1989-2015年云南省德宏州50岁及以上HIV感染者流行病学特征分析

目的 分析云南省德宏州1989-2015年50岁人群艾滋病疫情特征及流行趋势。方法 收集国家艾滋病防治综合信息系统中报告现住址为云南省德宏州,年龄50岁的临床诊断和实验室诊断艾滋病病毒感染者/艾滋病患者（HIV/AIDS）,截止日期为2015年12月31日,对其构成比、三间分布和趋势构成变化等进行分析。结果 现住址累计报告50岁HIV/AIDS病例1 193例,占累计报告数的7.98%;1 193例病例中,截止2015年底已死亡496例,病死率为41.58%。自2000年以来50岁HIV/AIDS的构成比逐年上升,从2000年的2.97%上升至2015年的19.94%。50岁HIV/AIDS在全州5县均有分布,芒市占当地报告HIV/AIDS构成比最高（占11.67%）。50岁HIV/AIDS人群分布以男性为主（64.79%,773/1 193）,平均年龄（58.316.96）岁,93.38%患者的文化程度为初中及以下,94.02%的职业为农民、待业和离退休人员。89.52%通过性接触传播,10.48%通过注射吸毒传播。女性、无配偶者、性接触传播者、农民和临床就诊检测发现者所占比例在不同时间段（1989-2003年、2004-2011年和2012-2015年）呈现上升趋势。结论 德宏州50岁人群艾滋病流行形式较为严峻,艾滋病防控工作应关注该年龄人群,结合艾滋病防治常规工作开展多元化的性健康教育应成为该人群艾滋病防治工作的重心。     

Cost-Effectiveness of the NIMH Multisite HIV Prevention Intervention

The objective of this study was to evaluate the cost-effectiveness of a state-of-the-art sexual-risk reduction intervention for high-risk men and women. The main intervention consisted of seven small-group sessions based on well-established principles of cognitive–behavioral therapy. This intervention was compared with a single-session video-based risk reduction intervention. The main outcome measure was the incremental cost–utility ratio, which equals the additional cost per additional quality-adjusted life year (QALY) saved by the cognitive–behavioral intervention, in comparison with the video intervention. A mathematical model of HIV transmission was used to translate reported sexual behavior changes into estimates of the number of HIV infections averted by the interventions, and associated savings in QALYs and averted HIV-related medical costs. For women, the incremental cost–utility ratio equaled $32,688 per QALY saved, which indicates that the cognitive–behavioral intervention was cost-effective compared to the video intervention. For men, the incremental cost–utility ratio was slightly negative, suggesting that the cognitive–behavioral intervention was highly cost-effective, or even cost-saving, compared to the video intervention. This analysis indicates that both brief and intensive sexual risk reduction interventions for high-risk populations can be cost-effective.     

Immune activation and induction of HIV-1 replication within CD14 macrophages during acute Plasmodium falciparum malaria coinfection

OBJECTIVES: To determine the impact of Plasmodium falciparum malaria coinfection and its treatment on cellular reservoirs of viral replication in HIV-1-infected persons and to relate this to changes in systemic immune activation. METHODS: Plasma samples were obtained from HIV-1-infected individuals (n = 10) at diagnosis of acute malaria, 4 weeks after parasite clearance and from HIV-infected aparasitemic controls (n = 10). Immunomagnetic HIV-1 capture analysis was used to determine the cellular origin of cell-free virus particles present in all 30 plasma samples and indices of immune activation were measured using enzyme-linked immunosorbent assays. RESULTS: Compared with controls, the detectable proportion of HIV-1 particles derived from CD14 macrophages and CD26 lymphocytes was increased in persons with acute malaria coinfection and correlated with markedly increased plasma concentrations of both proinflammatory cytokines and soluble markers of macrophage and lymphocyte activation. Parasite clearance following treatment with antimalarial drugs resulted in decreased detection of HIV-1 particles derived from the CD14 macrophage cell subset and correlated with a marked diminution in systemic immune activation. CONCLUSIONS: Acute P. falciparum malaria coinfection impacts virus-host dynamics in HIV-1-infected persons at the cellular level, notably showing a reversible induction of HIV-1 replication in CD14 macrophages that is associated with changes in immune activation.     

Non‐neutralizing epitopes induce robust hepatitis C virus (HCV)‐specific antibody‐dependent CD56+ natural killer cell responses in chronic HCV‐infected patients

Natural killer (NK) cell‐mediated antibody‐dependent cellular cytotoxicity (NK‐ADCC) is of considerable interest in viral infection. However, little is known about NK‐ADCC responses in chronic hepatitis C virus (HCV) infection. In this study, impaired non‐specific antibody‐dependent CD56⁺ NK cell responses were observed in chronic HCV infection, as shown by decreased degranulation (extracellular CD107a expression) and interferon (IFN)‐γ production in response to antibody‐bound P815 cells. A peptide pool composed of epitopes recognized by anti‐HCV‐E1/E2 antibodies could induce pronounced HCV‐specific antibody‐dependent NK cell responses in sera from approximately half the chronic HCV carriers. Additionally, HCV‐specific epitopes with the capacity to induce robust NK‐ADCC activity were identified. Five linear NK‐ADCC epitopes (aa211‐aa217, aa384‐aa391, aa464‐aa475, aa544‐aa551 and aa648‐aa659 of the HCV envelope) were identified and do not overlap with putative linear neutralizing epitopes. This study revealed the dysfunctional characteristics of antibody‐dependent CD56⁺ NK cell responses in chronic HCV carriers. The key non‐neutralizing NK‐ADCC epitopes identified in this study may act as new targets for immunological intervention.     

浙江省台州市未接受抗病毒治疗HIV感染者CD+4T淋巴细胞计数自然变化研究

目的探讨浙江省台州市未接受抗病毒治疗的HIV感染者CD4+T淋巴细胞计数自然变化速率及相关影响因素。方法对1996-2011年台州市报告发现的无抗病毒治疗史或接受抗病毒治疗前至少有过两次CD4+T淋巴细胞计数检测的HIV感染者进行回顾性队列研究,描述CD4+T淋巴细胞计数自然变化速率,并运用Lo-gistic回归分析其影响因素。结果共纳入研究对象412例,CD4+T淋巴细胞计数月均自然变化速率中位数M=-2.9(IQR:-9.7～1.6);286例(69.4%)HIV感染者末次CD4+T淋巴细胞计数结果低于首次;130例(31.6%)HIV感染者末次CD4+T淋巴细胞计数较首次水平下降≥30%,即显著下降。Logistic多因素回归分析显示,HIV感染者CD4+T淋巴细胞计数显著下降与年龄、职业、首次CD4+T淋巴细胞计数水平及首末次检测时间间隔存在关联。结论浙江省台州市HIV感染者CD4+T淋巴细胞计数自然变化总体平缓,但部分感染者CD4+T淋巴细胞计数快速下降且与多种因素有关。应定期随访检测HIV感染者CD4+T淋巴细胞计数水平,密切观察变化速率,以评估其病情进展并适时启动抗病毒治疗。     

北京市建筑工地农民工艾滋病知识和态度状况调查

目的调查建筑工地农民工艾滋病知识、态度现状,分析两者关系,为有效开展农民工艾滋病宣传教育提供依据。方法采用整群抽样方法抽取建筑工地,通过面对面问卷调查建筑工地农民工有关预防艾滋病的知识和态度。结果调查的818名建筑工地农民工以18～25岁为主,文化程度以初中为主,艾滋病基本知识知晓率在38.3%～91.3%之间,对艾滋病患者态度的认同率在27.0%～66.6%。结论建筑工地农民工对艾滋病知识的掌握还不全面,对艾滋病的歧视严重影响各项艾滋病防治工作的开展,建议加强艾滋病非传播途径知识和反歧视教育。     

北京市怀柔区艾滋病自愿咨询检测情况分析

目的了解北京市怀柔区自愿咨询检测(VCT)人群危险行为及感染状况,为进一步做好该人群艾滋病预防控制工作打基础。方法 2009—2010年采用国家统一制定的《自愿咨询个案登记表》对自愿咨询检测人群进行调查分析。结果 857名求询者中,男410人,女447人,多数因为高危性接触前来咨询检测,异性性接触为主;共检测出艾滋病病毒(HIV)感染者8例,感染率为0.93%;8例均为性接触感染。结论 VCT人群是感染艾滋病病毒(HIV)的高危人群及高发人群,应进一步扩大VCT门诊的覆盖面,更加深入地开展VCT工作。     

天津市津南区暗娼人群对艾滋病的认知状况

目的通过对天津市津南区暗娼人群的人口学状况、行为特征及对艾滋病相关知识的知晓程度的调查,探讨对暗娼人群进行艾滋病宣传教育的有效途径和方法。方法采用分层整群随机抽样的方法,对津南区38家娱乐场所的407名暗娼进行艾滋病知识的宣传教育,同时进行现场问卷调查,调查数据用SPSS 16.0软件进行统计分析。结果对艾滋病基本知识总体知晓率为84.52%。最近1次使用安全套的频率为70.02%,最近1个月内与客人发生性行为时安全套使用情况,每次都用的占47.42%。结论娱乐场所暗娼人群对艾滋病相关知识的了解和安全性行为的认知度不高,安全套使用率低,有必要加强健康教育,以减少该人群艾滋病的发生,遏制艾滋病由高危人群向一般人群的扩散和蔓延。