中国中部地区HIV母婴传播状况调查及其相关因素分析

目的:了解人类免疫缺陷病毒(HIV)在我国以血液传播为主的中部地区母婴传播率及影响母婴传播的相关因素,为开展预防阻断工作提供根据。方法:以当地因有偿供血或受血感染HIV后有生育史的妇女为调查对象,现场询问调查和检测,并对其子女配对的资料进行整理,回顾性分析HIV的母婴传播状况。结果:159例HIV阳性母亲生育的204名子女中,78例HIV阳性,母婴传播率为38.2%(78/204)。在159例HIV阳性母亲中,有39例为产后输血感染,所生的40名子女均母乳喂养,其中13例感染HIV,母乳传播率为32.5%(13/40)。对母婴传播的影响因素进行分析发现,母亲年龄、生产胎次对母婴传播率有一定影响,母亲年龄>30岁、多产的母婴传播率分别为48.5%、47.9%,高于母亲年龄<30岁、初产的36.2%、35.3%,但差异无统计学意义。胎儿性别也不影响母婴传播率。结论:在我国以有偿供血和受血为主要传播途径的中部地区,母婴传播率达38.2%,高于性传播和静脉吸毒的母婴传播率;影响母婴传播的因素是多方面的,其中HIV亚型作用不能排除。     

Effect of a national disaster on blood supply and safety: the September 11 experience

CONTEXT: An understanding of characteristics of blood donors donating in times of crisis may help predict blood supply safety and donor return patterns. OBJECTIVES: To characterize the volume of donations and prevalence of infectious disease markers in blood donated by US donors responding to the September 11, 2001, terrorist attacks, and to evaluate return rates in those who donated for the first time. DESIGN: Cross-sectional survey data from the National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study for 4 weeks before and 4 weeks starting with September 11, 2001, and the corresponding 8-week period in 2000. SETTING AND PARTICIPANTS: A total of 327065 volunteer blood donors making 373628 allogeneic donations at 5 large regional US blood centers. MAIN OUTCOME MEASURES: Changes in number of donations overall and by first-time and repeat status, prevalence of infectious disease markers, estimated risks of transfusion-transmitted viral infections, and first-time donor return rates. RESULTS: About 20000 allogeneic donations were collected weekly in the 4 weeks preceding September 11, whereas approximately 49 000 (2.5-fold increase) and approximately 26000 to 28000 (1.3-fold to 1.4-fold increases) donations were made per week in the first and in the second through fourth weeks starting with September 11, respectively. All demographic groups donated more than usual after the attacks, and after adjusting for seasonal and annual variation there was a 5.2-fold (95% confidence interval, 5.0-5.4) increase in the number of first-time donations vs a 1.5-fold (1.4-1.5) increase in the number of repeat donations made in the first week starting on September 11 vs the 4 weeks before. The weekly proportion of repeat donors returning after not donating for 10 or more years increased from 2% before September 11 to 6% in the first week starting with September 11. Donations confirmed positive for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen nearly tripled between 1 week before September 11 (0.1%) and 1 week after the attacks (0.3%), largely explained by the increase in first-time and lapsed repeat donors. Estimated viral residual risks increased slightly after the attacks (HIV, 1/1.5 million vs 1/1.8 million donations; HCV, 1/1.3 million vs 1/1.6 million; hepatitis B virus, 1/140000 vs 1/170000). First-time donor 12-month return rates for 2000 and 2001 were similar, approximately 28% (P =.37) for donors in the first week starting with September 11 (or September 12, 2000) and 30% (P =.69) for the second to fourth weeks. CONCLUSIONS: The September 11 events resulted in an influx of first-time donors without substantial increase in absolute risk of transfusion-transmissible viral infections. First-time donor return rates were equally relatively low before and after the attacks, suggesting that those donating in times of crisis have return behaviors similar to those of other first-time donors. Their relatively low return rates reinforce the need for education about the importance of donating regularly.     

中国农村地区艾滋病病毒感染者／病人的社会经济和行为学调查

为了解农村地区既往非法采供血和静脉吸毒感染HIV的感染者 /病人的社会经济学和行为学现状 ,于2 0 0 3年在山西闻喜县和广西凭祥市对 6 0位农村地区的HIV感染者 /病人进行调查。结果表明 ,农村地区HIV感染者和AIDS患者 ,尤其是经济落后地区因卖血 /血浆而感染的农民 ,其社会经济状况较差 ,由于患病后收入减少 ,医疗费用大幅度增加 ,因病致贫、因病返贫的现象突出。两种类型的感染者有着显著不同的社会经济学特征 ,由于发生感染的社会背景的差异 ,家人和社会对他们的态度和行为 ,以及他们本人的态度和行为也有较大的不同     

商丘市艾滋病VCT门诊HIV检测结果分析

目的:了解2005年商丘市疾病预防控制中心艾滋病自愿咨询检测(HIV voluntary counseling&testing,VCT)门诊求询者HIV感染状况,为本市艾滋病的预防控制提供依据。方法:对2005年1月~12月在本中心艾滋病VCT门诊203例求询者血液标本进行了HIV_抗体(1/2)检测,用酶联免疫吸附(ELISA)试验初筛,初筛试验阳性者用蛋白印迹检测法(WB)作确认试验。结果:检出HIV_抗体阳性30例,阳性率14.78%;男15例、女15例,男女之比为1∶1。年龄分布在18~70岁之间,其中1995年前后有偿献血感染13例,1995年前后输血感染11例,阳性配偶感染2例,不洁性行为3例,接触者1例。职业构成以农民为主(86.67%)。结论:我中心艾滋病VCT门诊求询者HIV感染仍以1995年前后有偿献血者及受血者为主,应加强控制HIV感染从高危人群向普通人群传播、配偶间传播及母婴传播,尽快制定具体干预措施。     

某地既往有偿献血人员HCV感染情况及危险因素分析

目的:了解江苏省某地区既往有偿献血人员丙型肝炎病毒(hepatits C virus,HCV)的感染情况并探讨其危险因素?方法:对该地区部分有既往有偿献血史的村民进行问卷调查和肝脏B超检查,并采集静脉血进行相关生化检测?应用EpiData和SPSS软件对数据进行录入及统计学分析?结果:781名调查对象共检测出抗-HCV抗体阳性510例,感染率为65.3%,抗体阳性者中持续感染者占70.6% (360/510),自限清除者占29.4% (150/510)?HCV持续感染者以1b+3混合型 (51.7%)和1b型 (32.9%)为主?持续感染组丙氨酸转氨酶(ALT)?天门冬氨酸转氨酶(AST)?谷氨酰转移酶(GGT)的异常率高于未感染组和自限清除组?多因素Logistic回归分析显示性别?献全血史和单采血浆史是既往有偿献血人群感染HCV的危险因素,OR值分别为1.50?2.27和3.27;年龄是HCV感染慢性化的危险因素,OR值为1.62?结论:既往有偿献血人群的HCV感染率处于较高水平,不洁采供血特别是单采血浆可能是导致HCV高感染率的主要原因?     

Prevalence, donation practices, and risk assessment of blood donors with hemochromatosis

CONTEXT: Despite changes in eligibility policies, practical barriers limit blood donations from individuals with hemochromatosis. Increased knowledge of hemochromatosis donor characteristics may help foster further changes that will promote more donations. OBJECTIVES: To estimate the prevalence of donors diagnosed as having hemochromatosis and to compare rates of unreported deferrable risks for transfusion-transmissible viral infections (TTVIs), positive screening test results for TTVIs, and donation patterns between hemochromatosis patient donors and donors reporting no medical conditions necessitating phlebotomy (non-health-related donors). DESIGN: An anonymous mail survey conducted in 1998 as part of the ongoing Retrovirus Epidemiology Donor Study. SETTING AND PARTICIPANTS: Among a stratified probability sample of 92 581 blood donors from 8 geographically diverse US blood centers, 52 650 (57%) responded. MAIN OUTCOME MEASURES: Prevalence of hemochromatosis among blood donors; prevalence of unreported deferrable risks and positive screening test results for TTVIs among hemochromatosis patient donors vs non-health-related donors. RESULTS: One hundred ninety-seven respondents (0.4%) identified themselves as hemochromatosis patients and 50 079 (95.1%) as non-health-related donors. An estimated 0.8% of all donations were from hemochromatosis patients, 45.8% of whom reported that they had donated blood to treat their illness. The proportion of repeat donors was higher in hemochromatosis patients than in non-health-related donors (83.5% vs 76.5%; P =.03). Among repeat donors, 68.7% of hemochromatosis patients reported donating at least 3 times in the past year compared with 49.1% of non-health-related donors (P<.001). The prevalence of unreported deferrable risks for TTVIs was similar in hemochromatosis patients (2.0%) and non-health-related donors(3.1%) as was the overall prevalence of positive screening test results (1.3% of hemochromatosis patients vs 1.6% of non-health-related donors). CONCLUSIONS: Although significant numbers of hemochromatosis patients reported donating blood for therapeutic reasons, our findings suggest that this population does not present a greater risk to blood safety than other donors.     

江苏省城乡儿童隐孢子虫感染

江苏省徐州市区和农村6个点隐孢子虫感染调查,≤15岁儿童5089例,隐孢子虫卵囊阳性89例,各点均有发现,平均感染率为1.75％(0.7～5.06％)。<4岁婴幼儿感染率明率高于4～15岁儿童(P<0.01)。部分病例血常规和免疫学检测,半数以上有贫血及细胞免疫功能低下。腹泻为本病主要临床表现,本组64％(57/89)出现腹泻,但亦发现较多的无症状带虫者。病例家人和畜粪便亦检获到隐孢子虫卵囊。     

Caregivers' perception of HIV-infected Dominican children's behaviour

Caregivers (mothers and non-mothers) of HIV children face many challenges related to both physical demands and emotional well-being. The perception of caregivers in the Dominican Republic, a country greatly impacted by HIV/AIDS, in regard to their children's behaviour, has not been investigated to date. To extend understanding of the potential behavioural issues involved in providing care to children without access to antiretroviral therapy, the Child Behaviour Checklist was administered to 52 caregivers of HIV Dominican children (2-8 years old). Both mothers and non-mothers perceived significant pathological internalizing behavioural symptoms in immunosuppressed children, compared to children with less disease progression. Analyses of gender comparisons revealed that older female children were perceived as withdrawn/depressed by their caregivers. These findings suggest that children's disease status may be an important contributor to caregiver perception in mothers, as well as non-mothers and indicate that gender-specific relationships warrant further study.     

The prevalence,intensity and ecological determinants of helminth infection among children in an urban and rural community in Southern Malawi

Rapid urbanisation and poor town planning in Malawi has been associated with poor environmental hygiene and sanitation. The aim of the present study was to investigate the prevalence, intensity and some potential risk factors of intestinal helminth infections among children aged 3 – 14 years in an urban and rural community in Southern Malawi. A randomised cross-sectional survey was conducted in July, 1998. Data were collected through questionnaire interview regarding socio-demographic and environmental conditions from households in both areas. Stool samples were collected from 273 children in the urban community and 280 in the rural. There was a significant difference (p<0.001) in the prevalence of helminth infections between the urban and rural communities, 16.5% and 3.6% respectively. Most of the infections were light (93.2% for Ascaris lumbricodes, 85.7% for hookworm). Large variance to mean ratios of egg intensity within age groups and the total study population suggested a high degree of aggregation of the parasites in the communities. Multiple logistic regression analysis showed that certain groups of children in the urban community were much more likely to develop helminth infection. They included children who had pools of water/sewage around houses (OR = 3.0, 95% CI = 1.4 ñ 6.5), did not wear shoes (OR a 7.1, 95% CI = 2.7 – 19.2), did not attend school (OR = 2.8, 95% CI = 1.2 ñ 6.5), had mothers who had 4 to 8 years of education (OR = 5.2, 95% CI = 2.0 – 14.0), had mothers below 35 years of age (OR = 4.09, 95% CI = 1.39 – 16.28) and living in an urban community (OR = 5.3, 95% CI = 2.6 – 12.1). Efforts to reduce helminth infections should focus on reducing exposures.     

儿童血压与其母亲妊娠高血压关系研究

为探讨母亲妊娠高血压对其子女血压的影响,本文采用回顾性定群分析的配对研究,结果显示有妊娠高血压史的母亲,其子女血压与对照比较无显著差别。说明妊娠高血压对儿童血压无明显影响。同时发现儿童血压与其母亲的体重指数之间存在相关关系。这些结果有助于进一步研究遗传和环境因素对儿童高血压形成的作用。     

安徽阜阳既往献血人群HIV-1感染者基因变异特征的研究

目的研究安徽省阜阳市既往献血人群中HIV-1感染者体内病毒流行株的亚型及序列变异特征。方法用巢式聚合酶链反应（nested-PCR）对HIV-1外膜蛋白（env）基因和核心蛋白（gag）基因进行扩增,获得244例患者的env基因V3-C3及其邻近区域序列和245例患者的gag基因区序列,应用MEGA软件进行分析,同时结合患者的疾病进展阶段进行相关性研究。结果系统进化树显示安徽省阜阳市患者体内HIV病毒的env和gag区序列属泰国B亚型;env和gag区的组内基因距离分别为9．11％和3．59％;按CD4细胞绝对计数分层,随CD4细胞绝对计数降低,env、Gag组内基因距离明显升高;随病毒载量水平增加,各组基因距离有增大的趋势,且差异均有统计学意义（P〈0．001）。env区V3环序列13份长期不进展者7份顶端四肽为GPGQ,53份缓慢进展者33份顶端四肽为GPGR,两者间差异有统计学意义（P=0．038）。结论安徽省阜阳市既往献血人群HIV-1感染者体内的病毒流行株是B′亚型。CD4和病毒载量作为疾病进程不同阶段的指标,与病毒变异有相关性,即随CD4降低、病毒载量升高病毒组内基因距离增大。HIV B′亚型V3环顶端四肽随疾病进展由GPGQ为主变为GPGR为主。     

Use of blood donation history of people with HIV infection to identify recipients at risk.

OBJECTIVE: To determine whether previous blood donations from HIV-positive patients posed a threat to recipients. DESIGN: Interviewer-administered questionnaire survey. SETTING: Regional HIV outpatient referral clinic for southern Alberta. PATIENTS: All 478 patients attending the clinic from May 1, 1993, to Mar. 31, 1994; 366 were excluded: 335 had not donated blood, and 31 could not provide reliable information regarding possible donations. INTERVENTIONS: Patients were asked at a routine clinic visit regarding the dates, frequency and location of previous blood donations. The Canadian Red Cross was informed, with patient consent, if the previous donations posed a potential risk of HIV transmission. OUTCOME MEASURES: Number of HIV-positive patients whose donations posed a possible or definite risk to recipients. RESULTS: A total of 545 units of blood had been donated by the 112 patients in the study; 57 units (donated by 29 patients) posed a possible risk, and 12 (given by 11 patients) posed a definite risk of HIV transmission to the recipients. Thirty-two of these donors had been unknown to the Red Cross through its "look-back" and "trace-back" protocols. Only 1 of the 13 patients found to be HIV positive by the Red Cross openly admitted donating blood to undergo HIV antibody testing; the remainder were either ill-informed or did not perceive themselves to be at risk. The patients were highly mobile, 36.7% donating blood at some time in a province other than the one where they had received their positive HIV test result. CONCLUSION: Asking HIV-positive patients about their blood donation history, although subject to recall bias, is a simple and inexpensive method for identifying high-risk blood donations. The Red Cross should routinely be notified, with patient consent, of all donations posing a risk in order to enhance the prospect for identifying HIV-positive blood recipients.     

The health status of children in a rural community in north eastern Zambia

The level of infant mortlity, which in some rural African communities approaches 300-400/1000, has often been used as an indication of the socioeconomic status of that community. This study analyzes health status and morbidity as part of a trypanosomiasis prevalence survey in a rural population of 1413 in North Eastern Zambia. The survey took female pregnancy histories, histories of diarrhea in children under 5 years of age, and weights and heights of all children. Physicians standardized measurement technics in training sessions. The infant mortality was estimated at 229/1000 and cumulative mortality by age 5 was 340/1000, using Brass model estimates. 51% of children had diarrhea within the 2-week recall period. 88% of mothers whose children had diarrhea felt it was serious enough to seek treatment, and only 6% depended on home treatments. 27% of the children showed wasting while stunting was observed in over 80% in the 3 and 4-year-old children. The adults were found to be small for their age in this environment, mean height and weight being 162.9 cm +or- 8.3 and 59.7 kg +or- 5.7 respectively, and for females, 154.5 cm +or- 5.2 and 52.8 kg +or- 6.7. High infant and child mortality rates caused in part by malnutrition exacerbated by malaria diarrheal diseases, and other infections, are cause for improved health intervention. Given the willingness to use health facilities on the part of mothers, it is likely that improvements will hinge on greater awareness and utilization of health services.     

感染HIV-1儿童经抗病毒治疗后乳酸浓度检测及其相关因素研究

目的研究中国感染艾滋病毒(human immunodeficiency virus type 1,HIV-1)儿童经抗病毒治疗后血浆乳酸浓度及相关影响因素。方法选择31例抗病毒治疗的感染HIV-1儿童与30例正常对照儿童,检测血浆乳酸浓度,结合儿童的基本信息、治疗方案及实验室检测结果进行综合分析。结果感染HIV-1患儿血浆乳酸浓度(2.32±0.60)mmol/L显著高于对照组儿童(1.60±0.88)mmol/L(P<0.01);d4T治疗组和AZT治疗组间血浆乳酸浓度、基线CD4+T淋巴细胞计数、基线病毒载量、性别、年龄以及HIV-1传播途径差异均无统计学意义(P>0.05)。结论外周血乳酸浓度可反映感染HIV-1儿童经抗病毒治疗后的线粒体毒性,有望成为线粒体毒性检测指标。     

HIV／AIDS-related Discrimination in Shanxi Rural Areas of China

Objective In order to explore the features of discrimination against people with HIV/AIDS in rural areas, a community-based intervention was carded out in two pilot communities of X County of Shanxi Province from September 2002 to October 2003. Methods Data were collected using qualitative methods (in-depth interview and focus group discussion) and anonymously structured questionnaires. Results (1) Severe discrimination against people infected with HIV/AIDS was revealed in the target communities. However, the response to HIV/AIDS was different in each community. (2) People were reluctant to disclose their HIV status or get tested for HIV, which endangered their sexual partners to contract HIV through unprotected sexual intercourses. (3) Attitudes towards people infected with HIV/AIDS varied. (4) Public education promoted a better understanding of HIV/AIDS which in turn improved community attitudes and behaviors towards people with HIV/AIDS. Conclusion HIV/AIDS-related discrimination undermines both individuals‘ and communities‘ responses to HIV/AIDS and may be a serious obstacle towards effective HIV/AIDS prevention and control.     

重庆市无偿献血人群HIV感染情况的调查分析

目的 通过分析重庆市无偿献血者人类免疫缺陷病毒(HIV)感染的情况,探寻如何保证新形势下血液安全的策略.方法 按血站常规检测献血者HIV感染状况,收集2000～2009年重庆市血液中心献血者HIV感染资料,重点分析2007～2009年间HIV感染者基本信息,分析其流行病学特征.结果 重庆市无偿献血人群的HIV感染率呈现...     

扬州市2015～2017年无偿献血者抗-HIV及HIV-RNA检测结果调查分析

目的?了解扬州市2015年2月～2017年12月无偿献血者抗-HIV抗体及HIV-RNA检测情况。 方法 针对扬州市2015年2月～2017年12月121 617例无偿献血者标本先进行2遍ELISA法检测抗-HIV抗体，然后对ELISA法结果两侧阴性或单侧阴性的116 500例核酸标本再用PCR法检测HIV-RNA。抗-HIV抗体阳性送扬州CDC确证，HIV-RNA阳性送江苏省血液中心进一步确证。 结果 2015年2月～2017年12月抗-HIV抗体检出阳性57例，占0.05%，确证阳性13例，占0.01%；确证阳性均为ELISA法双试剂阳性标本，ELISA法单试剂阳性经确证均为阴性；HIV-RNA阳性检出 4例，占0.003%，确证阳性2例，占0.002%。?结论?采、供血机构相关部门在献血前征询招募时，应充分考虑人群HIV感染分布特征，调整策略，相关部门应加强HIV相关知识的宣传普及工作，进一步确保血液安全。在血液病毒检测中，核酸检测与酶联免疫检测各具优势，两者互补，给予二者联合应用，提高血液病毒检测准确性。     

Seroprevalence of Hepatitis B, Hepatitis C, HIV Infections in Blood Donors of Khulna, Bangladesh

To determine changes (Trends) in infection rates of Hepatitis B surface antigen (HBsAg), Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV) in blood donors of Khulna Population. Specimens of 34953 voluntary blood donors & party or relative donors in Transfusion Medicine Department of Khulna Medical College Hospital from 2007 to 2009 were screened for HBsAg, anti-HCV, anti-HIV 1 & 2 reactivity in a cross-sectional survey by rapid test method. Reactive samples were verified using a recognized confirmatory test which consisted of a second generation enzyme immune assay (HBsAg), anti-HCV antibodies by anti-HCV EIA & for HIV by western Blot, respectively. The seroprevalence of HBsAg, Anti-HCV, HIV antibody 1 & 2 was 1.4%, 0.09% & 0.03% respectively in all blood donors. Prevalence of confirmed positivity was 0.62% for HBsAg, 0.04 % for Anti-HCV, 0.02% for HIV Western Blot. Between 2007 to 2009 a decreasing trend was observed in HBsAg frequency, HCV frequency decreased in 2009 compared to 2007. One HIV positivity found in 2009. Although the frequency of transfusion transmitted infections is low, party or relative donors have some risk factors than voluntary blood donors. Through more scrutiny in donor selection, improved serological test & reevaluation of infections routes in donor, infection reduction can be achieved.     

Time trends of paediatric HIV infection in North India

Paediatric HIV infection continues to pose a serious threat in the developing world. While in the developed world, mother to child transmission has been reduced to less than 3%, in India no regular zidovudine (azidothymidine) intervention programmes operate. Some 20 million babies are born each year and the number of infected babies could be >50,000 per year. The present study was designed to assess the change, if any, in the time trends of HIV infection in children over the last 15 years as observed at the surveillance centre attached to Nehru Hospital, Chandigarh. All patients reporting to the surveillance centre at the PGIME&R, Chandigarh were subjected to a detailed history and screened for HIV by the three tests protocol recommended by the WHO. In babies under 18 months of age, viral load assay or DNA analysis was done to confirm infection. Timetrends were ascertained over a 15-year period to assess the impact of information, education and communication programme launched by National AIDS Control Organisation. Data indicates that the total number of HIV positive cases increased 10-fold over the last 10 years. During 1991, 41 cases were recorded; the number increased to 439 in year 2001, and 574 in 2004 (r=0.98). A similar trend was observed in the paediatric age group. During the initial 5 years ie, 1987 to 1992 only 7 paediatric cases were documented positive while the number increased to 45 in the year 2001 to 64 in the year 2004 with a cumulative figure of 323 children. Linear regression analysis showed a highly significant trend (r=0.94). Out of the 323 cases, 44.6% were symptomatic. Maximum number of babies were observed in the age group of 3-5 years. Thirty-nine patients (12%) had acquired the infection through blood. Thus the information, education and communication programme has had very little impact on the HIV epidemic and it calls for urgent antiretroviral intervention in antenatal mothers to control the emerging paediatric HIV epidemic.     

河南省宝丰县2000～2013年艾滋病疫情分析

目的了解河南省宝丰县艾滋病流行现状,为制定预防控制措施提供科学依据。方法下载2000~2013年宝丰县各种途径发现并报告的艾滋病病毒感染者和患者(People living with HIV/AIDS,PLWHA)个案及随访资料,建立数据库并进行统计分析。结果宝丰县2000~2013年报告PLWHA 171例,其中艾滋病病人125例,死亡66例,各乡镇均有病例发生。男女之比为1.71:1。20~49岁青壮年占77.2%。农民占80.7%。性传播占55.6%,且从2004年起逐年上升,2010~2013年性传播比例均在70%以上。血液传播占36.8%,2001~2011年血液传播比例呈逐年下降趋势,2012和2013年连续两年无血液传播病例发生。感染途径由以血液传播为主转变为以性接触感染为主。母婴传播占4.7%。通过检测咨询发现病例67人,占39.2%,其他就诊者检测发现病例40例,占23.4%。结论应加强对高危人群的行为干预,落实母婴传播阻断措施。检测咨询和门诊筛查是发现PLWHA的主要途径。