河南省驻马店市2008-2014年艾滋病单阳家庭抗病毒治疗原阳者死亡率及影响因素分析

  目的  探讨福建省未接受抗病毒治疗艾滋病病毒感染者/艾滋病患者（HIV/AIDS）病例的分布特征及其影响因素。  方法  采用统一设计的调查问卷对所有符合条件的HIV/AIDS病例进行调查,收集基本人口学、疾病状态、CD4细胞检测和抗病毒治疗情况,应用单因素和多因素分析法探讨抗病毒治疗的影响因素。  结果  1987年1月1日 — 2016年12月31日,未接受抗病毒治疗HIV/AIDS病例4 054例,占累计报告病例的37.6 %。报告死亡1 274例,占31.4 %,病例报告当月发生死亡350例,占27.5 %。CD4细胞计数为（439.97 ± 245.93）个/μL,明显高于接受抗病毒治疗组[（283.73 ± 196.06）个/μL]（t = 29.985,P < 0.01）。女性（OR = 1.244, 95 % CI = 1.079～1.434）、35～44岁（OR = 1.249, 95 % CI = 1 .059～1.474）和45～54岁（OR = 1.420, 95% CI = 1.177～1.712）、高中或中专（OR = 1.369, 95 % CI = 1.062～1.764）和大专及以上（OR = 1.526, 95 % CI = 1.175～1.983）、AIDS（OR = 4.370, 95 % CI = 3.597～5.309）、CD4细胞计数200～349个/μL（OR = 2.800, 95 % CI = 2.238～3.503）和350～49个/μL （OR = 1.400, 95 % CI = 1.115～1.758）等是接受抗病毒治疗的有利因素,2016年及之后报告（OR = 0.207, 95 % CI = 0.165～0.259）、确认阳性后3～6个月 （OR = 0.689, 95 % CI = 0.568～0.836）和 ≥ 6个月 （OR = 0.446, 95 % CI = 0.367～0.541）进行CD4细胞检测、CD4细胞计数 ≥ 500个/μL（OR = 0.445, 95 % CI = 0.355～0.556）等是接受抗病毒治疗的不利因素。  结论  福建省HIV/AIDS病例未接受抗病毒治疗的比例较高。应针对抗病毒治疗实施的影响因素采取针对性的应对策略,提高抗病毒治疗的覆盖率,降低艾滋病的死亡率。     

HIV/AIDS患者高效抗逆转录病毒治疗依从性的研究进展

高效抗逆转录病毒治疗(HAART)可以有效地延缓HIV/AIDS患者的疾病进程,改善生活质量,但HAART要求近乎完美的依从性。其依从性的研究在西方发达国家开展较多,但在我国的相关研究不多。文章就国际上HIV/AIDS患者HAART依从性的评价方法及影响因素的研究进展进行了综述。     

The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users.

OBJECTIVES. Data from 538 women in a cohort study recruited in 1988-1989 were analyzed to determined whether trading sex for drugs or money was independently associated with human immunodeficiency virus (HIV) seroprevalence in a population of female intravenous drug users. METHODS. The women were grouped according to the number of partners with whom they reported trading sex for drugs or money during the previous 10 years: none, 1 through 49 (low), or 50 or more (high); the prevalence of HIV seropositivity in the three groups was 23.2%, 23.7%, and 47.6%, respectively. Logistic regression was used to compare the low- and high-trade groups separately with the group that reported no trading. RESULTS. Low trading was not associated with seroprevalent HIV infection. In a multivariate model, high trading (compared with no trading) was significantly associated with HIV seropositivity after adjustment for cocaine use, history of sexually transmitted diseases, and duration of intravenous drug use. CONCLUSIONS. These data indicate that, among intravenous drug-using women, high levels of trading sex for drugs or money were independently associated with HIV infection. This group needs to be targeted for further intensive intervention.     

Screening for HIV, HBV and HCV markers among drug users in treatment in rural south-east England

BACKGROUND: This study was designed as an opportunistic screening to estimate the prevalence of blood-borne viral infection among drug users in treatment in the rural population and to investigate related risk factors and use of general health services. METHODS: A total of 102 patients aged 18 years and over (78 male, 24 female) with problematic self-reported drug use, recruited between 1 February 1996 and 31 January 1997, in a mixed urban-rural population in south-east England, were interviewed for information on socio-demographic status, drug use history, HIV-related risk behaviours, hepatitis B vaccination, general practice consultations, and use of A&E departments and medical out-patient clinics. Diagnostic testing was offered to all patients for anti-HIV-1, anti-HBc, HBsAg and anti-HCV. RESULTS: The mean age at onset of illicit drug use for the entire sample was 15.33 (SD 3.36) years; 3.7 per cent (1/27), 20.4 per cent (18/88), and 55.8 per cent (48/86) had antibodies to HIV-1, HBc and HCV, respectively; 1.1 per cent (1/88) tested positive for HBsAg indicative of a carrier state. All 18 patients anti-HBc seropositive were male (p = 0.009). There was no gender difference for anti-HCV serological status. The proportion of town residents and village dwellers seropositive for anti-HBc and anti-HCV did not differ significantly. Patient's age at interview, age at onset of opioid use and duration of opioid use showed a significant association with anti-HBc and anti-HCV serological status. The proportion directly sharing injecting equipment was too small for rigorous statistical analysis; however, indirect sharing involving cooking equipment and frontloading rituals achieved statistical significance. Anti-HBc serological status showed a significant association with vaginal intercourse without a condom (p = 0.03); none of the sexual risk behaviour variables revealed any significant association with HCV infection. Although only one-third of the sample consented to HIV antibody test, consenting and non-consenting groups did not differ significantly except on one variable: having a drug-using sexual partner (chi2 = 5.6167; p = 0.017). Serum aspartate amino transferase and gamma-glutamyl transpeptidase concentrations were raised above the upper limit in 23 (25.7 per cent) of the 89 patients who gave blood specimens; 41.2 per cent (42/102) were referred to treatment by their general practitioners. There was no significant relationship between HBV and HCV serological status and general practice consultations. Only eight (7.8 per cent) had received hepatitis B vaccination, and although 48 (47.1 per cent) had in the preceding 12 months used A&E departments, only seven (6.2 per cent) had been seen in medical out-patient clinics. CONCLUSION: In this study the prevalence of HIV, HBV and HCV in the rural population is as high as has been reported for inner cities. The poor uptake of hepatitis B vaccination among drug users, their poor response to HIV antibody test and poor health service utilization suggest the need for an urgent appraisal of service provision and a review of prevention and treatment strategies.     

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan,China

Setting: Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China.Objectives: To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion.Design: Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ² test and log-binomial regression were used for data analysis.Results: Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2–1.5), 1.2 (95%CI 1.0–1.4) and 1.1 (95%CI 1.0–1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7–11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0–12.8).Conclusion: The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.     

Enfuvirtide, the first representative of a new class of drugs for the treatment of HIV infection : HIV fusion inhibitors

In March 2003, enfuvirtide was approved in the USA and the European Union for the treatment of patients with HIV infection who have experienced failure or intolerable side effects of treatment with at least one representative of each antiretroviral drug class. Enfuvirtide has a new mode of action: it binds to the viral envelope glycoprotein 41 that is involved in the fusion of the virus to the membrane of the CD4 T cell. In two large phase III studies, 90 mg of enfuvirtide administered twice daily subcutaneously in addition to a background treatment of other antiretroviral drugs, had a significant favourable effect on both the plasma viral load (decrease) and the CD4 counts (increase) compared to the background treatment alone. Disadvantages of treatment with enfuvirtide are its subcutaneous administration (98% of the patients had local adverse reactions) and the high costs involved (1500 euro per patient per month).     

哨点监测吸毒人群HIV、HCV及梅毒检测结果分析

目的:了解三亚市近年吸毒人群HIV、HCV、梅毒感染状态,以采取有效的预防和干预措施。方法:对三亚市哨点监测的1236名吸毒人员进行HIV、HCV及梅毒血清学检测。结果:1236名吸毒人群中HIV抗体阳性19例,阳性率1.54%,HCV抗体阳性1074例,阳性率86.89%,梅毒抗体阳性44例,阳性率3.56%,HCV/梅毒重叠感染41例,阳性率3.32%。结论:吸毒人群是HIV、HCV、梅毒感染的高危人群,采取切实可行的宣传教育和防治干预措施非常重要。     

Consumption of tobacco, alcohol, psychotropic drugs and illegal drugs in high school students of the department in the Upper Pyrenees

A study was conducted on a representative sample of high school students in Hautes-Pyrénées, to measure their consumption of toxics (tobacco, alcohol, psychotropic and illicit drugs) and to explore the role of selected explanatory factors. Consumption levels were high, particularly for tobacco: 45% were smoker and 4% smoked more than 15 cigarettes each day. Less than 5% were alcohol daily consumers. Technical school students are a high risk population when they are 16 years old or less. Evening out represents a risk indicator: use of toxics is more frequent for students having twice evenings out each month or more. Prevention should be global, including the adolescents concerned and adults.     

Seroprevalence of HIV,hepatitis b,and hepatitis c among opioid drug users on methadone treatment in the netherlands

Background  

Injecting drug users (IDU) remain an important population at risk for blood-borne infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). In the Netherlands, a program is being implemented to offer annual voluntary screening for these infections to opioid drug users (ODUs) screened in methadone care. At two care sites where the program is now operating, our study aimed to estimate the seroprevalence among ODUs screened for HIV, HBV and HCV; to evaluate HBV vaccination coverage; and to assess the feasibility of monitoring seroprevalence trends by using routine annual screening data.     

Knowledge,attitudes and beliefs of European injecting drug users concerning preventive measures for HIV

Strategies for controlling the HIV epidemic include education and information campaigns for intravenous drug users (IDUs), as for all high-risk groups, and the provision of various public health measures and treatment. These can only be effective if the IDU is aware of them and has a favourable image of them. A study of 2330 IDUs in 12 European countries recorded awareness and opinions of various categories of measures and institutions. Of all measures, those mentioned most often related to availability of new injecting equipment; specifically unrestricted sales in pharmacies and needle exchanges, which were also thought to be more useful than anything else. Prompted awareness of rehabilitative institutions was well over 90% in most countries, but up to a quarter of IDUs did not trust them and up to one fifth did not think that they were useful. There appears to be a general need for more effective communication with IDUs to improve the image of the services available.Participating centres:Belgium: S. Todts, VZW Free Clinic, Antwerp;Denmark: A.M. Worm, Bispebjerg Hospital, Copenhagen;France: N. Boullenger, Association Arcades, Noisy le Sec;Germany: D. Kleiber & A. Pant, Sozialpaedagogisches Institut Berlin;Greece: G. Papaevangelou, Athens School of Hygiene;Ireland: J. O'Connor, Drug Treatment Centre Board, Dublin;Italy: G. Rezza & C. Perucci, Istituto Superiore di Sanita, Rome;The Netherlands: H. Fennema, J. A.R. Van den Hoek & R. Coutinho, Department of Public Health & Environment, Amsterdam;Portugal: A.B. Calado & T.V. Nuñes Vicente, CEPD Coimbra;Spain: R. de Andres Medina & J.Gonzalez Lahoz, Instituto de Salud Carlos III, Madrid;Sweden: M. Bottiger & A. Annell, National Bacteriological Laboratory, Stockholm;United Kingdom: G.V. Stimson, Centre for Research on Drugs & Health Behaviour, London     

美沙酮维持治疗对海洛因成瘾者与HIV传播有关的危险行为的影响

目的 评估美沙酮维持治疗对海洛因成瘾者与HIV传播有关的危险行为的影响.方法 在贵州省8个美沙酮门诊内招募治疗时间不足2.5个月的海洛因成瘾者,通过面对面调查收集研究对象的基线信息和随访信息,基线信息包括人口学特征和与HIV传播有关的危险行为,随访调查只包括与HIV传播有关的危险行为.基线调查在2006年6月开始进行,随访调查在2007年6月结束.基线调查中共招募到1003例符合标准的研究对象,其中666例(66.4%)海洛因成瘾者在随访调查结束时仍在美沙酮门诊进行治疗.666例仍在接受治疗的海洛因成瘾者中,469例(70.4%)回答了随访调查问卷.使用Wilcoxon两样本非参数检验和McNemar检验对研究对象与HIV传播有关的危险行为的变化情况进行分析.结果 469例海洛因成瘾者平均每月使用海洛因的天数从26.4 d/月下降到0.9 d/月(Z=27.21,P＜0.05),饮酒天数基线为3.3 d/月,随访调查为3.7 d/月(Z=0.45,P=0.96).在过去30 d内共用针具行为的比例从基线的1.3%(6/469)下降到随访调查时的0.2%(1/469)(x2=5.00,P=0.02).基线调查时5.5%(26/469)的海洛因成瘾者报告在过去30 d内与多个性伴发生性行为,随访调查时这一比例达3.4%(16/469)(x2=3.18,P=0.08).基线调查显示6.4%(30/469)的海洛因成瘾者报告在过去30 d内和非固定性伴有过性关系,随访调查时达5.1%(24/469)(x2=0.95,P=0.33).基线调查时56.7%(17/30)的调查对象在与非固定性伴发生性关系时使用了安全套,随访时58.3%(14/24)使用了安全套(x2=1.96,P=0.16).结论 美沙酮维持治疗能够降低海洛因成瘾者通过共用针具传播HIV的危险,但未见传播HIV的危险性行为的统计学意义上的改变.     

参加美沙酮维持治疗海洛因成瘾者传播艾滋病高危行为及应对

美沙酮维持治疗(methadone maintenance treatment,MMT)可以减少海洛因成瘾者感染或传播艾滋病病毒(human immunodeficiency virus,HIV)的相关危险行为,但部分参加者在治疗期间仍然会有吸毒等危险行为发生。治疗期间发生危险行为的原因受治疗前和治疗本身等多种因素影响。采用较高治疗剂量、提高保持率、加强综合干预措施等可以减少海洛因成瘾者治疗期间危险行为的发生,提高MMT预防HIV传播的效果。