我国男男性行为人群中HIV-1病毒亚型分布及其演变

男男性行为人群(MSM)仍是我国HIV感染的高危人群,欧美B亚型、CRF01_AE和CRF07_BC亚型是其人群中流行的主要病毒亚型。近年来,MSM中HIV-1亚型的流行趋势发生改变,欧美B亚型所占比例显著下降,CRF01_AE和CRF07_BC亚型所占比例则明显增加,并且出现新的重组亚型。运用分子生物学技术分析我国男男性行为人群中HIV-1病毒亚型分布和变化趋势,可有助于阐明MSM人群中HIV-1的流行规律,追踪传染来源和确定相关危险因素,并为MSM人群精准干预提供重要的参考依据。     

四川省77名男男性行为人群HIV-1分子流行病学研究

目的了解四川省男男性行为人群(MSM)中感染艾滋病病毒Ⅰ型(HIV-1)各亚型的流行情况,探索HIV-1感染规律。方法采集近年来MSM人群中HIV感染者的样本,进行核酸提取、聚合酶链反应(PCR)及基因测序,对所得结果进行pol基因初步鉴定,同时用软件MEGA 4.1进行系统发生分析。结果在HIV感染者较多的成都、绵阳和达州三个地区采集的234份样本中,基因测序成功77份,其中CRF07_BC、CRF01_AE和B亚型分别为42份、24份和11份,各组群内基因离散率分别为(1.56%±1.10%)、(2.56%±0.82%)和(5.63%±2.02%)。结论各亚型组群内的部分感染者来自该亚型同一种毒株感染,CRF07_BC、CRF01_AE和B亚型毒株是当前四川省MSM人群HIV-1的主要流行毒株。     

广东省男男性行为者HIV-1传播特征

目的了解广东省男男性行为者(MSM)1型艾滋病病毒(HIV-1)基因型分布及传播特征。方法采用简单随机抽样方法估算样本量,随机从2013年报告的HIV感染者中抽样,选择传播途径为男男性行为的197份样本作为研究对象。采用巢式反转录聚合酶链反应(RT-PCR)扩增gag和env基因片段用于样本基因型确定,通过Neighbor-Joining进化树分析该人群主要流行毒株的来源和传播特征。结果在MSM中共检测到10种HIV-1基因型,其中以CRF07_BC(37.9%)、CRF01_AE(26.0%)和CRF55_01B(14.7%)为主,不一致基因型占检测样本的14.7%。系统进化结果表明,91.1%的CRF01_AE和93.9%的CRF07_BC感染病例与我国MSM中流行的毒株聚集成簇;20.0%的CRF01_AE和69.7%的CRF07_BC病例与省内传播有关。结论广东省MSM中流行的HIV毒株种类和来源复杂多样,省内传播和局部传播在省内病毒的传播和扩散中有重要作用。新型重组毒株的持续出现及其快速传播风险,提示应加强对该人群的监测并针对性地制定防控策略。     

北京市男男性行为者中人类免疫缺陷病毒1的流行亚型及其变化趋势

目的 了解北京市2005-2011年间男男性行为(MSM)人群HIV-1的流行亚型分布及其变化趋势.方法 2005-2006、2007、2008、2009和2010-2011年通过5次横断面调查,对北京市朝阳区MSM人群进行HIV-1抗体阳性筛查,采集阳性者的外周血,提取RNA,通过反转录及套式PCR扩增HIV-1的gag基因,并采用系统进化树来确定其亚型.结果 系统进化树分析发现,MSM人群中HIV-1的主要流行亚型为欧美B、CRF01_AE和CRF07_BC亚型.从2008年开始发现了CRF15_01B亚型,且2005-2011年此类人群中HIV-1主要流行亚型中欧美B亚型所占比例显著下降,而CRF01_AE亚型所占比例显著上升,CRF07_BC亚型所占比例逐年增加.结论 2005-2011年间北京市MSM人群中,HIV-1的流行亚型逐渐呈多元性,出现新的重组亚型,且主要亚型的流行趋势已发生改变.     

新疆乌鲁木齐市男性同性恋人群检测结果分析

目的 了解乌鲁木齐市男性同性恋人群(MSM)中HIV、HCV、梅毒感染情况,并应用HIV-1 BED-CEIA新近感染检测方法估计乌鲁木齐市男性同性恋人群的发病率.方法 利用网络招募方式获得求询者145名,采集血清样品143份进行HIV,HCV的ELISA初筛,对HIV阳性反应标本进行WB确证及HIV-1 BED-CEIA新近感染检测;143名求询者的样品进行梅毒RPR初筛和梅毒TPPA确认.结果 网络招募男性同性恋人群(MSM)中HIV阳性8名,检出率5.6%(8/143);HIV-1 BED-CEIA方法检出4名新近感染估计发病率6.74% (CI 0.13%～13.35%);梅毒阳性14名检出率9.8%;HCV均为阴性.结论 (1)男性同性恋人群(MSM)HIV感染率与HIV-1 BED-CEIA估计发病率较接近;(2)网络招募男性同性恋人群(MSM)梅毒的检出率比较高,其中有2名招募者HIV与梅毒合并感染;性病是HIV和HCV传播的协同因素,相对危险度均大于1(RR＞1).     

乌鲁木齐市在男男性行为者中开展尿液传递检测工作初探

正尿液传递检测是指受检者通过多种方式获得尿液采集管,自己采集尿液后,自愿选取邮寄、自送等方式,将尿液标本传递至专业实验室进行检测,通过手机客户端或专业实验室公共卫生网络平台获取尿液艾滋病病毒-1型(Human immune deficiency virus,HIV-1)初筛结果的一种全程匿名的HIV检测模式。男男性行为者(Men who have sex with men,MSM)是HIV感染的高危人群[1-3]。为了扩大MSM的检     

重庆市男男性行为人群2009年HIV-1 BED发病率调查

目的采用连续横断面调查和BED-捕获酶免疫试验(BED-capture enzyme immunoassay,BED-CEIA)估算重庆市男男性行为人群(MSM)2009年艾滋病病毒Ⅰ型(HIV-1)的发病率,分析流行趋势,讨论该方法应用于MSM人群的效率。方法利用"滚雪球"和同伴推动抽样方法(RDS),采用标准化问卷收集行为信息并采集血样,对HIV抗体确认阳性者采用BED-CEIA方法检测HIV-1新近感染,根据标准公式和2种校正公式,对该人群2009的发病率按不同年龄、寻找性伴方式、学历、收入状况等进行分层计算,与历年结果进行比较分析。结果共招募MSM志愿者942名,平均年龄为(26.32±7.11)岁,大专及以上学历者598人(63.48%);共发现HIV感染者142人,BED检测为新近感染者62人。重庆市MSM人群2009年HIV-1年发病率为15.43%(95%CI:11.59～19.28),较2008年增长了64.49%,与过去3年有显著性差异。21～30岁年龄组年发病率为15.03%(95%CI:10.42～19.42),通过网络寻找性伴组的年发病率为14.69%(95%CI:10.14～19.24),大专及以上学历组年发病率为13.74%(95%CI:9.25～18.23)。结论重庆市MSM人群HIV-1发病率呈快速上升趋势,2009年发病率校正之后的绝对值与前三年比较,结果有显著性差异;不同的校正公式得到的结果没有显著性差异,但与估计感染率之间存在令人深思的矛盾现象。     

我国男男性行为人群艾滋病高危行为干预方法的进展

男男性行为人群(MSM)是我国艾滋病防制工作的重点人群之一,本文对我国目前针对这一人群常用的一些行为干预方法在实际应用取得的进展做一综述,为各地疾控部门进一步改善MSM艾滋病防制工作提供参考和借鉴。     

防控HIV感染的新策略——使用抗逆转录病毒药物进行HIV-1感染的暴露前预防

HIV-1感染是目前全世界范围内最具挑战性的公共卫生难题.尽管联合抗逆转录病毒治疗(cART)显著改变了HIV-1感染的典型病程,极大地增加了HIV-1感染者的预期寿命,但如何有效地控制HIV-1的传播、减少新发感染者的数量并对特殊人群[如性工作者、发生男-男性行为者(men who have sex with men,MSM)人群等]实施有效干预仍是目前各个国家面临的共同问题.目前使用的预防HIV-1经性途径传播的策略包括安全套的推广使用、安全性行为的宣教等,并未有效地控制HIV-1在普通人群中的传播,在某些特殊人群(如非洲女性)甚至出现了发病率逐渐上升的趋势.     

天津市2008-2011年MSM人群HIV流行趋势分析

目的了解天津市2008-2011年男男性行为人群(MSM)艾滋病病毒(HIV)的流行趋势,为在该人群中开展相关控制措施提供依据。方法分析2008-2011年天津市监测中新发现的MSM中的HIV/艾滋病(AIDS)病例情况、MSM人群血清学监测的数据以及横断面调查数据。结果新发现HIV/AIDS病例中,MSM病例所占比例最高,2008-2011年病例报告显示的构成比及报告数量增长最快的传播途径是男男性传播。MSM病例中流动人口占53.3%,未婚占61.0%,高中及以上文化程度占69.6%,15～29岁占47.2%。无偿献血及自愿咨询和检测发现的阳性病例中,MSM所占的比例最高。血清学监测结果显示,天津市MSM人群HIV感染率维持在稳定水平。横断面调查结果显示,MSM近6个月发生同性性行为时每次都使用安全套构成的中位数为35.85%,近6个月中最近1次发生同性性行为时安全套使用率中位数为59.55%,近6个月与异性发生性行为比例的中位数为18.05%,梅毒检出的中位数为18.25%,HIV检出的中位数为6.25%。结论 MSM人群为天津市HIV/AIDS感染的主要人群,艾滋病流行趋势严重,危险行为普遍存在,急需采取有效措施控制HIV通过其传播及扩散。     

MSM人群急性HIV-1感染者病毒亚型分析

目的研究2007-2009年男男性行为人群（MSM）艾滋病病毒-1型（HIV-1）的基因亚型,以监测MSM人群HIV病毒株的最新流行情况。方法采集95例MSM急性HIV-1感染者的外周全血,从外周全血浓缩白细胞中提取脱氧核糖核酸（DNA）,用巢式聚合酶链反应（Nested-PCR）对HIV-1的前病毒DNA进行扩增,然后检测并分析PCR扩增产物的核苷酸序列,确定病毒的基因亚型。结果 95例感染者平均年龄为（35.02±9.15）岁,其中20～50岁的青壮年45例（94.74%）,未婚51例（53.68%）,大专或大学及以上文化程度者30例（占31.58%）。感染者中共发现CRF01_AE亚型、B亚型、BC重组亚型（包括CRF07_BC和CRF08_BC）及C亚型4种亚型。其中CRF01_AE重组亚型56例（占58.95%）,B亚型28例（占29.47%）,BC重组亚型10例（占10.53%）,C亚型1例（1.05%）。结论 MSM人群急性HIV-1感染者年轻化,文化程度普遍偏低。小样本流行病学调查显示,急性HIV-1感染者中有CRF01_AE亚型、B亚型、BC重组亚型及C亚型4种亚型病毒株流行,CRF01_AE亚型为MSM人群的主要亚型。     

MSM中HIV阳性者性行为特征及其影响因素的研究进展

男男性行为人群(Men who have sex with men,MSM)艾滋病病毒(Human immunodeficiency virus,HIV)阳性者的性行为和心理特征,与一般的MSM有显著差异,他们的不安全性行为仍然广泛存在,但更倾向于寻找阳性性伴,并选择被动肛交方式来"自我降低传播风险"。针对这一群体的特点,艾滋病防控重点,应该重在阻止二代传播,提高感染者生活质量。     

The dynamic face of HIV-1 subtypes among men who have sex with men in Beijing, China

The rapid increase of HIV-1 prevalence among Chinese men who have sex with men (MSM) provides an impetus for the acquisition of molecular epidemiologic information from this population. We conducted four serial cross-sectional surveys during year 2005-2009 and observed that the composition of HIV-1 subtypes was dynamically changing with from clade B to CRF01_AE from years 2005-2009. HIV-1 infection in this population includes the persistent circulation of multiple HIV-1 subtypes and complex new recombinants.     

A relative profile of HIV-negative users of French websites for men seeking men and predictors of their regular risk taking: a comparison with HIV-positive users

The Net Gay Barometre is a biennial survey among users of France's most popular websites for men who have sex with men (MSM). Given the recent increases in HIV infection and sexual risk practices among French MSM, this study aims to: (1) create a socio-sexual profile of HIV-negative men (HIV-); (2) identify predictors of regular unprotected anal intercourse (RUAI) in this group, and responding to a call for stratifying analyses of online samples of MSM by HIV status; and (3) perform the former two aims by comparing HIV- men with HIV-positive men (HIV+). Statistical analyses were conducted with 11,771 HIV- men and 2130 HIV+ men who completed the online survey between December 2008 and March 2009. Regarding the first aim, fewer HIV- men, relative to HIV+ men, were exposed to factors conducive to sexually transmitted infection; in the previous 12 months, smaller proportions of this group had gone to venues where sexual encounters were possible, engaged in an esoteric sexual activity, had a high number of casual partners, and practiced unprotected anal sex, RUAI or barebacking. However, multivariate regression analyses identifying predictors of RUAI in each group revealed common predictors: sensation-seeking, esoteric activities, oral contact with sperm, and barebacking (in a couple), although odds were generally higher in HIV+ men. Our findings raise the possibility of a sexual culture accentuating pleasure and adventurism that may gain in amplitude once seroconversion takes place.     

Circuit parties: sexual behaviors and HIV disclosure practices among men who have sex with men at the White Party, Palm Springs, California, 2003

The syphilis epidemic among men who have sex with men (MSM) in major US cities and concomitant increases in high-risk sexual behavior, have raised concerns of increased HIV transmission in this population. Therefore, to provide information for health promotion and disease awareness efforts, we investigated sexual behaviors, partner selection preferences and HIV serostatus disclosure practices of MSM at the White Party in Palm Springs, California. Circuit party attendees reported engaging in unprotected anal sex, however, a high proportion reported disclosing their HIV status. These findings suggest that some gay men are serosorting as a risk reduction strategy or implementing sexual risk reduction strategies to protect themselves and their partners. In our study, HIV-negative men were nine times more likely to report a preference for a seroconcordant sexual partner. The self-protecting attitudes of HIV-negative men in our sample outweighed the partner-protecting attitudes of HIV-positive men. This suggests that prevention interventions focusing on HIV-positive persons are warranted.     

Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US*

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N?=?532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs?>?6), multiple sex partnerships (AORs?>?1.8), and condomless sex in the context of substance use (AORs?>?3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.     

Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors

OBJECTIVE: To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States. METHODS: A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies. RESULTS: Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53-0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45-0.92), less gay identity (OR, 0.29; 95% CI, 0.17-0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30-0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30-0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07-2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history. CONCLUSIONS: Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.     

Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men

OBJECTIVES: The incidence of anal cancer among men who have sex with men (MSM) has continued to increase since the introduction of highly active antiretroviral therapy (HAART). The prevalence of the putative anal cancer precursor, anal intraepithelial neoplasia (AIN) was high among HIV-positive MSM prior to the availability of HAART but little is known about AIN since HAART was introduced. We characterized the prevalence of AIN among HIV-positive MSM and examined the association between AIN and various factors including use of HAART. DESIGN AND METHODS: A baseline point-prevalence analyses in a prospective cohort study of AIN was performed at a university-based research clinic. A total of 357 HIV-positive MSM with no history of anal cancer completed a questionnaire detailing behaviors and medical history, anal cytology and human papillomavirus (HPV) testing, and high-resolution anoscopy with biopsy for detection of AIN. RESULTS: Eighty-one percent of participants with available CD4+ cell counts at baseline had AIN of any grade; 52% had AIN 2 or 3; and 95% had anal HPV infection. In multivariate analysis, detection of > or = 6 HPV types [odds ratio (OR), 36; 95% confidence interval (CI), 7.4-171) and use of HAART (OR, 10; 95% CI, 2.6-38) were associated with AIN after adjustment for length of time participants were HIV-positive, CD4+ cell count and HIV viral load. CONCLUSIONS: The prevalence of AIN has remained high among HIV-positive MSM after the introduction of HAART. Our data indicate that HAART is not associated with a reduced prevalence of AIN and support measures to prevent anal cancer among HIV-positive MSM whether or not they are using HAART.     

Buenos Aires cohort of men who have sex with men: prevalence, incidence, risk factors, and molecular genotyping of HIV type 1

The prevalence, incidence, risk factors, and molecular genotyping of HIV-1 infection among men who have sex with men (MSM) were assessed through a prospective cohort study. The study was conducted in Buenos Aires from February 2003 to December 2004. Sociodemographic, sexual risk behavior data, and blood samples for HIV testing were collected at baseline and at 6 and 12 months. Cox regression analysis was applied to determine risk factors associated with HIV seroconversion. HIV-positive samples were analyzed by partial (pro/RT) and full-length genome sequencing. Of 811 HIV-negative participants evaluated at baseline, 327 volunteers that fulfilled the inclusion criteria were enrolled. Retention rates at 6 and 12 months were 97.2% and 91.5%, respectively. Twelve MSM seroconverted for HIV infection [incidence rate = 3.9 (95% CI = 2.0-6.7) per 100 person-years]. HIV seroconversion was associated with a greater number of different sexual contacts in the preceding 6 months (> or =10, hazard ratio = 3.3, 95% CI: 1.1-10.4). By partial pro/RT genotyping analysis, 83% HIV-positive samples were subtype B and 17% samples were BF recombinants, most of these being unique recombinant forms. This study describes for the first time the recruitment and follow-up of a cohort of MSM in Argentina. Retention rates and HIV incidence rate were high. These data should be considered as a promising potential population for HIV vaccine trials.