The role of sexually transmitted infections in the evolution of the South African HIV epidemic
The role of sexually transmitted infections in the evolution of the South African HIV epidemic
复制标题
DOI：
10.1111/j.1365-3156.2011.02906.x
复制
发表时间：
2012-02-01
影响因子：
3.3
通讯作者：
Coetzee, David J.
中科院分区：
文献类型：
--
作者：
Johnson, Leigh F.;Dorrington, Rob E.;Coetzee, David J.
目的评估性传播感染（STI）对南非艾滋病传播的影响程度，并估计STI治疗的改善对降低艾滋病发病率的影响程度。方法采用数学模型模拟艾滋病与其他6种STI之间的相互作用（生殖器疱疹、梅毒、软下疳、淋病、衣原体感染和滴虫病）以及细菌性阴道病和阴道念珠菌病。性传播感染对艾滋病毒传播概率的影响被假定为与观察性研究的荟萃分析评价一致，该模型被拟合到南非的艾滋病毒流行率数据。（不确定性范围：24-50%）下降到2010年的14%（8-18%），而生殖器疱疹引起的新感染比例增加。据估计，1994年至2004年期间，综合征管理方案使成人艾滋病毒发病率降低了6.6%（3.3-10.3%），到那时综合征管理覆盖率为52%。如果在1986年引入综合征管理，立即实现100%的覆盖率和两倍的就医率，艾滋病毒发病率将在未来十年减少64%（36-82%），但如果同样的干预措施推迟到2004年，艾滋病发病率将仅降低5.5%（2.8-9.0%）。结论性传播感染对南非艾滋病毒的传播起了重要作用，但是，由于性传播感染控制措施实施较晚，覆盖面不够理想，因此对艾滋病毒发病率的影响有限。
Objectives To assess the extent to which sexually transmitted infections (STIs) have contributed to the spread of HIV in South Africa and to estimate the extent to which improvements in STI treatment have reduced HIV incidence.METHODS A mathematical model was used to simulate interactions between HIV and six other STIs (genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection and trichomoniasis) as well as bacterial vaginosis and vaginal candidiasis. The effects of STIs on HIV transmission probabilities were assumed to be consistent with meta-analytic reviews of observational studies, and the model was fitted to South African HIV prevalence data.RESULTS The proportion of new HIV infections in adults that were attributable to curable STIs reduced from 39% (uncertainty range: 24-50%) in 1990 to 14% (8-18%) in 2010, while the proportion of new infections attributable to genital herpes increased. Syndromic management programmes are estimated to have reduced adult HIV incidence by 6.6% (3.3-10.3%) between 1994 and 2004, by which time syndromic management coverage was 52%. Had syndromic management been introduced in 1986, with immediate achievement of 100% coverage and a doubling of the rate of health seeking, HIV incidence would have reduced by 64% (36-82%) over the next decade, but had the same intervention been delayed until 2004, HIV incidence would have reduced by only 5.5% (2.8-9.0%).CONCLUSIONS Sexually transmitted infections have contributed significantly to the spread of HIV in South Africa, but STI control efforts have had limited impact on HIV incidence because of their late introduction and suboptimal coverage.