Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data.
Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data.
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DOI：
10.1371/journal.pone.0031227
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Hagan H
中科院分区：
文献类型：
--
作者：
Des Jarlais DC;Feelemyer JP;Modi SN;Arasteh K;Mathers BM;Degenhardt L;Hagan H
注射吸毒仍然是世界许多地区艾滋病毒流行的主要驱动因素。许多注射吸毒者（PWID）性活跃，因此，在PWID中高血清阳性率的艾滋病毒流行可能会引发自我维持的异性传播流行。确定了14个在艾滋病毒感染者中血清阳性率较高（<20%）的国家，这些国家有关于注射吸毒和异性恋艾滋病毒或艾滋病病例的可靠数据。图中新报告的艾滋病毒或艾滋病病例之间的PWID和异性恋，以确定两种类型的流行病之间的时间关系。异性恋者中新报告的病例超过PWID中新报告的病例的年份、流行曲线的各个方面和流行病例历史进行了分析，以评估PWID中的HIV流行是否“合理”或“极不可能”在每个国家引发了异性恋流行。在14个国家中，有11个国家实现了过渡。确定了注射吸毒者和异性恋艾滋病毒流行之间的两种时间关系，即快速高发病率转变与延迟低发病率转变。在六个国家，注射吸毒流行病引发异性恋流行病似乎“有道理”，在五个国家，注射吸毒流行病引发异性恋流行病似乎“极不可能”。新病例高峰年后PWID发病率的迅速下降和国民收入是异性恋流行病“极不可能”开始的最佳预测因素。在PWID血清阳性率高的国家，从注射吸毒者集中流行向异性恋流行的转变很常见，尽管有不同类型的转变。立即减少艾滋病毒感染者中艾滋病毒发病率的干预措施可能会减少注射吸毒者流行病引发异性恋流行病的可能性。
Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics. Fourteen countries that had experienced high seroprevalence (<20%) HIV epidemics among PWID and had reliable data for injection drug use (IDU) and heterosexual cases of HIV or AIDS were identified. Graphs of newly reported HIV or AIDS cases among PWID and heterosexuals were constructed to identify temporal relationships between the two types of epidemics. The year in which newly reported cases among heterosexuals surpassed newly reported cases among PWID, aspects of the epidemic curves, and epidemic case histories were analyzed to assess whether it was “plausible” or “highly unlikely” that the HIV epidemic among PWID might have initiated the heterosexual epidemic in each country. Transitions have occurred in 11 of the 14 countries. Two types of temporal relationships between IDU and heterosexual HIV epidemics were identified, rapid high incidence transitions vs. delayed, low incidence transitions. In six countries it appears “plausible” that the IDU epidemic initiated a heterosexual epidemic, and in five countries it appears “highly unlikely” that the IDU epidemic initiated a heterosexual epidemic. A rapid decline in incidence among PWID after the peak year of new cases and national income were the best predictors of the “highly unlikely” initiation of a heterosexual epidemic. Transitions from IDU concentrated epidemics to heterosexual epidemics are common in countries with high seroprevalence among PWID though there are distinct types of transitions. Interventions to immediately reduce HIV incidence among PWID may reduce the likelihood that an IDU epidemic may initiate a heterosexual epidemic.