南京市2018年艾滋病防治三个90%策略的进展及影响因素

目的  分析南京市2018年艾滋病防治策略“三个90%”目标的进展情况及其实现的影响因素。 方法  从艾滋病防治综合信息系统中获取南京市现存活的人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者/艾滋病(acquired immune deficiency syndrome, AIDS)患者检测发现、抗病毒治疗(antiviral therapy, ART)和病毒载量(viral load, VL)相关信息,分析“三个90%”进展情况,采用多因素Logistic回归分析模型分析影响因素。 结果  2018年南京市“三个90%”目标分别达到74.0%、88.5%和96.7%。经同性传播的HIV/AIDS检测发现率较低(χ² =86.15, P < 0.001)。注射吸毒传播(aOR=0.263,95% CI：0.156~0.442,P < 0.001)、 < 25岁年龄组(aOR=0.697,95% CI：0.540~0.899,P=0.005)以及监管场所发现(aOR= 0.353,95% CI：0.193~0.646,P=0.001)的HIV/AIDS治疗覆盖率较低;而同性传播(aOR=1.840,95% CI：1.390~2.434,P < 0.001)、35~44岁年龄组(aOR=1.826,95% CI：1.260~2.645,P=0.001)、汉族(aOR=1.797,95% CI：1.038~3.109,P=0.036)、大专及以上文化程度(aOR=1.652,95% CI：1.005~2.717,P=0.048)、已婚有配偶(aOR=1.466,95% CI：1.051~2.046,P=0.024)的HIV/AIDS治疗覆盖率较高。 结论  南京市朝着2020年实现“三个90%”的防治目标迅速迈进,但仍有一定的挑战,需要继续扩大HIV检测发现,加强吸毒人群、低龄和老年人等重点人群治疗关怀服务。     

台州市HIV感染者高血压治疗率与控制率现状

目的 了解台州市人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者高血压治疗与控制现状,为针对性开展高血压控制工作提供依据。 方法 基于2017年“HIV与衰老相关疾病前瞻性队列研究”的基线数据,于2019年9―12月对到台州市各区县疾病预防控制中心符合基线高血压标准的242名HIV感染者进行问卷调查和体格检查。 结果 本次调查时,HIV感染者的高血压治疗率和控制率分别为44.2%和54.5%。年龄≥45岁、有高血压家族史以及合并高血脂的病人高血压治疗率较高（均有P < 0.05）;未接受治疗者高血压控制率高于采用药物治疗者（χ²=12.067,P < 0.001）;接受治疗者高血压控制率影响因素为有高血压家族史（aOR=0.153,95% CI：0.055~0.420）、基线调查时为轻度（aOR=0.130,95% CI：0.041~0.406）或中重度高血压（aOR=0.263,95% CI：0.075~0.915）;未接受治疗者高血压控制率影响因素为抗病毒治疗时间≥6年（aOR=0.355,95% CI：0.165~0.765）;单一用药与联合用药者高血压控制率差异无统计学意义。 结论 HIV感染者的高血压治疗率和控制率有待提高。应加强该人群血压监测和管理工作,并进一步研究HIV感染合并高血压者的治疗方案。     

开远市嫖客人群艾滋病相关知识、高危行为和STDs感染状况分析

目的  了解开远市嫖客人群艾滋病(acquired immunodeficiency syndrome, AIDS)相关知识和高危行为状况, 以及感染人类免疫缺陷病毒(human immunodeficiency virus, HIV)、梅毒、生殖器单纯疱疹病毒(herpes simplex virus type 2, HSV-2)状况, 分析HSV-2感染相关因素, 为制定预防措施提供依据。 方法  采用“外展人员招募”与“滚雪球”方式招募对象, 问卷调查并采集血液和尿液进行相应实验室检查。 结果  98.22%的嫖客知晓艾滋病知识; 9.33%曾使用过毒品; 14.67%在最近一次商业性行为时未使用安全套; 62.22%曾有过非婚性伴, 在过去一年与非婚性伴有性行为的嫖客中, 59.55%未坚持使用安全套。嫖客中HIV/梅毒/HSV-2的总体感染率为18.22%, 其中HIV、梅毒、HSV-2的感染率分别为3.11%、1.33%、16.44%。年龄较大者HSV-2感染率较高[AOR=1.044, 95%CI: 1.016~1.073, P=0.002], 最近一次商业性行为中未使用安全套者HSV-2感染率较高[AOR=3.125, 95%CI: 1.229~7.945, P=0.017]。 结论  开远市嫖客人群艾滋病知识知晓率高, 但仍存在高危行为, 有较高的HIV和其它性传播疾病感染率, 需采取针对性干预措施, 提高该人群感染性传播疾病的风险意识, 促进他们在商业和非婚性行为中坚持使用安全套。     

天津市低档场所女性性服务者HIV/TP/HCV感染情况调查

目的了解天津市低档场所女性性服务者（FSW）人类免疫缺陷病毒（HIV）、梅毒螺旋体（TP）、丙型肝炎病毒（HCV）的流行现状及影响因素。方法2013-2014年每年的4-6月对天津市3个区县采用分层多阶段整群抽样方法,对低档场所FSW进行问卷调查和血清学检测。结果共监测1 377人,平均年龄为（33.20±8.755）岁,艾滋病知识知晓率为60.7%（836/1 377）,最近1个月与客人发生性行为时每次均使用安全套的比例为81.4%（1 121/1 377）,最近1年接受检测比例仅为27.3%（295/1 081）;HIV、TP和HCV阳性检出率分别为0.1%（2例）、7.6%（104例）和1.4%（19例）。汉族（OR=0.261,95%CI=0.141~0.486）与最近1个月与客人发生性行为时每次均使用安全套（OR=0.491,95%CI=0.314~0.769）为FSW感染TP的保护因素,最近1年被诊断患过性病（OR=8.120,95%CI=2.815~23.423）为感染TP的危险因素。结论天津市低档场所FSW接受HIV检测的比例较低,艾滋病知识知晓率低,感染性病艾滋病的风险较大。     

An open-label evaluation of safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide for post-exposure prophylaxis following potential exposure to human immunodeficiency virus-1

Background:Single-tablet regimen (STR) provides a convenient once-daily regimen for the prevention of human immunodeficiency virus (HIV) infection. Here, we investigated the safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a three-drug, STR for post-exposure prophylaxis (PEP) in Chinese individuals.Methods:This was a prospective, open-label, single-arm trial conducted in a sexually transmitted diseases and acquired immunodeficiency syndrome clinic of a tertiary hospital in Beijing, China. Adults requiring PEP were prescribed BIC/FTC/TAF one pill once a day for 28 days. Clinical and laboratory data were collected and analyzed at baseline, weeks 2, 4, 8, 12, and 24.Results:Of 112 participants enrolled in the study, 109 (97.3%) were male and the mean age was 30 ± 8 years. PEP completion was 96.4% (95% confidence interval: 91.1–99.0%). Two participants stopped PEP after 2 days because the source partner was identified as HIV uninfected. One participant was excluded due to hepatitis B virus infection according to the exclusion criteria. One discontinued due to the participant''s decision. No participant acquired HIV through week 24. Adherence was 98.9% (standard deviation [SD]: 3.3%) by self-reporting and 98.5% (SD: 3.5%) by pill count. Only five participants experienced mild clinical adverse events attributed to the study drug (including headache, diarrhea, and nausea) and four participants had elevated serum creatinine (grade 1).Conclusions:A once daily, STR of BIC/FTC/TAF used as PEP was safe and well-tolerated with a high rate of completion and adherence in Chinese. BIC/FTC/TAF may be a good option for PEP.Trial Registration:ChiCTR.org.cn, ChiCTR2100048080     

MSM人群对HIV暴露前预防知识知晓及相关因素研究

目的  了解不同城市和年份的男男性行为者(men who have sex with men, MSM)对HIV暴露前预防(pre-exposure prophylaxis, PrEP)知识知晓变化情况及其影响因素。方法  依托社区组织分别在2019年和2021年采用电子问卷收集北京市、深圳市和昆明市的MSM人群的基本社会人口学情况、PrEP知识知晓、行为学情况等,并进行相关因素分析。结果  共调查4 889名MSM,其中2019年2 399人,2021年2 490人。2019年PrEP知识知晓占6.29%,2021年占25.02%。多因素logistic回归分析模型分析结果显示,2019年调查对象PrEP知识知晓促进因素包括年龄在25~ < 35岁(OR=1.685, 95% CI: 1.007~2.821)和≥35岁(OR=29.01, 95% CI: 1.156~3.497)、咨询过PrEP(OR=1.731, 95% CI: 1.050~2.855)、暴露后预防(post-exposure prophylaxis, PEP)知识知晓(OR=3.178, 95% CI: 2.079~4.860)。2021年调查对象PrEP知识知晓相关因素包括文化程度(本科/大专：OR=3.291, 95% CI: 1.595~6.793;研究生及以上：OR=4.507, 95% CI: 2.104~9.652)、曾咨询过PrEP(OR=2.591, 95% CI: 1.906~3.521)、PEP知识知晓(OR=5.855, 95% CI: 3.071~11.161)、使用过PEP(OR=1.619, 95% CI: 1.191~2.200)、使用助性剂(OR=0.623, 95% CI: 0.492~0.789)、一年内检测次数为3~4次(OR=2.140, 95% CI: 1.265~3.619)和≥5次(OR=3.414, 95% CI: 1.987~5.865)。结论  2021年MSM的PrEP知识知晓水平较2019年大幅度提高,但总体仍然低。影响知晓水平的相关因素包括MSM年龄、文化程度、进行过HIV检测、知晓及应用过PEP措施等,应继续采取综合性的措施加强对MSM人群关于PrEP的宣传教育,提高其对PrEP正确的认知。     

安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素

目的  了解安徽省接受抗病毒治疗HIV感染者和AIDS病人(简称HIV/AIDS)死亡的影响因素。方法  采用1∶2匹配病例对照研究方法,回顾性收集2010―2019年安徽省接受抗病毒治疗HIV/AIDS的相关信息,采用条件logistic回归分析模型分析HIV/AIDS死亡的影响因素。结果  共调查4 347例HIV/AIDS,其中死亡组1 449例,对照组2 898例。多因素条件logistic回归分析模型分析显示,影响抗病毒治疗HIV/AIDS死亡的危险因素中,发生耐药、最近一次病毒载量≥1 000 copies/mL且未检测耐药、最近一次病毒载量无结果且未检测耐药分别是不耐药的1.75倍(95% CI: 1.22~2.52, P=0.003)、2.26倍(95% CI: 1.69~3.03, P＜0.001)、35.27倍(95% CI: 26.54~46.87, P＜0.001);30~50岁和≥50岁分别是18~30岁的1.40倍(95% CI: 1.01~1.94, P=0.042)和4.02倍(95% CI: 2.80~5.77, P＜0.001);男性是女性的1.37倍(95% CI: 1.08~1.74, P=0.011);注射吸毒传播途径是异性传播途径的6.27倍(95% CI: 2.00~19.61, P=0.002);治疗前WHO临床分期为Ⅲ期/Ⅳ期是Ⅰ期/Ⅱ期的1.41倍(95% CI: 1.12~1.76, P=0.007);治疗前CD4⁺T淋巴细胞计数＜200个/μL是≥350个/μL的1.95倍(95% CI: 1.50~2.54, P＜0.001)。结论  耐药、耐药检测、年龄、性别、传播途径、治疗前WHO临床分期、治疗前CD4⁺T淋巴细胞计数是安徽省接受抗病毒治疗HIV/AIDS发生死亡的影响因素。加强HIV/AIDS的耐药监测对减少艾滋病死亡具有重要意义,应对接受抗病毒治疗的HIV/AIDS及时进行病毒载量和耐药检测。     

2010―2020年成都市50岁及以上HIV/AIDS空间聚集性

目的  分析2010―2020年成都市50岁及以上HIV感染者和AIDS病人(简称HIV/AIDS)的空间聚集性特征和趋势,为50岁及以上艾滋病的区域化防控及资源调整提供参考依据。方法  从“中国疾病预防控制信息系统”筛选出2010―2020年成都市新报告的50岁以上HIV/AIDS并进行描述性分析,运用ArcGIS 10.6软件开展时空自相关分析及空间聚集性分析。结果  成都市50岁及以上新报告的HIV/AIDS近11年年均增长率为28.95%,病例普遍以小学文化程度为主,占50.07%;已婚有配偶,占63.00%;职业为农民为主,占61.98%;异性传播,占95.72%。HIV/AIDS人数在区域范围内呈现聚集性分布,病例高－高型聚集区随时间推移：北部地区由西部两个区县逐渐向东扩散至四个区县,并向南扩散到周边两个区县;南部地区三个区县扩散至周边四个区县。结论  2010―2020年成都市50岁及以上人群HIV/AIDS数持续增加,空间分布上呈现出明显的不均衡性,疫情较严重的区域集中在成都市中部偏北,随时间推移中部地区和东部地区的热点区域逐渐增多,并且呈现扩散趋势。     

Changes in Racial and Ethnic Disparities of HIV Diagnoses Among Adolescents and Young Adults Aged 13–24 Years, 2015–2019

PurposeWe examined changes in racial/ethnic disparities in HIV diagnoses among adolescents and young adults aged 13–24 years from 2015 through 2019.MethodsWe used national surveillance data for 2015–2019 from AtlasPlus to calculate 12 absolute and relative disparity measures for 7 racial/ethnic groups to understand HIV diagnosis trends over time. We calculated four absolute measures (Black-to-White rate difference, Hispanic-to-White rate difference, Absolute Index of Disparity [ID], population-weighted Absolute ID) and eight relative measures (Black-to-White rate ratio, Hispanic-to-White rate ratio, ID, population-weighted ID, population attributable proportion, Gini coefficient, Theil index, and mean log deviation).ResultsHIV diagnosis rates decreased by 15.9% across all racial/ethnic groups combined. All the absolute disparity measures we examined indicated substantial reductions (13.5%–18.5%) in absolute disparities. Most of the relative disparity measures (eight of eight population-unadjusted measures and five of eight population-adjusted measures) declined as well, but the change was relatively modest and ranged from a 3.3% decrease to a 2.1% increase across the measures.DiscussionDespite progress, racial/ethnic disparities in HIV diagnoses among adolescents and young adults remain. Programs and services that are culturally relevant and tailored for this population may assist with continued progress toward reducing racial/ethnic disparities.     

Humoral immune response following the inactivated quadrivalent influenza vaccination among HIV-infected and HIV-uninfected adults

BackgroundA limited amount of information is available about the immunogenicity of the quadrivalent inactivated influenza vaccine among human immunodeficiency virus (HIV)-infected individuals, especially in low and middle-income countries (LMICs).MethodsHIV-infected adults and HIV-uninfected adults received a dose of quadrivalent inactivated influenza vaccine including strains of H1N1, H3N2, BV and BY. Enzyme-linked immunosorbent assay (ELISA) and hemagglutination-inhibition assay (HAI) were used to determine IgA, IgG antibody concentration and geometric mean titers (GMT) at day 0 and day 28, respectively. Associated factors contributing to seroconversion or GMT changes were analyzed using simple logistic regression model.ResultsA total of 131 HIV-infected and 55 HIV-uninfected subjects were included in the study. In both HIV-infected and uninfected arms, IgG and IgA against influenza A and B all increased significantly at day 28 after receiving QIV (P < 0.001). GMTs of post-vaccination at day 28 showed that HIV-infected persons with CD4 + T cell counts ≤ 350 cells/mm³ were statistically less immunogenic to all strains of QIV than HIV-uninfected ones (P < 0.05). HIV-infected participants with CD4 + T cell counts ≤ 350 cells/mm³ were less likely to achieve seroconversion to QIV (H1N1, BY and BV) than HIV-uninfected individuals at day 28 after vaccination (P < 0.05). Compared with HIV-infected patients with baseline CD4 + T cell counts ≤ 350 cells/mm³, individuals with baseline CD4 + T cell counts > 350 cell/mm³ seemed more likely to generate antibody responses to H1N1 (OR:2.65, 95 %CI: 1.07–6.56) and BY (OR: 3.43, 95 %CI: 1.37–8.63), and showed a higher probability of seroconversion to BY (OR: 3.59, 95 %CI: 1.03–12.48). Compared with nadir CD4 + T cell count ≤ 350 cell/mm³, individuals with nadir CD4 + T cell count > 350 cell/mm³ showed a higher probability of seroconversion to H1N1(OR: 3.15, 95 %CI: 1.14–8.73).ConclusionInfluenza vaccination of HIV-infected adults might be effective despite variable antibody responses. HIV-positive populations with CD4 + T cell counts ≤ 350 are less likely to achieve seroconversion. Further vaccination strategies could be developed for those with low CD4 T cell counts.