抗病毒治疗阻断HIV单阳家庭夫妻间传播效率的网状Meta分析
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摘要
目的应用网状Meta分析方法,评价抗病毒治疗阻断艾滋病病毒(HIV)单阳家庭阴性配偶阳转效果的影响。方法检索国内外中英文数据库,收集抗病毒治疗阻断我国HIV单阳家庭夫妻间传播相关的队列研究。使用Stata软件应用频率学方法,进行网状Meta分析。结果共纳入30篇文献,我国HIV单阳家庭内阴性配偶阳转率为1.29/100人年(95%可信区间:1.1/100～1.7/100人年);在是否进行抗病毒治疗的10项研究中,未进行抗病毒治疗的HIV单阳家庭阴性配偶的阳转率为2.0/100人年;进行抗病毒治疗的家庭内传播率为0.6/100人年。其中提供抗病毒治疗时点、治疗方案、安全套使用情况、感染时间、换药与否、持续治疗时间等信息的7项研究显示,各因素对影响抗病毒治疗阻断HIV单阳家庭阴性配偶阳转的效果存在差异。结论抗病毒治疗方案的不同,对抗病毒治疗阻断HIV单阳家庭阴性配偶阳转的影响最大,其余各因素对阳转影响的大小依次为治疗时点、安全套、感染时间、换药、持续治疗时间。
Objective To evaluate the effect of antiviral therapy on blocking HIV positive conversion among sero-discordant couples by using network meta-analysis. Methods Chinese and English databases at home and abroad were searched to collect cohort studies in China regarding blocking HIV transmission between sero-discordant couples with antiviral therapy. Network meta-analysis was performed using Stata software. Results A total of 30 cohort studies were included. Meta-analysis showed that the negative spouse positive conversion rate in HIV sero-discordant couples in China was 1.29/100 person-years(95% CI: 1.1/100 person-years to 1.7/100 person-years). In the 10 studies with and without antiviral therapy, the HIV positive conversion rate of negative spouses in HIV sero-discordant couples without antiviral therapy was 2.0/100 person-years; and the household transmission rate of those with antiviral therapy was 0.6/100 person-years. Among them, 7 studies related to antiviral treatment time, treatment schemes, condom use, infection time, changes of the medical regimens, and duration of treatment showed that the effect of various factors blocking positive conversion of HIV sero-discordant couples were different. Conclusion The largest influence factor of antiviral therapy on blocking HIV positive conversion of the negative spouses of sero-discordant couples is antiviral treatment schemes. Other factors include treatment time, condom use, infection time, changes of medical regimens, and duration of treatment.
Objective To evaluate the effect of antiviral therapy on blocking HIV positive conversion among sero-discordant couples by using network meta-analysis. Methods Chinese and English databases at home and abroad were searched to collect cohort studies in China regarding blocking HIV transmission between sero-discordant couples with antiviral therapy. Network meta-analysis was performed using Stata software. Results A total of 30 cohort studies were included. Meta-analysis showed that the negative spouse positive conversion rate in HIV sero-discordant couples in China was 1.29/100 person-years(95% CI: 1.1/100 person-years to 1.7/100 person-years). In the 10 studies with and without antiviral therapy, the HIV positive conversion rate of negative spouses in HIV sero-discordant couples without antiviral therapy was 2.0/100 person-years; and the household transmission rate of those with antiviral therapy was 0.6/100 person-years. Among them, 7 studies related to antiviral treatment time, treatment schemes, condom use, infection time, changes of the medical regimens, and duration of treatment showed that the effect of various factors blocking positive conversion of HIV sero-discordant couples were different. Conclusion The largest influence factor of antiviral therapy on blocking HIV positive conversion of the negative spouses of sero-discordant couples is antiviral treatment schemes. Other factors include treatment time, condom use, infection time, changes of medical regimens, and duration of treatment.
引文
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[2] 明帅,王璐,王岚,等.单阳家庭夫妻间传播的流行病学研究进展[J].中国公共卫生,2011,27(12):1515-1517.
[3] Myron S,Marybeth McCauley,Ying Q Chen,et al.Prevention of HIV-1 infection with early antiretroviral therapy[J].N Englj Med,2011,11:365(6):493-550.doi:10.1056/NEJM0a 1105243.
[4] 张天嵩,钟文昭,李博,等.实用循证医学方法学[M].2版.长沙:中南大学出版社,2014:477-526.
[5] 曾宪涛.应用STATA做Meta分析[M].北京:军事医学科学出版社,2014.
[6] Wells G,Shea B,O Connell D,et al.The Newscastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis[EB/OL].2011.http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
[7] 曾宪涛,徐畅,张超,等.网状Meta分析在Stata软件中的实现[J].中国循证医学杂志,2013,13(11):1387-1391.
[8] 张超,陶华,李胜,等.应用Stata软件Mvmeta程序包实现网状Meta分析[J].中国循证医学杂志,2014,14(9):1150-1159.
[9] 刘小春,李再有,付金翠,等.2006—2013年玉溪市报告HIV感染者/AIDS病例双阳家庭及单阳家庭阳转状况分析[J].预防医学论坛,2015,21(5):354-356.
[10] Na He,Song Duane,Hinging Ding,et al.Antiretroviral therapy reduces HIV transmission in discordant couples in rural Yunnan,China[J].PLoS One,2013,8(11):e77981.
[11] M Kumi Smith,Daniel Westreich,Huixin Liu,et al.Treatment to prevent HIV transmission in sero-discordant couples in Henan,China,2006 to 2012[J].Clinical infectious diseases,2015,61(1):111-119.
[12] Tang ZZ,Lan GH,Chen YQ,et al.HIV-1 treatment-as-prevention A Cohort study analysis of sero-discordant couples in rural southwest China[J].Medicine,2015,94 (24):1-7.
[13] 陈素良,赵宏儒,张玉琪,等.HIV-1夫妻间传播的回顾性队列研究[J].中国艾滋病性病,2009,15(1):21-23.
[14] 朱萍.HIV感染者配偶艾滋病队列研究[D].上海:复旦大学,2012.
[15] Jiao Z,Mao Y,Zhang F,et al.Antiretroviral therapy to prevent HIV transmission in sero-discordant couples in China(2003-2011):a national observational cohort study[J].The Lancet,2013,382(9899):1195-1203.
[16] Wang Lan,Wang Lu,M.Kumi Smith,et al.Heterosexual transmission of HIV and related risk factors among sero-discordant couples in Hernan province,China[J].Chin Med J,2013,126(9):3694-3700.
[17] 崔燕,张静,陈学玲,等.新疆伊犁州HIV单阳家庭阳转率及其影响因素分析[J].中国妇幼保健,2016,31(6):3140-3143.
[18] 马功燕,陈海燕,陈进,等.艾滋病夫妻传播队列研究[J].公共卫生与预防医学,2013,24 (5):54-56.
[19] 陈坚,柳智豪,梁旭,等.艾滋病抗病毒治疗对配偶间人类免疫缺陷病毒传播的影响分析[J].中国现代医学杂志,2017,27(3):64-68.
[20] 朱秋映,杨小艺,江河,等.抗病毒治疗对广西壮族自治区HIV单阳家庭阴性配偶抗体阳转的预防效果[J].中华流行病学杂志,2015,36 (12):1401-1405.
[21] 刘慧鑫.高效抗逆转录病毒治疗对单阳家庭配偶间HIV性传播预防作用研究[D].北京:中国疾病预防控制中心,2015.
[22] 崔兆麟.河南省3个艾滋病疫情高发村家庭内传播规律队列研究[D].北京:中国疾病预防控制中心,2009.
[23] 马楠,段广才,王奇,等.河南省某地区配偶间 HIV性传播状况调查[J].郑州大学学报(医学版),2011,46(6):920-922.
[24] 陈方方,王岚,韩娟,等.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研究[J].中华流行病学杂志,2013,34(1):10-14.
[25] Ding YY,Wu ZY,Duan S,et al.Risk factors for incident HSV-2 infections among a prospective cohort of HIV-1-discordant couples in China[J].Sexually Transmitted Infections,2016,92(1):76-82.
[26] 段松,杨跃诚,项丽芬,等.云南省德宏州HIV感染者的阴性配偶中新发感染率研究[J].中华流行病学杂志,2010,31(9):997-1000.
[27] 张玉成,曹艳芬,杨跃城,等.云南省德宏州 HIV 感染者阴性配偶队列5年失访率及其影响因素[J].中华疾病控制杂志,2016,20(12):1274-1298.
[28] 陈琳,潘晓红,杨介者,等.浙江省843对HIV单阳夫妻危险行为及血清检测[J].中国公共卫生,2011,27(1):63-64.
[29] 陈方方.驻马店艾滋病抗病毒治疗对夫妻间性传播的作用及影响因素研究[D].北京:中国疾病预防控制中心,2016.
[30] Wang L,Ge Z,Luo J,et al.HIV transmission risk among sero-discordant couples:a retrospective study of former plasma donors in Hernan,China[J].J AIDS,2010(55):232-238.
[31] 陈琳,潘晓红,杨介者,等.浙江省2009—2013年单阳家庭配偶HIV血清学阳转率分析[J].中华流行病学杂志,2015,36(8):857-861.
[32] 杨蓉蓉,桂希恩,熊勇,等.艾滋病单阳家庭配偶抗-人类免疫缺陷病毒阳转状况的5年随访分析[J].中华传染病杂志,2014,32(6):334-337.
[33] 张静.新疆伊犁州HIV单阳家庭阳转情况及影响因素研究[D].乌鲁木齐:新疆医科大学,2016.
[34] 毛宇嵘,郑锡文,热孜燕,等.新疆伊宁市婚检人群婚后艾滋病病毒性传播研究[J].中华流行病学杂志,2004,25(4):322-324.
[35] 明帅,王岚,王璐,等.驻马店市抗病毒治疗单阳家庭夫妻间性传播HIV影响因素分析[J].中国艾滋病性病,2012,18(5):276-279.
[36] 张渝婧.柳州市HIV 单阳家庭流行病学特征及基于抗病毒治疗的预防性服药意愿研究[D].合肥:安徽医科大学,2015.
[37] 唐慧玲,金屡华,张子根.金华市HIV单阳家庭阴性配偶阳转情况及其影响因素[J].中国艾滋病性病,2018,24(8):850-851.
[38] 陈海燕.HIV/AIDS配偶HIV感染及影响因素分析[J].预防医学,2017,30(7):658-666.
[39] 田金徽,李伦,赵晔,等.网状 Meta 分析的撰写与报告[J].中国药物评价,2013,30(6):321-333.
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