北京市男男性行为人群HIV和梅毒本底感染及新发感染调查研究

Prevalence and incidence of HIV and syphilis among men who have sex with men in Beijing

目的了解北京市男男性行为者(MSM)人类免疫缺陷病毒(HIV)和梅毒的感染情况与影响因素。方法 2011年7月～2011年12月在北京招募MSM,进行本底调查,符合队列纳入标准者第3和6个月随访调查;使用平板电脑一对一问卷调查;快速检测试剂检测HIV和梅毒螺旋体抗体;统计分析使用SAS 9.2统计软件包,影响因素分析单因素采用χ2检验或Fisher确切概率法,P<0.05的变量纳入多因素logistic回归模型分析。结果本底共招募500名MSM/HIV和梅毒感染率分别为5.60%(28/500)和26.40%(132/500);多因素logistic回归分析显示:与HIV感染有统计学意义的因素有:最近一年未做过HIV抗体检测或不知晓检测结果 (OR=2.57,95%CI:1.16～5.68)、第一次与男性发生性行为年龄≤18岁(OR=2.45,95%CI:1.07～5.62)、最近3个月发生过肛交的男性人数>3人(OR=2.83,95%CI:1.25～6.42);梅毒感染的独立影响因素为年龄>30岁(OR=1.68,95%CI:1.13～2.52)、最近3个月发生过肛交的男性人数>3人(OR=1.83,95%CI:1.15～2.92)。395名MSM进入队列,6个月随访队列保持率为88.10%(348/395),HIV和梅毒螺旋体血清抗体阳转率分别为5.36/100人年(95%CI=2.19～8.53)和8.13/100人年(95%CI=3.53～12.73)。结论北京市MSM人群HIV/梅毒感染率及新发感染率均维持在较高水平,需要对MSM细分,以提供更有针对性的宣教及行为干预;MSM知晓检测结果与接受检测同样重要,可尝试在HIV检测咨询机构推广HIV快速检测试剂以提高检测结果知晓率。

Objective To understand the current prevalence and incidence of human immunodeficiency virus （HIV） and syphilis among men who have sex men （MSM） in Beijing. and to identify the factors predicting prevalence of HIV and syphilis. Methods MSM were recruited and surveyed in Beijing from July to December 2011. Subjects who met the inclusive criteria of the cohort were enrolled and followed up to six months. A one-to- one questionnaire interview was conducted by using tablets and blood samples were collected to test HIV-antibody and syphilis antibody via rapid test. SAS9.2 software was used to analyze the data. Chi-square or Fisher tests were employed for univariate analysis of sociodemographic and behavioral variables. Variables with P〈0. 05 in univariate analysis were considered statistically significant and included in the multivariable logistic regression model. Results A total of 500 MSM were enrolled with the prevalence of 5.60% （28/500） for HIV and 26.40% （132/500） for Treponema pallidum at the baseline survey. Multivariate logistic regression analysis showed that factors such as no HIV testing in the last year or without knowing the testing result （017 2.57, 95% CI： 1.16-5.68）, the age at the first sexual intercourse less than or equal to 18 years old （OR= 2.45, 95% CI： 1.07 5.62） and having had anal sex with four or more male partners in the last three months （OR= 2.83, 95% CI： 1.25-6.42） increased the risk of HIV infection. Meanwhile, factors as age older than 30 years old （OR=1. 68, 95G CI： 1.13-2.52） and having anal intercourse with four or more male sex partners in the last three months （OR=1. 83, 95% CI： 1.15-2.92） were independently associated with syphilis infection. Of the 395 eligible MSM, 88.10% （348/395） were still in the cohort at the 6-month follow-up vis it. The seroconversion rates were 5.36 per 100 person-years （95% CI： 2.19-8.53） for HIV antibody and 8.13 per 100 person-years （95G CI： 3.53 12.73） for syphilis antibody. Conclusions The prevalence and incidence of HIV and syphilis remain at an alarmingly high level among MSM population in Beijing. Sub-classification of MSM is needed in order to provide more targeted education and behavioral intervention. Rapid testing should be promoted in the counseling and testing centers to increase the awareness of test results.