采用集合RNA检测方法估计高危人群的HIV感染发病率

目的 及时发现艾滋病自愿咨询检测(VCT)人群和男男性行为人群(MSM)HIV抗体窗口期感染者,并估计发病率.方法 收集2012年1-10月云南省疾病预防控制中心VCT门诊和MSM活动室HIV抗体筛查阴性样本,以50∶1和10∶1二级集合方式进行HIV-1 RNA检测,并随访HIV-1 RNA阳性者,最后以Ron Brookmeyer方法估计VCT和MSM人群的HIV感染年发病率.结果 1400份VCT门诊HIV抗体筛查阴性样本中,发现2名HIV-1 RNA阳性窗口期感染者,HIV感染年发病率为1.87％(95％CI:1.23％-2.65％).MSM 500份HIV抗体筛查阴性样本中,发现2名HIV-1 RNA阳性窗口期感染者,HIV感染年发病率为5.31％(95％CI:3.52％ - 7.45％).结论 集合RNA检测为及时发现VCT和MSM的HIV窗口期感染者提供有效方法,建议通过提高集合RNA检测频率等方式,加强MSM及其他高危人群HIV感染窗口期的筛查.     

天津市男男性行为人群HIV-1急性期感染研究

目的 了解天津市MSM人群HIV-1急性期感染的免疫学与病毒学特征,分析不同检测方法对HIV-1急性期感染样本检出情况。方法 2015年10月至2016年10月依托MSM人群志愿者工作组招募MSM,快速法进行HIV抗体初筛,初筛阳性样品进一步复检和确证,阴性样品进行HIV-1 RNA集合核酸检测,核酸结果阳性者重新采样测定病毒载量和CD₄⁺T淋巴细胞/CD₈⁺T淋巴细胞计数（CD₄/CD₈）,抗体初筛阴性且两次核酸结果均为阳性者判定为HIV-1急性期感染。采用HIV四代ELISA试剂和P24 ELISA试剂对首次采集的HIV-1急性期感染样本进行检测,比较2种方法检出效果。结果 共招募和调查MSM 3 016例,HIV抗体快速检测阳性193例,确证阳性179例。HIV抗体快速检测阴性2 823例,核酸检测发现17例为HIV-1急性期感染。研究对象HIV-1感染率为6.53%（197/3 016）,HIV-1急性期感染率为0.56%（17/3 016）。病毒载量为（5.63±1.50）log₁₀拷贝数/ml,CD₄为（442.82±268.17）个/μl,CD₈为（1 069.65±668.22）个/μl,CD₄/CD₈比值为（0.49±0.25）,HIV-1急性期感染者与慢性期感染者相比,病毒载量、CD₄和CD₄/CD₈比值的差异均有统计学意义（U=148,P<0.01、U=272,P=0.042和t=3.147,P=0.005）,人口学特征仅有职业的差异有统计学意义（χ²=11.016,P=0.026）。HIV-1急性期感染检测试剂的灵敏度比较,P24 ELISA试剂高于四代ELISA试剂（Fisher精确概率法,P=0.017）。结论 MSM人群HIV-1急性期感染风险较高,采用P24 ELISA试剂可提高HIV-1急性期感染的检测灵敏度。加强HIV核酸检测是提高感染发现的重要途径。     

广西壮族自治区2012年艾滋病哨点中老年嫖客HIV感染危险因素调查

目的了解广西壮族自治区(广西)中老年嫖客感染HIV现状、相关高危行为和危险因素。方法2012年4-7月在广西艾滋病哨点对≥40岁的中老年嫖客进行面对面访谈,获取一般人口学、艾滋病知识知晓率、行为学、检测等信息,并采集3～5 ml血液检测HIV抗体,数据采用SPSS 18.0软件分析。结果14个嫖客哨点共调查4260人,初中及以下文化程度占82.1%,72.0%在低档场所发生商业性交易,年龄越大嫖娼场所档次越低;嫖客艾滋病知识知晓率为74.2%,HIV阳性嫖客知晓率为65.8%;共检出73名HIV抗体阳性,阳性率(肘)为1.40%,自愿咨询检测点来源人群较其他来源人群具有更高的HIV感染危险(OR=23.672,95%CI：4.984.112.434),中档场所嫖娼人群较低档场所具有较低的HIV感染危险(OR=O.410,95%CI：0.190。0.885),梅毒阴性(OR=O.255,95%CI：0.132～0.491)、丙型肝炎阴性(OR=O.154,95%CI：O.059～0.401)者HIV感染危险较低,嫖客婚内/J''t,性行为安全套使用率均较低,且嫖娟场所档次越低,安全套使用率越低;嫖客既往HIV抗体检测率仅为4.6%,41名嫖客有CD₄⁺T淋巴细胞检测结果,其中80.5%的CD₄⁺T淋巴细胞数<350 cell/I.tl,61.0%的CD₄⁺T淋巴细胞数<200 cell/lal。结论广西中老年嫖客HIV阳性率高,与低档场所暗娼发生无保护性行为是感染HIV的重要危险因素。     

反向梅毒筛查血清学检测结果分析

目的分析以螺旋体抗原血清学试验为初筛的反向梅毒检测方法不一致结果(血清 梅毒螺旋体抗体阳性而非梅毒螺旋体抗体阴性)的特点,并据此选择可靠的反向梅毒筛查流程。 方法 回顾性分析反向梅毒筛查方法的实验室数据,以ELISA作为梅毒螺旋体抗体初筛试验,初 筛阳性标本均进行梅毒螺旋体抗体确认(梅毒螺旋体明胶粒子凝集试验,TPPA)和定量非梅毒螺 旋体抗体检测(甲苯胺红不加热试验,TRUST),采用f检验统计分析实验室数据。结果21 049 份筛选标本中ELISA初筛阳性666份(3．16％)。其中TRUST阳性169份,经TPPA确认168份阳 性,1份阴性,ELISA检测假阳性率为0．6％(1/169)。在666份初筛阳性标本中,TRUST阴性497 份,不一致血清结果(ELISA结果阳性,TRUST结果阴性)的比率为74．6％(497/666),497份标本经 TPPA确认,有74份为阴性,ELISA检测假阳性率为14．9％(74/497)。经f检验,TPPA阳性组内 TRUST阴性和阳性结果构成比的差异有统计学意义(x2=110．025,P=0．000),即TRUST阴性率 (71．6％,423/591)显著高于TRUST阳性率。结论选择ELISA作为梅毒螺旋体抗体初筛方法,应 对初筛阳性标本先做TPPA确认,再对确认阳性标本进行定量非螺旋体抗体检测,可避免假阳性 结果。     

中国部分地区HIV阳性男男性行为者合并HCV感染状况及其自然清除率调查

目的分析中国部分城市HIV阳性男男性行为者(MSM)中丙型肝炎病毒(HCV)感染状况及自然清除能力。方法以沈阳、北京、长沙和昆明市HIV确证阳性的MSM为研究对象,收集基本人口学资料及CD₄⁺T细胞淋巴细胞计数、HIV病毒载量、肝脏相关生化指标等临床信息,并进行HCV抗体和HCV RNA检测,并将HCV抗体阳性标本分为病毒自然清除(RNA-/Ab+)和慢性感染(RNA+/Ab+)两种感染状态。结果在513例HIV阳性MSM中,检出HCV抗体阳性10例(阳性率为1.94% ),其中4例HCV RNA阳性(阳性率为0.77% ),除1例HCV感染者正在接受抗病毒治疗HCV核酸检测阴性外,共5例感染者能够自然清除HCV RNAo HCV自然清除者相对于慢性感染(病毒血症)者具有较低的氨基转移酶水平和较高CD₄⁺T细胞淋巴细胞水平。结论目前调查地区HIV阳性的MSM中HCV感染率处于较低水平,但仍需定期监测。     

河南省驻马店市HlV单阳家庭阴性配偶抗体阳转率及其影响因素研究

目的了解河南省驻马店市HIV单阳家庭阴性配偶抗体阳转率及其影响因素。方法收集分析当地2006-2011年艾滋病综合防治信息系统和HIV单阳家庭随访管理信息系统中HIV单阳家庭随访信息,每6个月随访一次,包括HIV单阳家庭阴性配偶的人口学信息、原阳性配偶感染特征和抗病毒治疗情况,以及夫妻间性行为特征和社会支持情况,并检测阴性配偶的HIV血清阳转情况。采用Cox比例风险模型分析HIV单阳家庭阴性配偶抗体阳转的影响因素。结果4813户HIV单阳家庭中,127例阴性配偶发生HIV抗体阳转,2006-2011年总HIV抗体阳转率为0.63/100人年,各年抗体阳转率为0.29/100人年~1.28/100人年,维持在1%左右。HIV阴性配偶受教育程度为初中以下(RR=1.50,95%C1:1.02~2.21,P=0.04)、原阳性配偶为未接受抗病毒治疗(RR=3.16, 95%CI: 2.20~4.56,P<0.01)和最近一次CD₄⁺淋巴细胞检测结果<200 cel即1(RR=2.11, 95%C1:1.40~3.19, P<0.01)、最近半年夫妻性生活中性行为频率≥4次/月(RR=4.27, 95%CI: 2.89-6.30, P<0.01)和从不使用安全套(RR=6.40, 95%CI: 3.67-11.17, P<0.01)以及最近半年家庭未获得过经济支持和关怀救助(RR=4.75, 95%CI: 2.34 - 9.64, P<0.01)均是阴性配偶HIV抗体阳转的影响因素。结论近年来驻马店市HIV单阳家庭阴性配偶抗体阳转率趋于稳定,并较之前水平有所下降。随访中需加强感染者抗病毒治疗和依从性管理及夫妻性行为干预,宣传正确的安全套使用知识及搭建社会支持平台。     

浙江省台州市新报告成年HIV感染者中HCV合并感染研究

目的 了解浙江省台州市2009-2012年新报告成年HIV感染者中合并感染HCV的情况, 分析HIV/HCV合并感染者中血浆HCV病毒载量水平。 方法 对2009-2012年浙江省台州市新报告的572例成年HIV感染者检测HCV抗体, 并对HCV抗体阳性的标本进行HCV RNA定量检测。 结果 共有42例HCV抗体检测阳性, HIV感染者中HCV合并感染率为7.3%(95%CI: 5.2%~9.5%)。46~86岁HIV感染者的HCV合并感染率显著低于18~45岁年龄组(OR=0.12, 95%CI: 0.02~0.58);高中及以上文化程度的HIV感染者HCV合并感染率显著低于小学及以下文化程度者(OR=0.13, 95%CI: 0.02~0.78);经血传播HIV感染者HCV合并感染率显著高于异性传播HIV感染者(OR=49.46, 95%CI: 13.71~178.48);同性传播HIV感染者HCV合并感染率则低于异性传播HIV感染者(OR=0.11, 95%CI: 0.01~0.86)。42例HIV/HCV合并感染者中33例(78.6%)血浆HCV病毒载量在检测限以上, HCV复制相对活跃, 其中HBsAg阳性者血浆HCV RNA检出率(100%)显著高于HBsAg阴性者(75.7%)(P=0.002)。9例(21.4%)血浆HCV病毒载量则低于检测下限(5.0×10² IU/ml), 处于相对抑制状态。单因素logistic回归分析未发现HIV/HCV合并感染者HCV相对抑制率与其社会人口学特征、HIV传播途径、CD₄⁺T淋巴细胞计数等有关联。 结论 浙江省台州市HIV感染者中HCV感染率较高, 多数HIV/HCV合并感染者血浆HCV病毒载量也较高, 其对病情进展影响有待持续观察。     

尿液HIV 1抗体检测及其临床意义 FREE

目的探讨尿液标本中人免疫缺陷病毒（HIV） 1抗体检测的临床意义。方法应用酶联免疫吸附试验（ELISA）对59例经疾病预防控制中心（CDC）确诊的HIV感染者及30例健康体检者血液和尿液标本同时进行HIV 1抗体检测;以确认结果为准,计算尿液HIV 1抗体检测的敏感度、特异度。结果59例经CDC确诊的HIV感染者血清HIV 1抗体全部阳性,相应尿液中HIV 1抗体阳性53例,阴性6例;对照组30例的血清HIV 1抗体全部阴性,相应尿液1例HIV 1抗体阳性,经血清ELISA法及胶体硒法对该样本进行HIV 1抗体检测均阴性。以确认结果为准,尿液HIV 1抗体检测阳性敏感度为89.83%,特异度为96.67%。结论在采集血液标本不便的情况下,可通过检测尿液HIV 1抗体对高危人群进行HIV感染筛查。     

北京市男男性行为者“互联网+”干血斑HIV核酸检测可行性及HIV感染危险因素研究

目的 应用“互联网+”干血斑HIV核酸检测策略了解MSM的HIV核酸阳性率及MSM感染HIV的影响因素。方法 采用方便抽样的方法招募1 375位MSM，采集干血斑样本并邮寄到实验室进行HIV核酸检测。调查对象凭检测条码到指定网站查询检测结果。采用非条件logistic回归分析MSM感染HIV的影响因素。结果 MSM中新发现HIV感染者的HIV核酸阳性率为9.7%（131/1 349），HIV抗体阳性率为8.3%（112/1 349）。HIV早期感染者占新发现的HIV核酸阳性者的14.5%（19/131），检测核酸阳性距最后1次高危行为时间间隔为6～120 d。多因素logistic回归分析结果显示，MSM感染HIV的影响因素包括30～39岁（与<30岁者比较，OR=1.88，95% CI：1.07～3.29）、月收入≥8 000元（与无收入者比较，OR=0.42，95% CI：0.19～0.96）、最近6个月肛交行为中未坚持使用安全套（与最近6个月未发生肛交行为或肛交时坚持使用安全套者相比，OR=2.22，95% CI：1.45～3.40）、使用过Rush Poppers（与未使用过Rush Poppers者相比，OR=2.33，95% CI：1.49～3.64）、使用过毒品（与未使用过毒品者相比，OR=5.43，95% CI：2.32～12.69）、没有固定性伴（与有固定性伴者相比，OR=1.74，95% CI：1.13～2.68）。结论 北京市MSM的早期感染者占有较大比例，开展“互联网+”干血斑HIV核酸检测能够在更短的时间内发现早期HIV感染者，有助于减少二代传播。有必要在MSM中开展禁毒、禁用Rush Poppers、推广使用安全套、倡导稳定性关系等措施。     

集合PCR方法在艾滋病自愿咨询检测（VCT）人群中的应用研究

[目的]了解集合PCR方法在艾滋病自愿咨询检测（VCT）人群中的运用效果。[方法]收集2009年VCT人群HIV抗体阴性的血浆样本1600份,以1：5：50的方法集合样本,再用RT-PCR的方法检测HIV核酸。[结果]共检测VCT门诊HIV抗体阴性样本1600份,发现1例HIV核酸阳性,追踪检测其HIV抗体、CD4计数和病毒载量。[结论]集合PCR方法应用于艾滋病高流行地区VCT人群可以更加及时地发现早期感染者,控制传染源。     

HIV Discrimination and the Health of Women Living with HIV

ABSTRACT

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African-American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

HIV discrimination and the health of women living with HIV

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

HIV transmission to female sexual partners of HIV antibody-positive hemophiliacs

To study heterosexual transmission of the human immunodeficiency virus (HIV), 21 HIV antibody-positive hemophiliacs and their 21 spouses-sexual partners were evaluated. None belonged to other AIDS risk groups. HIV antibody was detected in four (19 percent) of the female partners. HIV was isolated from peripheral blood lymphocytes of one hemophiliac (4.8 percent), and one female partner (4.8) was antibody-positive. None of the couples engaged in anal intercourse. Compared with HIV antibody-negative female partners, HIV antibody-positive female partners were younger (P less than .05), had younger hemophiliac partners (P less than .05), and were likely (although not significantly so) to engage in oral sex (P = .08) and to have had more than one sexual partner in the previous 5 years (P = .08). Condoms were used all the time by only eight couples (40 percent), and pregnancy occurred in two other couples (9.5 percent), despite prior counseling. These data confirm the low frequency of heterosexual transmission of HIV from HIV antibody-positive hemophiliacs to their female sexual partners and suggest, moreover, that this may be due to the low rate of HIV infectivity in HIV seropositive hemophiliacs exposed to HIV. Further, these data document the need to design more effective educational programs to prevent heterosexual transmission of HIV.     

HIV reporting

The Washington State Board of Health unanimously approved the drafting of a rule requiring the use of coded identifiers, rather than names, for HIV case reporting. Physicians and labs would report the names of people who test positive to county health departments for use in epidemiological studies. The names would be encoded within 90 days, and the codes would be forwarded to the State Department of Health for tracking.     

HIV reporting

The California debate over HIV surveillance resumed with the introduction of a bill to use coded identifiers to track HIV infections. Bill 103 is similar to another bill vetoed by Gov. Pete Wilson in 1998. Wilson favors name-based reporting. The new governor, Democrat Gray Davis, appears more open to using unique identifiers.