立2004年3月-2010年12月期间参加治疗的吸毒成瘾人员队列,对参加治疗时HIV抗体阴性者每6个月进行HIV随访检测,计算HIV新发感染率,采用单因素分析和Cox比例风险回归模型,对与新发感染有关的因素进行预测分析。结果累计随访检测治疗人员101 821人,发现596例新发感染,HIV新发感染率0.35/100人年(95%CI:0.32～0.38/100人年)。少数民族治疗人员新发感染率较高(最高3.21/100人年),文化程度低者新发感染率较高(小学及以下0.58/100人年)。不同地区新发感染率不同,最高省份为1.83/100人年。62.1%的感染发生在治疗最初的1年中。Cox比例风险回归显示,女性(HR=1.290,95%CI:1.058～1.574,P=0.012)、少数民族(HR=2.861,95%CI:2.363～3.463,P<0.000 1)、小学及以下文化程度(HR=1.765,95%CI:1.465～2.12 7,P<0.000 1)、注射吸毒(HR=3.302,95%CI:2.504～4.354,P<0.000 1)、共用注射器(HR=1.943,95%CI:1.622～2.326,P<0.000 1)会增加治疗期间HIV感染的风险,参加治疗时年龄较大者感染风险较低(每增加1岁HR=0.980,95%CI:0.968～0.992)。结论我国参加MMT吸毒人员HIV新发感染率的民族和地区差异大,主要发生在参加治疗的前几个月,女性、少数民族、低文化程度、曾注射吸毒和共用注射器会增加治疗期间HIV感染的风险,参加治疗时年龄较大者感染风险较小。具有这些特征的吸毒人员在入组治疗时,要给予特别关注,并开展针对性的干预。

New HIV infections among drug users receiving methadone maintenance treatment in China

Objective To describe the HIV incidence among clients attending methadone maintenance treatment(MMT) clinics in China,and explore the factors associated with new HIV infections.Methods The open cohort of HIV negative drug users who attended MMT clinics from March 2004 to December 2010 were established,and follow up HIV tests were conducted every six months.New cases of HIV infection were numerated and HIV incidence rate among MMT clients was calculated.Single factor analysis and Cox proportional hazard regression model were used to evaluate factors associated with HIV infections.Results A total of 101 821 MMT clients received follow up HIV tests between March 2004 and December 2010,and the HIV incidence was 0.35 per 100 person years(95%CI 0.32-0.38 per 100 person years).MMT clients of ethnic minority had higher incidence(the highest was 3.21 per 100 person years),and those with primary schooling or less also had higher incidence(for the illiterate and those with primary schooling-0.58 per 100 person years).The HIV incidence varied considerably between different provinces,and the highest incidence was 1.83 per 100 person years,and of all the HIV infection cases,62.1% were infected during the first year when they were enrolled in MMT clinics.The results of Cox proportional hazard regression model showed that such factors,as femininity(HR=1.290,95%CI:1.058-1.574,P=0.012,younger age to receive MMT(older vs.younger(year) HR=0.983,95%CI:0.972-0.995),ethnic minority(HR=2.861,95% CI:2.363-3.463,P<0.000 1),primary schooling or less(HR=1.765,95%CI:1.465-2.127,P<0.000 1),drug injection(HR=3.302,95%CI:2.504-4.354,P<0.000 1),and sharing needles(HR=1.943,95%CI:1.622-2.326,P<0.000 1),were associated with the new infections among MMT clients.Conclusion The HIV incidence in MMT clients in China varies among different ethnic groups and provinces.Most infections occurred among MMT clients in the first a few months of their treatment.Younger age,ethnic minority,lower schooling,drug injecting and needle sharing would increase the risk to HIV infection among them.Therefore,the drug users with the above three characteristics need to be given special attention and supports when they participate in MMT.