Estimation of HIV-1 incidence among five focal populations in Dehong, Yunnan: a hard hit area along a major drug trafficking route
Estimation of HIV-1 incidence among five focal populations in Dehong, Yunnan: a hard hit area along a major drug trafficking route
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DOI：
10.1186/1471-2458-10-180
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发表时间：
2010-04-07
影响因子：
4.5
通讯作者：
Jiang, Yan
中科院分区：
文献类型：
--
作者：
Duan, Song;Shen, Sheng;Jiang, Yan
背景：自1989年全国首批146例艾滋病病毒感染者被发现以来，德宏州一直是中国艾滋病疫情最严重的地区之一。2004年以来，德宏市地方和国家政府投入了大量财政资源防治艾滋病。本研究的目的是跟踪德宏市5个重点人群中HIV-1患病率和发病率的动态变化，并评估艾滋病预防和控制工作的影响。方法：2004 - 2008年对5个重点人群进行连续横断面调查。使用归一化光密度0.8和调整，用BED IgG捕获酶免疫分析法检测HIV血清阳性标本，以确定最近的血清转换（中位数，155天）。结果：2004 - 2008年，注射吸毒者（IDUs）的HIV年感染率从2004年的15.0% （95% CI = 11.4% ~ 18.5%）下降到2008年的4.3% (95% CI = 2.4% ~ 6.2%)；趋势检验P < 0.0001]。其他焦点人群的发病率保持稳定，如艾滋病毒不一致的夫妇（从5.5%到4.7%不等）、女性性工作者（从1.4%到1.3%不等）、孕妇（0.1%）和婚前夫妇（0.2到0.1%）。总体而言，近期HIV-1感染的女性比例高于男性（P < 0.0001）。结论：德宏市艾滋病毒流行在5年内持续扩大，但在注射吸毒者中蔓延速度放缓，注射吸毒者和不和谐夫妻的艾滋病毒感染率仍然较高。针对高危亚群采取强化预防措施，进一步减缓疫情，控制HIV向中国其他地区的传播，并需要进行多因素分析，以探索哪种措施对不同人群更有效。
Background: Since 1989 when the first 146 HIV positives in China were identified, Dehong Prefecture had been one of the areas hardest-hit by HIV in China. The local and national governments have put substantial financial resources into tackling the HIV epidemic in Dehong from 2004. The objective of this study was to track dynamic changes in HIV-1 prevalence and incidence among five focal populations in Dehong and to assess the impact of HIV prevention and control efforts.Methods: Consecutive cross-sectional surveys conducted in five focal populations between 2004 and 2008. Specimens seropositive for HIV were tested with the BED IgG capture enzyme immunoassay to identify recent seroconversions (median, 155 days) using normalized optical density of 0.8 and adjustments.Results: From 2004 to 2008, estimated annual HIV incidence among injecting drug users (IDUs) decreased significantly [from 15.0% (95% CI = 11.4%-18.5%) in 2004 to 4.3% (95% CI = 2.4%-6.2%) in 2008; trend test P < 0.0001]. The incidence among other focal populations, such as HIV discordant couples (varying from 5.5% to 4.7%), female sex workers (varying from 1.4% to 1.3%), pregnant women (0.1%), and pre-marital couples (0.2 to 0.1%) remained stable. Overall, the proportion of recent HIV-1 infections was higher among females than males (P < 0.0001).Conclusions: The HIV epidemic in Dehong continued to expand during a five-year period but at a slowing rate among IDUs, and HIV incidence remains high among IDUs and discordant couples. Intensive prevention measures should target sub-groups at highest risk to further slow the epidemic and control the migration of HIV to other areas of China, and multivariate analysis is needed to explore which measures are more effective for different populations.