四川省吸毒人群艾滋病病毒和梅毒新发感染的队列研究

A prospective cohort study on human immunodeficiency virus and syphilis seroconversion among injecting drug users

目的调查四川省某地区静脉吸毒人群艾滋病病毒(HIV)和梅毒血清抗体阳转情况及其危险因素。方法 2002年11月在四川省西昌市以社区为基础招募HIV血清抗体阴性的静脉吸毒人群前瞻性研究队列333人,在队列每6个月随访时调查静脉吸毒人群高危吸毒行为和性行为情况, 并采集血样进行HIV和梅毒抗体检测。结果队列随访2年,静脉吸毒人群队列保持率和HIV血清抗体阳转率分别为75．7％和2．53／100人年(95％CI:1．10-3．97),在多因素Poisson回归模型分析中,民族(RR=12．42,95％CI:2．72-56．74,P=0．0012)、近3个月共用针头或注射器(RR=4．06, 95％CI:1．29-12．81,P=0．0168)与HIV血清抗体阳转的关系有统计学意义。该研究队列梅毒血清抗体阳转率为4．71/100人年(95％CI:2．59-6．82),在多因素Poisson回归模型中,女性(RR= 4．42,95％CI:1．78-10．99,P=0．0014)与梅毒血清抗体阳转的关系有统计学意义。结论该地区静脉吸毒人群HIV和梅毒新发感染率高,应采取有效的干预措施以控制HIV的传播流行。

Objective To study the rate of human immunodeficiency virus（HIV） seroconversion, HIV transmission and related risk factors among injecting drug users（IDUs） in an area of Sichuan province. Methods In November 2002, a communlty-based baseline survey was conducted to recruit 333 HIV- seronegative IDUs for a prospective cohort study in Xichang county of Sichuan province, China. Follow-up visits were carried out every 6 months to study the situation of drug use, sexual behaviors of the IDUs and blood specimens were collected to test for antibodies against HIV and syphilis. Results During a 24-month follow-up period, cohort retention rate and HIV incidence were 75.7% and 2.53 per 100 person-years [ 95 % confidence interval（CI） ： 1.10-3.97） ], respectively, Multivariate Poisson regression model showed that risk factors which were significantly associated with HIV seroconversion would include： ethnicity （RR-12.42; 95%CI： 2.72-56.74, P= 0.0012） and needle or syringe sharing in the past 3 months （ RR - 4.06 ; 95 % CI ： 1.29-12.81, P = 0,0168）. Syphilis seroconversion in this cohort was 4.71 per 100 person-years （95 % CI ： 2.59- 6.82）. In muhivariate Poisson regression being female （ RR = 4,42 ; 95 % CI：1.78-10,99, P-0.0014） appeared to be the only factor which was significantly associated with syphilis seroconversion. Conclusion Our study results showed that there was a rapid transmission of HIV and syphilis among IDUs in Sichuan province, suggesting that effective intervention should be urgently taken.