河南省某市HIV单阳家庭阴性配偶抗体阳转情况

Sero-conversion of HIV sero-negative partners among discordant couples in a city of Henan province

目的了解河南省某市HIV单阳家庭阴性配偶抗体阳转情况及其变化趋势，并探讨其影响因素。方法以2006年7月起该市管理的经采供血、输血或血制品而感染HIV的单阳家庭阴性配偶共3088名为研究对象，每6个月随访1次至2010年12月，采用ELISA法（初筛试验）和Westernblotting法（确认试验）检测其HIV抗体阳转情况；问卷调查收集阴性配偶的人口学信息、行为学信息，并关联当地实验室检测数据库中原阳配偶的血清学信息，分析阴性配偶抗体阳转的影响因素。结果在3088名研究对象中，132例HIV抗体阳转，总抗体阳转率为1．17／100人年（95％CI：0．99／100人年-1．39／100人年）；每次随访阳转率中，2008年1-6月阳转率最大（0．82％），2010年1-6月阳转率最小（0．13％），9次随访抗体阳转率呈下降趋势（X^2趋势=8．907，P〈0．05）；问卷调查中，男性阴性配偶占56．6％（1513／2673），小学及以下文化程度者占56．2％（1501／2673）；自报最近6个月有过性生活者占81．4％（2176／2673），最近1年性生活频次〈4次／月的占45．7％（1169／2558），坚持使用安全套者占94．5％（2418／2558）；原阳配偶最近1次CD4^＋T细胞计数〈200个／μl者占17．4％（437／2505）。多因素Cox回归分析发现，阴性配偶为男性（RR=1．58，95％CI：1．02-2．43）、小学及以下文化程度（RR=2．77，95％CI：1．68-4．57）、最近1年有性生活（RR=4．39，95％CI：1．53-12．56）及原阳配偶最近1次检测CD4＋^＋T细胞计数〈200个／μl（RR=2．36，95％CI：1．42-3．93）是阴性配偶抗体阳转的危险因素，而最近1年性生活频次〈4次／月（RR：0．18，95％C1：0．10-0．32）和坚持使用安全套（职=0．07，95％CI：0．05-0．12）是阴性配偶抗体阳转的保护因素。结论该市原阳配偶通过采供血、输血或血制品感染HIV的单阳家庭，其阴性配偶抗体阳转率处于较低水平，且随访阳转率随时间呈下降趋势，这可能与原阳配偶CIM^＋T细胞计数升高及安全套使用比例较高有关。

Objective To understand the overall HIV sero-conversion rate and its trend and risk factors of uninfected partners in sero-diseordant couples. Methods A total of 3088 uninfected partners, whose HIV positive partners infected via former plasma donation or blood transfusion from July, 2006 to December 2010,were chosen as a fix cohort. They were tested for HIV antibodies twice a year using ELISA by local CDC from July ,2006 to December,2010. Data regarding demographic, sexual behavior information of uninfected partners and infection, serologic characteristics of positive partners were retrospectively surveyed and collected to analyze possible risky factors. Results A total of 132 in 3088 uninfected partners were sero-converted,with a sero-conversion rate of 1.17/100 person years （95% CI：0. 99/100 person years - 1.39/100 person years）. Sero-eonversion rate reached the peak（0. 82% ） in the following interval of January and June in 2008 and have a bottom conversion rate （0. 13%） in the same month interval in2010. Conversion rate outcome showed a downward trend in following （ X^2trend = 8. 907, P 〈 0. 05 ） . In the survey,56. 6% （1513/2673） uninfected partners were males, 56.2% （1501/2673） were with lower education level. Among uninfected partners, as reported by themselves, having sex in recently 6 months accounted for a proportion of 81.4% （2176/2673）, sex frequency of less than 4 times per month accounted for 45.7% （1169/2558） and consistent using of condom accounted for 94. 5% （2418/2558）. The proportion of the index partners＇ most recently CD4 cell count less than 200 cells per μl was 17.4% （437/2505）. Results from multivariate of Cox regression showed that male negative partners（RR = 1.58,95% CI： 1.02 - 2.43 ）, negative partners with lower education level （ RR = 2. 77,95% CI： 1.68 - 4. 57 ）, having sexual activity in latest one year （ RR = 4. 39,95% CI： 1.53 - 12. 56 ） and CD4 count less than 200 cells per μl （RR=2. 36,95% CI： 1.42- 3.93） were associated with increased risk of HIV sero-conversion, while intercourse frequency less than 4 times per month （ RR = 0. 18,95% CI： 0. 10 - 0. 32 ） , consistent using of condom（RR =0.07,95% CI：0. 05 -0. 12） decreased the risk of conversion. Conclusion In this city,the conversion rate of negative partners whose positive partner infected via former plasma donation or blood transfusion is relatively low and behave a downward trend. Serologic surveillance, education and intervention based on couple are needed to be enhanced.