浙江省2015-2021年HIV抗体阳性暗娼特征及HIV-1亚型分析

Characteristics and HIV-1 subtypes of HIV-positive female sex workers in Zhejiang Province,2015–2021

目的了解浙江省HIV抗体阳性暗娼特征及HIV-1亚型分析,为防控艾滋病经异性性行为传播提供科学依据。方法以浙江省2015-2021年报告有商业异性性行为的女性HIV感染者为研究对象,从中国疾病预防控制信息系统中收集病例报告、随访和治疗数据,并收集研究对象cART前血样进行HIV-1亚型分析。使用描述性分析和χ~2检验探索研究对象特征及HIV亚型分布情况。结果共有484例HIV抗体阳性暗娼纳入研究,其中外省户籍占68.8%(333例),户籍分布在全国24个省(自治区、直辖市)。报告地区分布在浙江省82个县(市、区),在宁波市、金华市和温州市部分县区形成3个相对聚集区域。共获得228例研究对象血样,包括10种HIV-1亚型,主要为CRF07_BC(76例,占33.3%)、CRF01_AE(70例,占30.7%)和CRF08_BC(48例,占21.1%)。8个县(市、区)报告的研究对象有4种及以上的亚型分布。截至2022年12月31日,46.3%(224例)研究对象离开浙江省,4.1%(20例)和9.9%(48例)的研究对象在浙江省内跨市和跨县流动。浙江省内随访管理和流出省外的HIV抗体阳性暗娼确证时年龄、婚姻、首次CD4细胞计数分组、随访状态和接受cART情况差异有统计学意义。结论浙江省2015-2021年报告HIV抗体阳性暗娼以外省户籍为主,县区分布广泛且呈一定聚集性,感染HIV-1毒株亚型分布多样,确证后跨省流动比例高,跨省和省内流动并存,需建立跨区域协同管理机制,强化治疗管理,需提供更有针对性的干预关怀服务,控制再传播风险。

Objective To investigate the characteristics and HIV-1 subtypes of HIV-positive female sex workers(FSWs)in Zhejiang Province and provide scientific evidence for controlling HIV transmission through sexual behavior.Methods FSWs diagnosed between 2015 and 2021 in Zhejiang Province were recruited as participants.Data of study participants on HIV case reports,follow-up,and combined antiretroviral therapy(cART)were collected from the China Information System for Disease Control and Prevention(CISDCP).Plasma was collected before administration of cART for the HIV subtype analysis.A descriptive analysis andχ~2 test were used to explore the characteristics of household registration provinces,HIV subtypes,and mobility after HIV confirmation.Results A total of 484 FSWs were included in this study,68.8%(333 cases)had household registrations in 24 provinces outside Zhejiang.They were diagnosed in 82 counties in Zhejiang Province,primarily in three geographically concentrated areas in the cities of Ningbo,Jinhua,and Wenzhou.Ten HIV-1 gene subtypes and two UFRs were identified among the 228 study participants.The main subtypes were CRF07_BC(76,33.3%),CRF01_AE(70,30.7%),and CRF08_BC(48,21.1%).Eight counties reported four or more HIV-1 subtypes.By the end of December 31,2022,46.4%of the participants moved outside Zhejiang Province,and 4.1%and 9.9%moved inter-city and inter-county in Zhejiang,respectively,after HIV confirmation.Statistically significant differences were found in age,marital status,first CD4 count,follow-up,and cART status distribution between participants who stayed in Zhejiang and those who moved outside the province.Conclusions In Zhejiang Province,HIV-positive FSWs were mainly from other provinces,sporadically diagnosed,and relatively concentrated in certain areas,and their HIV-1 subtypes were diverse.The proportion of people who moved outside Zhejiang after their HIV confirmation was high,and interprovincial and intra provincial mobility coexisted.Efforts should be made to establish a collaborative mechanism across provinces to strengthen c ART management and provide more targeted interventions and care services to halt the potential transmission risk.