南京市MSM人群HIV新发感染情况及影响因素分析
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摘要
目的了解南京市男男性行为人群(men who have sex with men,MSM)人类免疫缺陷病毒(human immunodeficiency virus,HIV)新发感染率及其影响因素。方法 2013年4~8月在江苏省疾病预防控制中心健康咨询中心门诊基线招募MSM,2013年10月~2014年2月对不同时间进入队列的研究对象进行6个月的随访后,同时加入新MSM。基线及随访阶段均进行问卷调查和HIV、梅毒、单纯疱疹病毒2型(herpes simplex virus 2,HSV-2)等血清学检测。结果基线共招募MSM 370名,HIV感染率为12.97%,在第6个月随访时,共随访到225人,随访阶段新入队列256名MSM,双向队列中MSM人群HIV新发感染率为8.40/100人年。多因素Cox回归分析显示,最近一年患过尖锐湿疣(HR=5.730,95%CI:1.351~24.312)、梅毒现症感染(HR=4.807,95%CI:1.838~12.573)均是HIV新发感染的危险因素。交互作用分析发现,尖锐湿疣合并梅毒或HSV-2感染时比单独或没有感染这两种性传播疾病(sexually transmitted disease,STD)时,HIV感染的风险大,且这三种STD分别与同伴教育存在时,同伴教育可降低STD原有的致HIV感染的风险。结论南京市MSM人群HIV新发感染率较高,且梅毒、尖锐湿疣等性传播疾病可增加HIV新发感染的风险。
Objective To investigate the HIV incidence and its associated factors among MSM in Nanjing.Methods Man who had oral or anal sex with man in latest year in Nanjing were enrolled into our baseline study in health and counseling center of Jiangsu Provincial Center for Disease Control and Prevention from April to August in 2013.From October in 2013 to February in 2014,these MSM were followed after 6 months,and new expected MSM were also enrolled into the cohort at the same time.Questionnaire survey and serological tests for HIV,treponema pallidum and herpes simplex virus 2( HSV-2) were performed among MSM in the baseline and follow-up study.Results All of 370 MSM were enrolled into our baseline study and the rate of HIV infection was 12.97%( 48 /370).After 6 months,225 MSM were followed up and 256 new MSM were enrolled.In the ambispective cohort,HIV incidence among MSM was 8.40 /100 person-years.Multivariate Cox regression analysis revealed that having condyloma acuminatum( CA) infection during the latest year( HR = 5.730,95% CI: 1.351-24.312) and syphilis infection( HR = 4.807,95% CI: 1.838-12.573) were significantly associated with HIV seroconversion.Interaction analysis revealed that MSM with coinfection of CA and syphilis or HSV-2had higher risk of HIV infection than those with infection alone or without infection,and peer education could decrease the risks of HIV infection when MSM with STD infections received peer education.Conclusions HIV incidence is very high in MSM population in Nanjing.The infection of syphilis or CA can increase the risk of HIV incidence.
Objective To investigate the HIV incidence and its associated factors among MSM in Nanjing.Methods Man who had oral or anal sex with man in latest year in Nanjing were enrolled into our baseline study in health and counseling center of Jiangsu Provincial Center for Disease Control and Prevention from April to August in 2013.From October in 2013 to February in 2014,these MSM were followed after 6 months,and new expected MSM were also enrolled into the cohort at the same time.Questionnaire survey and serological tests for HIV,treponema pallidum and herpes simplex virus 2( HSV-2) were performed among MSM in the baseline and follow-up study.Results All of 370 MSM were enrolled into our baseline study and the rate of HIV infection was 12.97%( 48 /370).After 6 months,225 MSM were followed up and 256 new MSM were enrolled.In the ambispective cohort,HIV incidence among MSM was 8.40 /100 person-years.Multivariate Cox regression analysis revealed that having condyloma acuminatum( CA) infection during the latest year( HR = 5.730,95% CI: 1.351-24.312) and syphilis infection( HR = 4.807,95% CI: 1.838-12.573) were significantly associated with HIV seroconversion.Interaction analysis revealed that MSM with coinfection of CA and syphilis or HSV-2had higher risk of HIV infection than those with infection alone or without infection,and peer education could decrease the risks of HIV infection when MSM with STD infections received peer education.Conclusions HIV incidence is very high in MSM population in Nanjing.The infection of syphilis or CA can increase the risk of HIV incidence.
引文
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[9]Price MA,Rida W,Mwangome M,et al.Identifying at-risk populations in Kenya and South Africa:HIV incidence in cohorts of men who report sex with men,sex workers,and youth[J].J Acquir Immune Defic Syndr,2012,59(2):185-193.
[10]Yang H,Hao C,Huan X,et al.HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing,China[J].Sex Transm Dis,2010,37(4):208-213.
[11]胡海洋,周良佳,张之,等.江苏省男男性行为者HIV新发感染状况及影响因素研究[J].中华疾病控制杂志,2014,18(2):93-96.
[12]Templeton DJ,Jin F,Prestage GP,et al.Circumcision and Risk of Sexually Transmissible Infections in a Community-Based Cohort of HIV-Negative Homosexual Men in Sydney,Australia[J].J Infect Dis,2009,200(12):1813-1819.
[13]Jin F,Prestage GP,Kippax SC,et al.Risk factors for genital and anal warts in a prospective cohort of HIV-negative homosexual men:The HIM study[J].Sex Transm Dis,2007,34(7):488-493.
[14]Jin F,Prestage GP,Imrie J,et al.Anal Sexually Transmitted Infections and Risk of HIV Infection in Homosexual Men[J].J Acquir Immune Defic Syndr,2010,53(1):144-149.
[15]DonàMG,Palamara G,Di Carlo A,et al.Prevalence,genotype diversity and determinants of anal HPV infection in HIV-uninfected men having sex with men[J].J Clin Virol,2012,54(2):185-189.
[16]吴焱,伦文辉,赵刚.尖锐湿疣的全身细胞免疫研究进展[J].中华实验和临床感染病杂志·电子版,2009,3(01):55-57.
[2]Xu JJ,Zhang M,Brown K,et al.Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang,China[J].Sex Transm Dis,2010,37(7):432-439.
[3]Ruan Y,Jia Y,Zhang X,et al.Incidence of HIV-1,syphilis,hepatitis B,and hepatitis C virus infections and predictors associated with retention in a 12-month follow-up study among men who have sex with men in Beijing,China[J].J Acquir Immune Defic Syndr,2009,52(5):604-610.
[4]Hao C,Yan H,Yang H,et al.The incidence of syphilis,HIV and HCV and associated factors in a cohort of men who have sex with men in Nanjing,China[J].Sex Transm Infect,2011,87(3):199-201.
[5]Xu J,An M,Han X,et al.Prospective cohort study of HIV incidence and molecular characteristics of HIV among men who have sex with men(MSM)in Yunnan Province,China[J].BMC Infect Dis,2013,13:3.
[6]李东亮,高彦杰,于明润,等.北京市男男性行为者HIV新发感染率及影响因素研究[J].中华流行病学杂志,2012,33(7):663-666.
[7]Bernstein KT,Marcus JL,Nieri G,et al.Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion[J].J Acquir Immune Defic Syndr,2010,53(4):537-543.
[8]Dukers NH,Fennema HS,van der Snoek EM,et al.HIV incidence and HIV testing behavior in men who have sex with men:using three incidence sources,The Netherlands,1984-2005[J].AIDS,2007,21(4):491-499.
[9]Price MA,Rida W,Mwangome M,et al.Identifying at-risk populations in Kenya and South Africa:HIV incidence in cohorts of men who report sex with men,sex workers,and youth[J].J Acquir Immune Defic Syndr,2012,59(2):185-193.
[10]Yang H,Hao C,Huan X,et al.HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing,China[J].Sex Transm Dis,2010,37(4):208-213.
[11]胡海洋,周良佳,张之,等.江苏省男男性行为者HIV新发感染状况及影响因素研究[J].中华疾病控制杂志,2014,18(2):93-96.
[12]Templeton DJ,Jin F,Prestage GP,et al.Circumcision and Risk of Sexually Transmissible Infections in a Community-Based Cohort of HIV-Negative Homosexual Men in Sydney,Australia[J].J Infect Dis,2009,200(12):1813-1819.
[13]Jin F,Prestage GP,Kippax SC,et al.Risk factors for genital and anal warts in a prospective cohort of HIV-negative homosexual men:The HIM study[J].Sex Transm Dis,2007,34(7):488-493.
[14]Jin F,Prestage GP,Imrie J,et al.Anal Sexually Transmitted Infections and Risk of HIV Infection in Homosexual Men[J].J Acquir Immune Defic Syndr,2010,53(1):144-149.
[15]DonàMG,Palamara G,Di Carlo A,et al.Prevalence,genotype diversity and determinants of anal HPV infection in HIV-uninfected men having sex with men[J].J Clin Virol,2012,54(2):185-189.
[16]吴焱,伦文辉,赵刚.尖锐湿疣的全身细胞免疫研究进展[J].中华实验和临床感染病杂志·电子版,2009,3(01):55-57.