上海市嘉定区男男性行为者HIV新发感染及队列保持影响因素研究

目的了解上海市嘉定区男男性行为者(MSM)队列保持、艾滋病病毒(HIV)新发感染以及相关影响因素,为开展MSM综合干预提供建议。方法通过自愿咨询检测(VCT)门诊、同伴推动、网络动员、外展干预等方式招募MSM,建立随访队列,并对随访队列数据进行统计分析。结果共招募334名MSM,排除HIV阳性39人(11.68%),HIV抗体血清阴性基线队列295人,12个月后随访到149人,队列保持率50.51%。Logistic回归模型分析显示:年龄组[比值比(OR)值为1.32,95%可信区间(CI):1.04～1.68]、知识得分(OR值为1.34,95%CI:1.04～1.72)是队列保持危险因素。总观察时间300.67人年,HIV确证阳转6人,新发感染率为2.00/100人年(95%CI:0.81～4.15/100人年);梅毒快速血浆反应素环状卡片试验(RPR)转阳2人,新发感染率为0.67/100人年(95%CI:0.11～2.20/100人年)。COX回归模型分析显示:过去是否患过性病[风险比(HR)值为14.11,95%CI:2.37～84.16]是艾滋病新发感染的危险因素。结论 MSM艾滋病患病率、新发感染率较高,患有性病的MSM容易新发感染艾滋病病毒;MSM队列保持困难,低知识水平、低年龄MSM更容易失访。     

玉溪市红塔区美沙酮维持治疗者HCV和HIV抗体阳转分析

目的了解玉溪市红塔区美沙酮维持治疗者艾滋病病毒(HIV)及丙型肝炎病毒(HCV)抗体阳转情况,探讨相关的影响因素。方法对2008-2016年间玉溪市红塔区美沙酮维持治疗者进行随访,入组时开展问卷调查,入组时及随后每年进行HIV和HCV抗体检测,计算HIV和HCV抗体阳转率并运用COX比例风险回归模型分析其影响因素。结果分别有1 256名基线HIV抗体阴性和343名基线HCV抗体阴性的研究对象纳入队列,抗体阳转率分别为0.07/100人年[95%可信区间(CI):0.06～0.08/100人年]和12.69/100人年(95%CI:8.78～16.60/100人年)。多因素模型控制潜在的混杂作用后结果显示,入组时正在注射吸毒者、入组时首次美沙酮剂量 25 mL者HCV抗体阳转的风险高于入组时未注射毒品和入组时首次美沙酮剂量≤25 mL者[风险比(HR)=3.54, 95%CI:1.64～7.62,HR=2.94, 95%CI:1.71～6.01]。HCV抗体阳转率由基线至第1次随访期间的21.61/100人年下降至第6～7次随访期间0/100人年。结论玉溪市红塔区美沙酮维持治疗在减少HIV经吸毒途径传播中初显成效,但HCV抗体阳转率仍然较高,其中入组时正在注射吸毒者、首次美沙酮剂量较高者HCV阳转风险较高,坚持服用美沙酮者HCV阳转风险较低。     

金华市MSM队列HIV阳转及高危行为变化情况

目的了解金华市男男性行为人群（MSM）的艾滋病病毒（HIV）抗体阳转及高危行为变化情况。方法采用前瞻性队列研究,招募符合纳入标准的MSM组建队列。纳入队列的MSM每隔3个月进行一次随访调查,并采集血样检测HIV抗体。结果共纳入90名HIV抗体阴性的MSM,队列基线调查艾滋病防治核心知识知晓率为83.3%,队列保持率为78.9%（71/90）,比较基线调查和随访到的性行为情况,随着随访次数增加,最近3个月与同性性伴发生安全性行为所占构成比增加;最近3个月与固定同性性伴和临时同性性伴发生性行为时都采取保护措施的比例有明显提高,与异性性伴发生性行为时安全套使用情况无变化。HIV血清抗体阳转率为3.9/100人年。结论参与队列定期随访和检测后,MSM的高危性行为有所下降。由MSM社会组织鼓励动员参加定期随访和检测是值得推广的有效干预措施。     

深圳市男男性行为人群HIV／梅毒发病密度研究

目的了解深圳市男男性行为人群（MSM）的艾滋病病毒（HIV）/梅毒发病密度,探索防治性病对预防控制艾滋病的作用。方法知情同意原则下,招募符合纳入标准的MSM;建立并保持队列,收集社会人口学、性行为和安全套使用等资料;抽血检测HIV/梅毒,随访观察HIV/梅毒转归结局。结果 609例入选队列,HIV阴转阳19例,观察总人年数249.7人年,发病密度7.6[95%可信区间（CI）：4.6～11.9]/100人年;梅毒酶联免疫吸附试验（ELISA）阴转阳18例,观察总人年数134.9人年,发病密度13.3（95%CI：7.9～21.1）/100人年;梅毒ELISA阳性队列HIV发病密度是梅毒ELISA阴性队列HIV发病密度的2.2倍。结论梅毒对HIV传播具有协同作用,有必要在该人群中实施有效的性病预防措施以控制HIV传播     

新疆库车县HIV感染者阴性配偶队列研究

目的观察新疆库车县HIV感染者阴性配偶中HIV新发感染率,为指导HIV感染者阴性配偶的干预工作提供科学依据。方法在HIV感染者阴性配偶中建立前瞻性队列,每3个月进行一次定位随访,每6个月完成一次问卷调查和HIV、梅毒、丙型肝炎的检测,队列随访周期为一年。结果纳入阴性配偶队列共113人,随访观察101人,一年随访期间HIV新发感染率0.93/100人年(1/108人年),梅毒新发感染率10.00/100人年(10/100人年),丙型肝炎新发感染率0.95/100人年(1/105人年);最近6个月内与主要性伴性行为的不同频次之间、最近一个月性行为每次安全套使用率差异有统计学意义(χ2=15.81,P<0.005)。结论库车县HIV感染者阴性配偶中HIV新发感染率较低,提示库车县艾滋病综合防治工作及HIV感染者阴性配偶干预工作取得了一定成效,今后应进一步加大干预力度和频度,特别针对文化程度偏低的"单阳"家庭,运用各种形式普及HIV/STD相关知识,采取他们容易接受的方式开展干预,使其真正意识到相关的危险行为,树立安全的性行为观念,增强其自我保护意识,预防HIV在"单阳"家庭中的二代传播。     

红河州MSM艾滋病相关知识及行为的随访调查

目的了解云南省红河州男男性行为人群（MSM）的艾滋病防治知识、行为及艾滋病病毒（HIV）抗体和梅毒血清学年阳转情况,为制定干预措施提供依据。方法采用前瞻性队列研究,招募符合标准的MSM,每6个月随访调查1次,项目期共完成2次随访调查。结果共招募了200名MSM,6个月随访调查178人,队列保持率89．00％;12个月随访调查158人,队列保持率79．00％。艾滋病防治知识知晓率从招募时的93．67％提高到98．73％;最近6个月与同性肛交时每次都用安全套的比例从招募时的34．85％上升到80．65％,最近一次与同性肛交时每次都用安全套的比例从招募时的54．55％上升到87．10％,与异性性行为时每次都使用安全套的比例从12．50％提高到47．06％。研究期间有3人出现HIV抗体阳转,无梅毒阳转。结论随访调查中,MSM的艾滋病知识知晓率、安全套使用率有所提高,但同性肛交、异性性行为情况无明显变化。应加强对辖区MSM的干预服务工作,以及HIV和相关疾病的监测检测覆盖范围。     

HIV单阳家庭配偶间传播研究进展

目的综述HIV"单阳"家庭配偶间传播流行病学相关研究进展。方法查阅相关文献并进行综述分析。结果受各种因素影响,不同地区"单阳"家庭阴性配偶的HIV阳转率存在较大差异,23个国家的研究显示,"单阳"家庭中阴性配偶的阳转率从4.2/100人年～47.4/100人年不等;国内研究表明,中国"单阳"家庭阴性配偶的阳转率为1.2/100人年,其中,河南省(0.9/100人年)和云南省(1.7/100人年)的阴性配偶阳转率显著低于印度(6.5/100人年),发展中国家的阴性配偶阳转率显著高于发达国家;在"单阳"家庭中,影响HIV传播的生物因素主要包括性别、先证者的病程、病毒载量、性传播疾病(STD)状况等。结论与国外对"单阳"家庭的研究相比,国内研究对HIV合并感染的梅毒、淋病等STD检测较多,而对HSV-2的检测较少;男性包皮环切在许多国外文献中都被证明与HIV的传播有关,而国内对其研究较少;从研究数量上看,对HIV"单阳"家庭的相关研究多集中在非洲地区,相比于MSM人群,国内有关"单阳"家庭的研究较少,缺少随访时间长、样本量大的队列研究;作为HIV经性传播的重要途径之一,"单阳"家庭配偶间传播的影响因素应当得到进一步的研究。     

HIV单阳家庭配偶间传播研究进展

目的综述HIV"单阳"家庭配偶间传播流行病学相关研究进展。方法查阅相关文献并进行综述分析。结果受各种因素影响,不同地区"单阳"家庭阴性配偶的HIV阳转率存在较大差异,23个国家的研究显示,"单阳"家庭中阴性配偶的阳转率从4.2/100人年～47.4/100人年不等;国内研究表明,中国"单阳"家庭阴性配偶的阳转率为1.2/100人年,其中,河南省(0.9/100人年)和云南省(1.7/100人年)的阴性配偶阳转率显著低于印度(6.5/100人年),发展中国家的阴性配偶阳转率显著高于发达国家;在"单阳"家庭中,影响HIV传播的生物因素主要包括性别、先证者的病程、病毒载量、性传播疾病(STD)状况等。结论与国外对"单阳"家庭的研究相比,国内研究对HIV合并感染的梅毒、淋病等STD检测较多,而对HSV-2的检测较少;男性包皮环切在许多国外文献中都被证明与HIV的传播有关,而国内对其研究较少;从研究数量上看,对HIV"单阳"家庭的相关研究多集中在非洲地区,相比于MSM人群,国内有关"单阳"家庭的研究较少,缺少随访时间长、样本量大的队列研究;作为HIV经性传播的重要途径之一,"单阳"家庭配偶间传播的影响因素应当得到进一步的研究。     

北京市2011-2013年男男性行为者梅毒新发感染及影响因素的前瞻性随访研究北大核心

目的了解北京市男男性行为者（MSM）中梅毒的新发感染及影响因素,为开展更具针对性、有效性和科学性的预防干预措施提供科学依据。方法 2011年7月至2013年7月完成MSM基线队列招募,运用问卷调查的形式,收集研究对象的社会人口学和性行为情况,并进行梅毒抗体检测。结果 3年内梅毒抗体阴性基线共招募1074名MSM,6个月随访到660人,梅毒新发感染率为6.12/100人年[95%可信区间（CI）=4.09~8.14]。多因素COX回归分析结果显示,研究对象大专以下的文化程度[风险指数（HR）=2.47,95%CI=1.24~4.91,P=0.01],首次与男性发生性关系的年龄（HR=2.24,95%CI=1.04~4.80,P〈0.01）和2011-2013年3年内艾滋病病毒检测次数（HR=3.94,95%CI=1.49~10.41,P〈0.001）是梅毒血清抗体阳转的影响因素。结论北京市MSM中梅毒新发感染率仍处在较高水平,急需针对梅毒新发感染的相关影响因素开展预防干预工作。     

北京地区2001-2010年MSM人群HIV感染状况及综合干预模式的探讨

目的了解北京地区男男性行为人群(MSM)近年来艾滋病病毒(HIV)感染状况,探索控制MSM人群HIV传播的有效干预模式。方法 2001-2010年间,每隔3年对MSM人群进行HIV筛查,调查HIV感染危险因素。通过队列研究方法,在MSM人群中建立3年期随访队列,探讨该人群HIV干预模式。结果北京地区MSM人群HIV感染率从2001年的1.33%递增为2010年的15.33%。同性性经历时间较短、性伴数量多、性伴HIV阳性、性行为中以被动方为主、合并感染梅毒等性病以及合并肛周疾病,是MSM人群感染HIV的高危因素。经干预后,队列人群中HIV检出率为3.2%,同期社会MSM人群HIV检出率为8.7%~15.33%。结论以HIV传染源干预为主的综合干预措施,可能有助于减少该人群HIV的传播。     

深圳市罗湖区MSM的HIV感染情况及相关危险因素

目的了解深圳市罗湖区男男性行为人群（MSM）艾滋病病毒（HIV）感染情况及相关危险因素。方法采用以时间场所抽样调查方法,在最佳时段,在MSM活动场所招募MSM进行问卷调查,并采集血样检测HIV、梅毒和丙型肝炎病毒（HCV）抗体。HIV感染的相关危险因素采用Logistic回归模型进行分析。结果 2008年4月至2009年11月共招募MSM 870名,HIV检测阳性率为4.5%（39例）,梅毒阳性率为11.7%（102例）,HCV阳性率为0.9%（8例）。74.5%的MSM向男性提供过商业性性服务。多因素Logistic回归分析显示,招募场所为家庭会所或桑拿、性取向为同性恋以及梅毒阳性,分别是MSM感染HIV的危险因素。结论罗湖区从事商业性性服务的MSM比例较高,桑拿及家庭会所感染率较高,应考虑在现有干预方案基础上增加针对性的有效干预措施。     

长沙市男男性行为者HIV和梅毒感染现状及影响因素分析

目的 了解长沙地区男男性行为者(MSM)艾滋病病毒(HIV)和梅毒感染状况及其影响因素.方法 2018年10月至2019年6月期间,委托非政府组织(NGOs)应用滚雪球的方法招募MSM,开展问卷调查和HIV及梅毒检测.采用多因素Logistic回归模型分析HIV和梅毒感染的影响因素.结果 共招募1 220名MSM,其中...     

Hepatitis C virus seroconversion among HIV-positive men who have sex with men with no history of injection drug use: Results from a clinical HIV cohort

BACKGROUND:

Internationally, there is a growing recognition that hepatitis C virus (HCV) may be sexually transmitted among HIV-positive men who have sex with men (MSM).

OBJECTIVE:

To report the first Canadian estimate of HCV seroincidence in 2000 to 2010 and its risk factors among HIV-positive MSM with no known history of injection drug use.

METHODS:

Data from the Ontario HIV Treatment Network Cohort Study, an ongoing cohort of individuals in HIV care in Ontario, were analyzed. Data were obtained from medical charts, interviews and record linkage with the provincial public health laboratories. The analysis was restricted to 1534 MSM who did not report injection drug use and had undergone ≥2 HCV antibody tests, of which the first was negative (median 6.1 person-years [PY] of follow-up; sum 9987 PY).

RESULTS:

In 2000 to 2010, 51 HCV seroconversions were observed, an overall incidence of 5.1 per 1000 PY (95% CI 3.9 to 6.7). Annual incidence varied from 1.6 to 8.9 per 1000 PY, with no statistical evidence of a temporal trend. Risk for seroconversion was elevated among men who had ever had syphilis (adjusted HR 2.5 [95% CI 1.1 to 5.5) and men who had acute syphilis infection in the previous 18 months (adjusted HR 2.8 [95% CI 1.0 to 7.9]). Risk was lower for men who had initiated antiretroviral treatment (adjusted HR 0.49 [95% CI 0.25 to 0.95]). There were no statistically significant effects of age, ethnicity, region, CD4 cell count or HIV viral load.

CONCLUSIONS:

These findings suggest that periodic HCV rescreening may be appropriate in Ontario among HIV-positive MSM. Future research should seek evidence whether syphilis is simply a marker for high-risk sexual behaviour or networks, or whether it potentiates sexual HCV transmission among individuals with HIV.     

Potential Bridges for HIV Infection to Men Who Have Sex With Men in Guangzhou,China

To assess the potential for HIV acquisition among men who have sex with men (MSM) in Guangzhou, China, we conducted a cross-sectional, anonymous, face-to-face survey of MSM in the metropolitan area of Guangzhou, China. As a pilot recruitment for a cohort study, participants were recruited by convenience sampling through newspaper and television advertising, website information, and respondent referral. Blood samples were tested for HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis. Client-centered HIV and STD counseling was provided.A total of 201 MSM were interviewed and 200 blood samples were tested. The prevalence of HIV antibody was 0% (97.5% CI 0–1.8%); 17.5% of MSM were HBV surface antigen positive; 1.0% had HCV antibodies; 10.5% had antibodies to syphilis. Syphilis seropositivity was associated with sex with a foreign MSM in the last six months and 10.4% reported sex with a foreign MSM overall. The majority (54.7%) reported unprotected anal sex with other men. Nearly one-third (31.8%) had regular female partners; 25.9% were currently married to a woman; 6% had casual female partners; 4.5% had sex with a female sex worker; 4.5% had sex with a male sex worker; and 12.9% had unprotected vaginal sex and unprotected anal sex with a man in the past six months. Only one MSM reported injection drug use (0.5%). The currently low prevalence of HIV but high level of unprotected anal sex, high prevalence of syphilis infection, and sexual networks that include foreign MSM point to a transient window for HIV prevention among MSM in Guangzhou. We recognize challenges to recruiting a representative sample of MSM and retaining them in longitudinal cohort studies.     

山东省男男性行为人群艾滋病梅毒感染率及其影响因素

目的了解山东省男男同性性行为人群(MSM)艾滋病病毒(HIV)、梅毒感染状况及其影响因素,为进一步做好MSM艾滋病防治工作提供依据。方法 2010年4-7月,按照多阶段整群随机抽样方法选取MSM人群,由经过统一培训的调查员对MSM进行面对面问卷调查,抽取静脉血检测艾滋病、梅毒抗体,对影响HIV、梅毒感染的因素进行Logistic回归分析。结果共调查3 200名MSM,收集有效问卷3 086份,有效问卷率96.44%,采集血液标本3 073份。调查对象最小15岁,最大74岁,平均年龄为(26.36±6.38)岁。最近六个月与同性发生过肛交性行为者占72.68%(2 243/3 086),其中每次都使用安全套者占32.59%(731/2 243);最近六个月与同性发生商业性行为者占11.83%(365/3 086),最近六个月与异性发生性行为者占22.72%(701/3 086)。HIV抗体阳性检出率1.01%(31/3 073),梅毒抗体阳性检出率4.69%(144/3 073)。Logistic回归分析显示,年龄较大、最近六个月发生同性肛交性行为、最近一年患过性病、没有接受安全套宣传发放服务,是HIV/梅毒感染的危险因素。结论山东省MSM人群HIV感染率较低,但梅毒感染率较高,提示MSM人群存在HIV广泛传播的可能性,需要在MSM人群中进一步加强艾滋病宣传和行为干预。     

Large transmission cluster of acute hepatitis C identified among HIV‐positive men who have sex with men in Bangkok,Thailand

A rapidly emerging and highly concentrated hepatitis C virus (HCV) outbreak has recently been observed among both acute and chronic HIV‐positive men who have sex with men (MSM) in Bangkok, Thailand. NS5B regions of the HCV genome were amplified using nested PCR and sequenced. Phylogenetic inference was constructed by Maximum Likelihood methods and clusters were identified with support and genetic distance thresholds of 85% and of 4.5%. Forty‐eight (25 acute HIV and 23 chronic HIV) MSM with incident HCV infection were included in the analysis. HCV genotype (GT) was 85% GT 1a and 15% GT 3a or 3b. Median age at HCV diagnosis was 34 (interquartile range, 28‐41) years. 83.3% (40/48) had history of syphilis infection and 36% (16/44) reported crystal methamphetamine use. Only 2 (4%) reported ever injecting drugs, both crystal methamphetamine. In the phylogenetic clustering analysis, 83% belonged to one of two clusters: one large (75%) and one small (8%) cluster. All clusters were GT 1a. MSM with acute HIV infection were more likely to be in a cluster (92%) than those with chronic infection (74%). HCV screening should be regularly performed for MSM in ART clinics, and offering direct‐acting antiviral agents to all MSM with HCV infection might contain the HCV epidemic from expanding further.     

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).     

HIV‐positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C

Acute hepatitis C virus infection remains a major health concern in human immunodeficiency virus(HIV)‐infected men who have sex with men (MSM). New direct‐acting antiviral agent (DAA) combination therapy has not yet been approved for the treatment for acute hepatitis C virus(HCV), thereby potentially causing deferral of HCV treatment. Therefore, we aimed to study the course of liver disease after an episode of acute HCV. This study is a retrospective single‐centre cohort of HIV‐positive MSM with acute HCV infection. Liver fibrosis was estimated by Fibroscan^® and Fibrotest^®. Liver‐related and non‐liver‐related outcomes were documented. Overall 213 episodes of acute HCV infection in 178 men were documented. Median follow‐up for all included patients was 38.7 months. Spontaneous HCV clearance was found in 10.8% of patients, which was significantly associated with older age, lower HCV RNA levels, and higher ALT levels upon initial acute HCV diagnosis. Treatment with interferon‐based therapy was initiated in 86.3% of cases, resulting in a sustained virological response(SVR) rate of 70.7%. After 3 years’ follow‐up, significant liver fibrosis of METAVIR F2 stage or higher was found in 39.4% of patients after first acute HCV diagnosis. Higher age, physician‐declared alcoholism, and nonresponse to acute HCV therapy were independently associated with higher fibrosis stages. Ten patients died during the observation period (IR 1.4/100 patient‐years) and four during interferon treatment. Significant liver fibrosis is a common finding in HIV‐positive MSM following acute HCV infection despite high treatment uptake and cure rates, suggesting the need for close liver disease monitoring particularly if HCV treatment is deferred.     

重庆市男男性行为人群近1年HIV检测情况及影响因素

目的了解重庆市男男性行为人群(MSM)近1年艾滋病病毒(HIV)检测情况及其影响因素。方法于2009年9-10月,在重庆市通过同伴推动抽样法(Respondent-driven sampling,RDS)招募510名MSM进行问卷调查及HIV和梅毒血清学检测,用RDSAT和SAS进行统计学分析。结果 57.1%的MSM曾经做过HIV检测,近1年HIV检测率为39.7%,HIV和梅毒感染率分别为14.9%和6.3%。在多因素Logistic回归分析结果中,MSM近1年HIV检测的影响因素为:近6个月与最近1个男性性伴主动肛交时使用安全套(AOR=1.7,95%CI:1.1～2.6)、知道最近1个男性性伴的HIV感染状况(AOR=2.0,95%CI:1.2～3.4)和近12个月接受过免费的性病检查或治疗(AOR=7.2,95%CI:3.9～13.0);年龄(>25岁:AOR=0.5,95%CI:0.3～0.8)和担心检测结果阳性受到歧视(AOR=0.5,95%CI:0.3～0.8)。结论急需开展有针对性的宣传教育和干预工作,来促进MSM定期HIV检测以降低HIV的传播。