金华市艾滋病单阳夫妻随访队列研究
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摘要
目的分析艾滋病单阳夫妻中阴性配偶艾滋病病毒(HIV)新发感染率,判断夫妻间性传播水平,为制定针对性的艾滋病防治措施提供依据。方法建立开放性队列,每6个月随访1次,收集人口学、高危行为特征等信息,采集血样进行检测。采用Kaplan-Meier法和COX比例风险回归模型进行单因素和多因素分析。结果 197对单阳夫妻中4例阴性配偶阳转,HIV新发感染率0.69/100人年[95%可信区间(CI):0.02～1.36/100人年]。COX模型分析结果:阳性方"不愿意使用安全套"(HR=2.149,95%CI=1.278～6.680)、不用安全套时阴性方"不能拒绝性行为"(HR=8.650,95%CI=2.219～13.719)、阴性方安全套低效能(HR=1.356,95%CI=1.177～11.078)、阳性方未接受抗病毒治疗(HR=6.923,95%CI=1.850～27.372)、阳性方病毒载量水平未查者(HR=4.059,95%CI=1.541～12.951)和≥100拷贝/mL者(HR=1.201,95%CI=1.648～10.963)是感染HIV危险因素。结论金华市单阳夫妻阴性配偶新发感染率较低。预防控制夫妻间艾滋病传播关键应定位为夫妻双方,规范阳性告知,推广安全套的持续性使用,进一步提高阳性配偶的抗病毒治疗覆盖率和服药依从性,定期监测病毒载量水平,保证抗病毒治疗效果。
Objective To investigate the new HIV infection of negative spouse in HIV discordant couples, and estimate the sexual transmission level, to provide a basis for the measures of AIDS prevention and control. Methods An open cohort was established, and followed up every six months. The information about demography, high-risk behaviors, and blood samples were collected. Kaplan-meier and Cox proportional risk regression models were used for single and multifactor analysis. Results A total of 197 couples participated in the study, 4 HIV sero-conversion spouses were identified, with the new infection rate of 0.69/100 person-year(95%CI:0.02-1.36/100 person-year).The Cox model analysis result showed that the risk factors of HIV infection included "HIV positive spouse were reluctant to use condoms"(HR=2.149, 95% CI=2.149-6.680); "HIV negative spouse could not refuse sex without a condom(HR=8.650, 95% CI=8.650-13.719); "condom was ineffectively used "(HR=1.356, 95% CI=1.356-11.078); "HIV positive spouse did not receive anti-retrovirus therapy(ART)"(HR=6.923, 95% CI=6.923-27.372); "HIV positive partner did not test for viral load"(HR=4.059, 95% CI=4.059-12.951); and "those viral load was≥100 copies/mL(HR=1.201, 95% CI=1.201-10.963). Conclusion The new infection rate is low among the negative spouses in Jinhua. In the follow-up management of HIV/AIDS, we should normalize the positive notification,promote condom use, expand the coverage of ART, and ensure medication adherence and regular monitoring of viral load levels, so as to prevent HIV spreading among discordant couples.
Objective To investigate the new HIV infection of negative spouse in HIV discordant couples, and estimate the sexual transmission level, to provide a basis for the measures of AIDS prevention and control. Methods An open cohort was established, and followed up every six months. The information about demography, high-risk behaviors, and blood samples were collected. Kaplan-meier and Cox proportional risk regression models were used for single and multifactor analysis. Results A total of 197 couples participated in the study, 4 HIV sero-conversion spouses were identified, with the new infection rate of 0.69/100 person-year(95%CI:0.02-1.36/100 person-year).The Cox model analysis result showed that the risk factors of HIV infection included "HIV positive spouse were reluctant to use condoms"(HR=2.149, 95% CI=2.149-6.680); "HIV negative spouse could not refuse sex without a condom(HR=8.650, 95% CI=8.650-13.719); "condom was ineffectively used "(HR=1.356, 95% CI=1.356-11.078); "HIV positive spouse did not receive anti-retrovirus therapy(ART)"(HR=6.923, 95% CI=6.923-27.372); "HIV positive partner did not test for viral load"(HR=4.059, 95% CI=4.059-12.951); and "those viral load was≥100 copies/mL(HR=1.201, 95% CI=1.201-10.963). Conclusion The new infection rate is low among the negative spouses in Jinhua. In the follow-up management of HIV/AIDS, we should normalize the positive notification,promote condom use, expand the coverage of ART, and ensure medication adherence and regular monitoring of viral load levels, so as to prevent HIV spreading among discordant couples.
引文
[1] 中华人民共和国卫生部.2011年中国艾滋病疫情估计[R].联合国艾滋病规划署,世界卫生组织,2011.
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[6] 潘晓红,杨介者,陈琳,等.浙江省农村外来婚嫁女HIV感染的流行病学特征分析[J].中华预防医学杂志,2010,44(11):1023-1026.
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[9] 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.
[10] 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.
[11] Dunkle KL,Stephenson R,Karita E,et al.New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda:an analysis of survey and clinical data[J].Lancet,2008,371(9631):2183-2191.
[12] Melo GM,Santos BR,De Cassia Lira R,et al.Sexual transmission of HIV-1 among sero-discordant couples in Porto Alegre,southern Brazil[J].Sex Transm Dis,2008,35(11):912-915.
[13] Hugonnet S,Mosha F,Todd J,Mugeye K,et al.Incidence of HIV infection in stable sexual partnerships:a retrospective cohort study of 1802 couples in Mwanza Region,Tanzania[J].J Acquir Immune Defic Syndr,2002,30(1):73-80.
[14] 李化荣,王哲,杨磊.河南地区影响HIV夫妻间性传播危险因素研究[J].中国艾滋病性病,2008,14(1):39-41.
[15] 乔晓春.山西省家庭内夫妻间HIV性传播的流行病学研究[C].首届晋冀鲁豫流行病学术交流会论文集,2008:121-130.
[16] 冯孟贤,刘民,刘珏,等.抗病毒治疗阻断HIV单阳家庭内传播效果的Meta分析[J].中国艾滋病性病,2015,21(8):668-672.
[17] Anglemyer A,Rutherford GW,Baggaley RC,et al.Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples[J].Cochrane Database Syst Rev,2013,310(15):1619-1620.
[18] Cohen MS,Chen YO,Mccauley M,et al.Prevention of hiv-1 infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[19] 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):276-279,292.
[20] Gayley WE Jr.Effectiveness of condoms in reducing heterosexual transmission of HIV[J].Am Fam Physician,2004,70(7):1268-1269.
[21] 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(15):3140-3143.
[22] 冯孟贤,刘民,刘珏,等.抗病毒治疗阻断HIV家庭内传播的研究进展[J].中国艾滋病性病,2015,21(7):644-647.
[2] 惠珊,许艳,王璐,等.部分省市艾滋病异性性传播方式构成及特征分析[J].疾病监测,2012,26(6):458-462.
[3] 汤后林.艾滋病单阳家庭配偶阳转的影响因素及传播模型研究[D].北京:中国疾病预防控制中心,2014.
[4] 朱萍.HIV感染者配偶艾滋病队列研究[D].上海:复旦大学,2012.
[5] 明帅,王璐,葛增,等.河南省某市HIV单阳家庭阴性配偶抗体阳转情况[J].中华预防医学杂志,2013,47(4):337-341.
[6] 潘晓红,杨介者,陈琳,等.浙江省农村外来婚嫁女HIV感染的流行病学特征分析[J].中华预防医学杂志,2010,44(11):1023-1026.
[7] 段松,郭浩岩,庞琳,等.云南省德宏州艾滋病传播模式分析[J].中华预防医学杂志,2008,42(12):866-869.
[8] 陈素良,赵宏儒,张玉琪,等.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.
[9] 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.
[10] 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.
[11] Dunkle KL,Stephenson R,Karita E,et al.New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda:an analysis of survey and clinical data[J].Lancet,2008,371(9631):2183-2191.
[12] Melo GM,Santos BR,De Cassia Lira R,et al.Sexual transmission of HIV-1 among sero-discordant couples in Porto Alegre,southern Brazil[J].Sex Transm Dis,2008,35(11):912-915.
[13] Hugonnet S,Mosha F,Todd J,Mugeye K,et al.Incidence of HIV infection in stable sexual partnerships:a retrospective cohort study of 1802 couples in Mwanza Region,Tanzania[J].J Acquir Immune Defic Syndr,2002,30(1):73-80.
[14] 李化荣,王哲,杨磊.河南地区影响HIV夫妻间性传播危险因素研究[J].中国艾滋病性病,2008,14(1):39-41.
[15] 乔晓春.山西省家庭内夫妻间HIV性传播的流行病学研究[C].首届晋冀鲁豫流行病学术交流会论文集,2008:121-130.
[16] 冯孟贤,刘民,刘珏,等.抗病毒治疗阻断HIV单阳家庭内传播效果的Meta分析[J].中国艾滋病性病,2015,21(8):668-672.
[17] Anglemyer A,Rutherford GW,Baggaley RC,et al.Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples[J].Cochrane Database Syst Rev,2013,310(15):1619-1620.
[18] Cohen MS,Chen YO,Mccauley M,et al.Prevention of hiv-1 infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[19] 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):276-279,292.
[20] Gayley WE Jr.Effectiveness of condoms in reducing heterosexual transmission of HIV[J].Am Fam Physician,2004,70(7):1268-1269.
[21] 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(15):3140-3143.
[22] 冯孟贤,刘民,刘珏,等.抗病毒治疗阻断HIV家庭内传播的研究进展[J].中国艾滋病性病,2015,21(7):644-647.