我国HIV感染孕产妇妊娠、分娩及婴儿喂养方式的meta分析

目的了解2003~2011年我国人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染孕产妇的继续妊娠率、剖宫产率及其所生婴儿的人工喂养率情况,为艾滋病母婴传播的预防工作提供参考。方法计算机检索PubMed、Web of Science、The Cochrane Library、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）、万方数据库（WanFang Data）和中国生物医学文献数据库（CBM）,检索时间从建库至2013年5月,纳入国内外公开发表的关于我国HIV感染孕产妇继续妊娠、剖宫产及其所生婴儿人工喂养情况的文献。由2名研究者独立筛选文献、提取资料并评价质量。采用Comprehensive MetaAnalysis Version2.0软件进行meta分析。采用meta回归分析方法探讨异质性的来源。结果共检索到2 356篇文献,最终纳入61篇。Meta分析结果显示,2003~2011年,我国HIV感染孕产妇的继续妊娠率依次为67.50%[95%CI（51.73%,80.10%）]、60.49%[95%CI（18.59%,91.13%）]、51.80%[95%CI（28.13%,74.68%）]、62.59%[95%CI（54.60%,69.96%）]、64.93%[95%CI（50.18%,77.29%）]、70.65%[95%CI（62.20%,77.88%）]、65.66%[95%CI（59.70%,71.16%）]、67.85%[95%CI（52.66%,80.02%）]、75.00%[95%CI（59.46%,85.99%）];2004~2010年HIV感染孕产妇的剖宫产率依次为26.33%[95%CI（9.41%,55.14%）]、43.40%[95%CI（34.30%,52.96%）]、42.57%[95%CI（35.73%,49.70%）]、69.43%[95%CI（13.48%,97.07%）]、46.68%[95%CI（27.27%,67.16%）]、61.14%[95%CI（49.37%,71.75%）]、56.60%[95%CI（36.36%,74.85%）];2004~2010年HIV感染孕产妇所生婴儿人工喂养率除2005年为82.65%[95%CI（69.07%,91.04%）]以外,其余年份均达90.00%以上。结论近年来我国HIV感染孕产妇继续妊娠率总体上升;剖宫产率较高,波动较大且仍在上升;HIV感染孕产妇所生婴儿人工喂养率稳定在较高水平。

中国2004—2010艾滋病母婴传播率及母婴阻断药物应用状况的系统评价

目的了解我国2004—2010年艾滋病母婴传播及母婴阻断药物应用状况。方法全面检索中国生物医学文献数据库（CBM）和PubMed等中英文数据库中中国艾滋病母婴传播相关文献,检索时间均从建库到2013年5月。对纳入的文献采用参照AHRQ横断面研究评价标准和STROBE声明拟定的4条标准进行质量评价。将样本量、监测地点和监测年份作为主要异质性来源进行meta回归分析。采用Comprehensive Meta-Analysis V2.0software进行meta分析。结果共检索到2 356篇文献,最终纳入51篇进行分析。2004—2010年我国艾滋病母婴传播率依次分别为12.90%（95%CI：7.48%-21.36%）、16.35%（95%CI：10.41%-24.73%）、6.45%（95%CI：3.73%-10.93%）、6.25%（95%CI：2.39%-15.36%）、5.56%（95%CI：2.79%-10.76%）、3.10%（95%CI：1.59%-5.97%）、2.29%（95%CI：1.36%-3.83%）,孕产妇中阻断药物应用率依次分别为70.39%（95%CI：24.42%-94.59%）、71.99%（95%CI：61.49%-80.54%）、78.79%（95%CI：70.19%-85.43%）、86.84%（95%CI：79.24%-91.94%）、82.71%（95%CI：76.62%-87.48%）、81.85%（95%CI：75.55%-86.80%）、86.16%（95%CI：53.20%-97.15%）;2005—2010年婴儿阻断药物应用率依次分别为80.72%（95%CI：72.89%-86.70%）、81.84%（95%CI：71.55%-88.98%）、85.43%（95%CI：80.99%-88.97%）、89.75%（95%CI：81.82%-94.45%）、92.39%（95%CI：84.97%-96.31%）、90.34%（95%CI：85.50%-93.68%）。结论近年来我国艾滋病母婴传播率呈下降趋势,孕产妇及婴儿阻断药物应用率都有所升高。

Repeat HIV Testing and Incident Rates among Individuals Attending Voluntary Counseling and Testing Clinics in Wuxi, China： A Retrospective Study

Objective We aimed to elucidate the rates of repeat HIV testing and incident HIV diagnosis, and baseline CD4^＋ T cell count among individuals attending HIV voluntary counseling and testing （VCT） clinics in Wuxi, China. Methods A repeat HIV testing within 12 months was recorded if individuals had their first test with negative results, during 2013-2014 and retested within 12 months. An incident HIV diagnosis was recorded if individuals had their first test with negative results, during 2013-2015 and had a subsequent positive result at any point by the end of 2015. Data on HIV testing and diagnosis among individuals attending 32 VCT clinics from 2013 to 2015 and HIV diagnosis from other clinical services in Wuxi, China, were retrieved. A multivariate logistic regression model was used to analyze factors associated with repeat HIV testing. Cox regression was used to evaluate factors associated with incident HIV diagnosis. Results From 2013 to 2014, 11,504 individuals tested HIV negative at their first recorded test, with 655 （5.7%） retesting within 12 months. Higher repeat HIV testing within 12 months was associated with male gender [adjusted odds ratio （a OR） = 1.7, 95% confidence interval （CI）： 1.4-2.2], risk behaviors [commercial heterosexual behaviors （a OR = 1.4, CI： 1.1-1.6）, male-male sexual behaviors （a OR = 3.7, CI： 2.7-4.9）], injection drug use （a OR = 9.9, CI： 6.5-15.1）, and having taken HIV tests previously （a OR = 2.0, CI： 1.6-2.4）. From 2013 to 2015, 1,088 individuals tested negative on HIV test at their visit and at ≥ 2 subsequent tests; of them 30 had incident HIV diagnosis. The overall rate of incident HIV diagnosis among all VCT individuals was 1.6 （95% CI： 1.1-2.1） per 100 person-years. Incident HIV diagnosis was associated with male gender [adjusted hazard ratio （a HR） = 8.5, 95% CI： 1.9-38.1], attending hospital-based VCT clinics （a HR = 7.8, 95% CI： 1.1-58.3）, and male-male sexual behavior （a HR = 8.4, 95% CI： 1.5-46.7）. Individuals diagnosed at VCT clinics had higher CD4＋ T cell count compared with those diagnosed at other clinical services （median 407 vs. 326 copies/mm3, P = 0.003）. Conclusion VCT individuals in Wuxi, China, had a low repeat HIV testing rate and high HIV incidence. VCT-clinic-based interventions aimed at increasing repeat HIV testing are needed to detect more cases at an earlier stage, especially among individuals at high risk for HIV infection such as men who have sex with men.

Early infant male circumcision:Systematic review,risk-benefit analysis,and progress in policy

AIM To determine whether recent evidence-based United States polices on male circumcision(MC) apply to comparable Anglophone countries,Australia and New Zealand.METHODS Articles in 2005 through 2015 were retrieved from PubM ed using the keyword "circumcision" together with 36 relevant subtopics.A further PubM ed search was performed for articles published in 2016.Searches of the EMBASE and Cochrane databases did not yield additional citable articles.Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further.The most relevant andrepresentative of the topic were included.Bibliographies were examined to retrieve further key references.Randomized controlled trials,recent high quality systematic reviews or meta-analyses(level 1++ or 1+ evidence) were prioritized for inclusion.A risk-benefit analysis of articles rated for quality was performed.For efficiency and reliability,recent randomized controlled trials,metaanalyses,high quality systematic reviews and large welldesigned studies were used if available.Internet searches were conducted for other relevant information,including policies and Australian data on claims under Medicare for MC.RESULTS Evidence-based policy statements by the American Academy of Pediatrics(AAP) and the Centers for Disease Control and Prevention(CDC) support infant and later age male circumcision(MC) as a desirable public health measure.Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria.Together,these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects,phimosis that causes difficult and painful erections and "ballooning" during urination,inflammatory skin conditions,inferior penile hygiene,candidiasis,various sexually transmissible infections in both sexes,genital ulcers,and penile,prostate and cervical cancer.Our risk-benefit analysis showed that benefits exceeded procedural risks,which are predominantly minor,by up to 200 to 1.We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime.Wide-ranging evidence from surveys,physiological measurements,and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function,sensitivity or pleasure.United States studies showed that early infant MC is cost saving.The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews.CONCLUSION Affirmative MC policies are needed in Australia and New Zealand.Routine provision of accurate,unbiased education,and access in public hospitals,will maximize health and financial benefits.

Clinical impact of hepatitis B and C virus envelope glycoproteins

Chronic infection by either hepatitis B virus(HBV)or hepatitis C virus(HCV)share epidemiological characteristics with risks for development of severe complications such as liver cirrhosis and hepatocellular carcinoma.HBV and HCV also share a high genetic variability. Among highly variable regions,viral genes encoding surface proteins(hepatitis B surface antigen,E1/E2 HCV glycoproteins)play key roles in the stimulation of the host-related immune response and viral entry into hepatocytes.Specific segments of HBV envelope proteins(preS1,"a"determinant)are crucial in the entry process into permissive cells.HCV entry is a complex multistep process involving multiple cell cofactors (glycosaminoglycans,low density lipoprotein receptor, SR-B1,CD81,claudin-1,occludin,EGFR,EphA2)in the interaction with HCV E1/E2 envelope glycoproteins.In vitro both viruses can be controlled by antibody-me-diated neutralization targeting viral envelope,also essential in preventing HBV infection in vivo as observed through successful vaccination using HBs antigen.But preventive vaccination and/or therapeutic pressure can influence HBV and HCV variability.For HBV,the patterns of antiviral drug resistance in chronic hepatitis are complex and the original pol/S gene overlap has to be taken into account.Treatment-induced HBV mutations in pol could indeed generate S mutants with subsequent modified antigenicity or increased cancer induction.Variability of HBV and HCV envelope proteins combining high exposure to selective pressures and crucial functional roles require investigation in the context of diagnostic,vaccination and treatment tools.In this editorial a synthesis is performed of HBV and HCV envelope properties at the entry step and as antigenic proteins,and the subsequent clinical impact.

Post-transcriptional gene silencing, transcriptional gene silencing and human immunodeficiency virus

While human immunodeficiency virus 1(HIV-1) infectionis controlled through continuous, life-long use of a combination of drugs targeting different steps of the virus cycle, HIV-1 is never completely eradicated from the body. Despite decades of research there is still no effective vaccine to prevent HIV-1 infection. Therefore, the possibility of an RNA interference(RNAi)-based cure has become an increasingly explored approach. Endogenous gene expression is controlled at both, transcriptional and post-transcriptional levels by noncoding RNAs, which act through diverse molecular mechanisms including RNAi. RNAi has the potential to control the turning on/off of specific genes through transcriptional gene silencing(TGS), as well as finetuning their expression through post-transcriptional gene silencing(PTGS). In this review we will describe in detail the canonical RNAi pathways for PTGS and TGS, the relationship of TGS with other silencing mechanisms and will discuss a variety of approaches developed to suppress HIV-1 via manipulation of RNAi. We will briefly compare RNAi strategies against other approaches developed to target the virus, highlighting their potential to overcome the major obstacle to finding a cure, which is the specific targeting of the HIV-1 reservoir within latently infected cells.

Protocol for a Respondent-Driven Sampling Study Exploring the Roles of Peer Norms in HIV-Related Practices of Gay Men

Introduction: Sexual behaviour among gay and other men who have sex with men (GMSM) is influenced by the shared understanding of HIV/STI risk and peer norms regarding sexual behaviour. However, there is little research evidence to support this relationship. The unique geographic spread of Australian communities, the history of Australian HIV epidemic and the different patterns in risky sexual practices and HIV diagnoses across Australia present an opportunity to explore the role of social norms and GMSM behaviours in shaping different patterns of HIV epidemics. We describe the protocol of the study of contemporary norms in networks and communities of GMSM (CONNECT) which investigates gay community behavioural norms and practices. Methods: CONNECT is aimed to 1) identify the patterns of connections between individuals in GMSM communities and assess how they shape HIV-related behaviours;2) describe the relationship between social norms and sexual practices;and 3) compare the norms and patterns of behaviour in geographically and epidemiologically distinct GMSM populations in three Australian states New South Wales, Victoria and Western Australia, in order to identify local community norms and barriers to effective HIV prevention. This quantitative cross-sectional study uses respondent-driven sampling (RDS) for recruitment. Results: Analyses will be carried out on individual and community level and will investigate the relationship between community-level behavioural norms and associated practices of individuals. Conclusion: CONNECT is anticipated to inform HIV prevention services to better target and increase the effectiveness of the current health promotion for GMSM in the context of increasing HIV/STI incidence.

Effectiveness of ivermectin mass drug administration in the control of soil-transmitted helminth infections in endemic populations: a systematic review and meta-analysis

Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides sterc-oralis and Trichuris trichiura presents significant limitations.Emerging evidence indicates that community-wide PC[or mass drug administration(MDA)]using ivermectin,commonly used in other neglected tropical disease(NTD)control programs,may play an important role in controlling these parasites.We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations.Methods We searched Pubmed,EMBASE,and Web of Science on February 14,2023,for studies that investigated the effectiveness of ivermectin PC,either alone or in combination with other anthelmintic drugs,on STH infec-tions,and provided a measure of STH prevalence before and after PC.We calculated pooled prevalence reductions for each STH using random-effects meta-analyses.Our protocol is available on PROSPERO(registration number CRD42023401219).Results A total of 21 were eligible for the systematic review,of which 15 were eligible for meta-analysis.All studies delivered ivermectin through MDA.The pooled prevalence reduction of S.stercoralis following MDA with ivermec-tin alone was 84.49%(95%CI:54.96-94.66)across five studies and 81.37%(95% CI:61.62-90.96)across seven studies with or without albendazole.The prevalence reduction of T.trichiura was 49.93%(95%CI:18.23-69.34)across five studies with ivermectin alone,and 89.40%(95%CI:73.66-95.73)across three studies with the addition of albendazole.There was high heterogeneity for all syntheses(I^(2)>65%).Conclusions This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S.stercoralis and T.trichiura.Based on these findings,revising inter-national STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination ofSTHsandotherNTDs.

Anal cancer screening in women with a history of human papillomavirusrelated lower genital tract cancers:a pilot study

Objectives Women diagnosed with a history of lower genital tract cancer(LGTC)and precancer are at increased risk of anal cancer.Screening for anal cancer in a manner analogous to cervical cancer may detect precursor anal high-grade squamous intraepithelial lesions(HSILs)and prevent progression to cancer.Methods In a pilot study of anal cancer screening,women with previous LGTC and aged≥18 years in Sydney,Australia underwent a digital anorectal examination,anal swab for human papillomavirus(HPV)and p16/Ki67 testing and completeda questionnaire.Participants with positive HPV and/or p16/Ki67 results were referred for a high-resolution anoscopy(HRA)and evaluation of their HSILs.Results Of 52 participants,46 agreed to screening and 6 provided demographic information only.Median age was 46.5 years(IQR:36.059.0).Anal high-risk HPV(HRHPV)was detected in only seven(15.2%)participants(three HPV16).Eight(17.4%)had positive p16/Ki67 dual staining,with invalid results for 25(54.4%).0f 10 women referred for HRA,9 attended and 3 had HSILs,representing 6.5%of the screened population.Questionnaires were completed by 41 participants(89.1%).The majority reported that being screenedwas reassuring(97.5%)and was positive for their health(95.1%).Conclusion This pilot study demonstrated a lower-than-expected prevalence of anal HRHPV.Screening with HRHPV and p16/Ki67 staining identified anal HSILs in 6.5%of screenedwomen.Despitesomediscomfort,screeningwas viewed as beneficial by almost all participants.The utility of p16/Ki67dual staining was low,suggesting it may not be a suitable anal cancer screening methodology.

Sexual Risk Behavior and Satisfaction Among Men Who Have Sex With Men Living With Detectable HIV Viral Loads:A Nationwide Online Survey in China

Little is known about sexual behavior and satisfaction among men who have sex with men(MSM)with detectable HIV viral loads(VL)in China.This study aims to investigate sexual risk behavior and sexual satisfaction among MSM living with HIV in China,as well as poten-tial predictors.This cross-sectional study was conducted in February 2021 using an anonymous online survey based on WeChat.Data were collected on sociodemographics,sexual behavior,HIV clinical information,sexual satisfaction and mental health.Descriptive sta-tistics,logistic regression and multivariable logistic regression were performed.MSM with detectable HIV VL(VL+)or VL not sure were more likely to report inconsistent condom use,even with HIV-negative/unknown-status regular male partners.Having an HIV-positive regular partner and recreational drug use were positively associated with inconsistent condom use during anal sex among MSM with undetectable VL(VL-).Alcohol use before or during sexual activities was positively associated with inconsistent condom use during anal sex among VL+or VL not sure MSM.A total of 58.3%of participants reported being sexually satisfied.MSM living with HIV who were currently employed,had experienced anal sex in the prior 6 months,had VL-HIV status,or had more frequent ejaculation during sex/masturbation were more likely to report sexual satisfaction.The development of targeted education and interventions to minimize sexual risk behavior among MSM living with HIV is in dire need.Treating sexual dysfunction and developing a reasonable antiretroviral therapy regimen to achieve viral suppression can help promote sexual satisfaction in MSM living with HIV.

Correlates of Sexual Lifestyles Among Older Adults Living With HIV in China: Findings From the Sexual Well-being (SWELL) Study

Sexual lifestyles are closely related to overall human health and well-being.Few studies have focused on sexual lifestyles among older adults living with HIV(OALHIV),especially in low-and middle-income countries.This study is a part of the sexual well-being among older adults in China(SWELL)study,which is a multicenter cross-sectional study focused on sexual health among older adults aged 50 years and older.Participants were 680 OALHIV(≥50 years old)from the SWELL study conducted from June 2020 to December 2022.Data were collected through one-on-one interviews.We used logistic regression to assess the correlates of sexual activity and sexual satis-faction.Among all participants,37.1%were sexually active.Being older,male,in a steady relationship and employed were associated with being sexually active.The prevalence of sexual satisfaction was 69.8%among sexually active OALHIV.Being homosexual and reporting a better general health status were associated with sexual satisfaction.The OALHIV who have depressive symptoms were less likely to report sexual satisfaction.To support holistic healthy aging among OALHIV,it is important for healthcare providers to be educated about the importance of enquiring about sexual activity,satisfaction and problems and addressing concerns while conveying sex-positive attitudes during clinical reviews,as these are still critical aspects of their health and well-being.

Immediate and long-term outcomes after treat-all among people living with HIV in China:an interrupted time series analysis

Background In 2003,China implemented free antiretroviral therapy(ART)for people living with HIV(PLHIV),establishing an eligibility threshold of CD4<200 cells/μl.Subsequently,the entry criteria were revised in 2012(eligibility threshold:CD4≤350 cells/μl),2014(CD4≤500 cells/μl),and 2016(treat-all).However,the impact of treat-all policy on HIV care and treatment indicators in China is unknown.We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China.Methods Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019,from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China.We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators:monthly proportion of 30-day ART initiation,mean CD4 counts(cells/μl)at ART initiation,and mean estimated time from infection to diagnosis(year).We built separate models according to gender,age,route of transmission and region.Results Monthly data on ART initiation and collection were available for 75,516 individuals[gender:83.8%males;age:median 39 years,interquartile range(IQR):28-53;region:18.5%Northern China,10.9%Northeastern China,17.5%Southern China,49.2%Southwestern China].In the first month of treat-all,compared with the contemporaneous counterfactual,there was a significant increase in proportion of 30-day ART initiation[+12.6%,incidence rate ratio(IRR)=1.126,95%CI:1.033-1.229;P=0.007]and mean estimated time from infection to diagnosis(+7.0%,IRR=1.070,95%CI:1.021-1.120;P=0.004),while there was no significant change in mean CD4 at ART initiation(IRR=0.990,95%CI:0.956-1.026;P=0.585).By December 2019,the three outcomes were not significantly different from expected levels.In the stratified analysis,compared with the contemporaneous counterfactual,mean CD4 at ART initiation showed significant increases in Northern China(+3.3%,IRR=1.033,95%CI:1.001-1.065;P=0.041)and Northeastern China(+8.0%,IRR=1.080,95%CI:1.003-1.164;P=0.042)in the first month of treat-all;mean estimated time from infection to diagnosis showed significant increases in male(+5.6%,IRR=1.056,95%CI:1.010-1.104;P=0.016),female(+14.8%,IRR=1.148,95%CI:1.062-1.240;P<0.001),aged 26-35(+5.3%,IRR=1.053,95%CI:1.001-1.109;P=0.048)and>50(+7.8%,IRR=1.078,95%CI:1.000-1.161;P=0.046),heterosexual transmission(+12.4%,IRR=1.124,95%CI:1.042-1.213;P=0.002)and Southwestern China(+12.9%,IRR=1.129,95%CI:1.055-1.208;P<0.001)in the first month of treat-all.Conclusions The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes.To advance the work of rapid ART,efforts should be made to streamline the testing and ART initiation process,provide comprehensive support services,and address the issue of uneven distribution of medical resources.

Burdens Attributable to Intimate Partner Violence in Women Aged 15 Years or Older—China,1990–2019

Summary What is already known about this topic?Intimate partner violence(IPV)represents a significant global public health concern.What is added by this report?The burden of HIV/AIDS related to IPV demonstrated an upward trend from 1990 to 2019,exhibiting an annual growth of 4.66%in age-standardized death rates(ASDR)and 4.42%in age-standardized disabilityadjusted life years(DALYs)rates.Notably,the age groups 30–34 and 50–54 experienced a higher IPV burden compared to other age groups.What are the implications for public health practice?There is a pressing need for public health policymakers to develop efficacious interventions aimed at bolstering the surveillance and prevention of IPV targeted at women in China.

Improving estimates of waning immunity rates in stochastic SIRS models with a hierarchical framework

As most disease causing pathogens require transmission from an infectious individual to a susceptible individual,continued persistence of the pathogen within the population requires the replenishment of susceptibles through births,immigration,or waning immunity.Consider the introduction of an unknown infectious disease into a fully susceptible population where it is not known how long immunity is conferred once an individual recovers from infection.If,initially,the prevalence of disease increases(that is,the infection takes off),the number of infectives will usually decrease to a low level after the first major outbreak.During this post-outbreak period,the disease dynamics may be influenced by stochastic effects and there is a non-zero probability that the epidemic will die out.Die out in this period following the first major outbreak is known as an epidemic fade-out.If the disease does not die out,the susceptible population may be replenished by the waning of immunity,and a second wave may start.In this study,we investigate if the rate of waning immunity(and other epidemiological parameters)can be reliably estimated from multiple outbreak data,in which some outbreaks display epidemic fade-out and others do not.We generated synthetic outbreak data from independent simulations of stochastic SIRS models in multiple communities.Some outbreaks faded-out and some did not.We conducted Bayesian parameter estimation under two alternative approaches:independently on each outbreak and under a hierarchical framework.When conducting independent estimation,the waning immunity rate was poorly estimated and biased towards zero when an epidemic fade-out was observed.However,under a hierarchical approach,we obtained more accurate and precise posterior estimates for the rate of waning immunity and other epidemiological parameters.The greatest improvement in estimates was obtained for those communities in which epidemic fade-out was observed.

澳大利亚人乳头状瘤病毒疫苗计划实施5年对年轻人群生殖器疣患病情况的影响：国家调查数据分析

目的评估2007年中开始的澳大利亚人乳头状瘤病毒（HPV）疫苗计划对生殖器疣患病情况的影响。设计国家调查数据趋势分析。数据来源数据收集于2004--2011年度澳大利亚8所性健康服务机构；其中2所最大的临床中心收集了自我报告的本中心2009年度HPV疫苗现状。研究对象2004--2011年度首次就诊的85770名澳大利亚出生的国民；其中7686（9．0％）名患生殖器疣。主要结局测量比较前疫苗时期（2004—2007年中）和疫苗时期（2007年中-2001年末）不同人群生殖器疣新发病率变化趋势。结果疫苗时期21岁以下和21～30岁女性诊断患有生殖器疣的比例明显下降，发病率分别从2007年度的11．5％和11．3％下降至2011年度的0．85％和3．1％，P均〈0．001。在30岁以上的女性中未发现发病率的明显下降。在21岁以下和21～30岁异性恋男性人群中疫苗时期生殖器疣的发病率较前疫苗时期明显下降，分别由2007年度12．1％和18．2％下降至2011年度2．2％和8．9％，P均〈0．001。30岁以上的异性恋男性人群中发病率无明显下降。2011年235名21岁以下女性在使用HPV疫苗后无新发生殖器疣病例。结论年轻女性生殖器疣发病率的显著下降和2011年度部分年轻女性使用疫苗后的零发病率，说明HPV疫苗获得实验室外的良好功效。异性恋男性生殖器疣发病率的显著下降可能是由于群体免疫所致。

High HIV incidence epidemic among men who have sex with men in china: results from a multi-site cross-sectional study

Background:Recent upsurge of new HIV infections among men who have sex with men(MSM)is a major concern in China.Paucity of national-level information regarding the burden and predictors of this progressive epidemic of new infections called for a multi-centric,timely and comprehensive investigation.Methods:Mixed methods were used to recruit MSM from seven cities in China between 2012 and 2013.Recent and established HIV infections were estimated by Western Blot and BED HIV-1 capture enzyme immunoassay.Syphilis and herpes simplex virus-2(HSV-2)were also tested.Results:A total of 4496 eligible MSM were recruited.The majority was aged≤35 years(77.5%),migrants(60.3%),never married(69.8%),and played receptive role in anal sex(70.5%).The HIV prevalence was 9.9%,and 41.9%were recently infected,with sensitivity/specificity adjusted HIV incidence of 8.9(95%CI:7.6-10.2)/100 Person-Years.The prevalence of history HSV-2 and syphilis were 12.5%and 8.5%,respectively.Recent HIV infection was associated with having multiple male partners(aOR=1.4,95%CI 1.1-1.9),recreational drug use(aOR=2.2,95%CI 1.6-3.0),anal bleeding(aOR=2.1,95%CI 1.4-3.0),syphilis infection(aOR=2.8,95%CI 1.9-4.3)and history HSV-2 infection(aOR=2.3,95%CI 1.5-3.3).Conclusion:High rate of recent HIV infection is potentially resulting in progressive deterioration of the overall HIV epidemic among MSM in China.Targeted interventions to address high-risk MSM including those having multiple partners,history of recreational drug use and syphilis or HSV-2 infection seemed to be the need of the hour.

四联与三联抗逆转录病毒疗法作为HIV感染者一线治疗效果比较:一项随机对照试验的系统综述和meta分析

目的比较四药联用(四联)和三药联用(三联)的抗逆转录病毒疗法作为HIV感染者一线治疗的疗效和安全性,并探讨现有的临床试验对临床实践及未来研究的启示。研究设计随机对照试验的系统综述和meta分析。数据来源系统检索了PubMed、EMBASE、CENTRAL、Web of Science及Allied Health Literature数据库2001年3月至2016年12月期间发表的研究(其中PubMed和EMBASE的检索更新至2018年6月),以及合格研究和相关综述的参考文献。入选标准比较四联与三联抗逆转录病毒疗法作为HIV感染者一线治疗的作用,并评价了至少一种疗效或安全性结局的随机对照试验。分析方法对检测不到的HIV-1 RNA、CD4 T细胞计数、病毒学失败、新发艾滋病事件、死亡和严重不良反应等结局的资料采用随机效应模型进行meta分析。结果共找到12项合格研究,包括4251例HIV感染者。四联和三联抗逆转录病毒疗法对各个疗效和安全性结局的影响均类似,且没有一个总体效应估计值的点值落在支持四联疗法的一侧。与三联疗法相比,四联疗法组出现不同结局的相对危险度及其95%可信区间如下:检测不到的HIV-1 RNA,0.99(0.93~1.05);病毒学失败,1.00(0.90~1.11);新发艾滋病事件,1.17(0.84~1.63);死亡,1.23(0.74~2.05);严重不良反应,1.09(0.89~1.33)。两组CD4 T细胞计数增加的平均差值为-19.55个细胞/μl(-43.02~3.92)。无论联合抗逆转录病毒疗法的具体方案如何,上述2组比较的结果大体不变,且在所有亚组和敏感性分析中均变化不大。结论在HIV感染者的一线治疗中,四联抗逆转录病毒疗法的效果并不优于三联疗法。这一发现为当前推荐三联疗法作为一线治疗的指南提供了支持。除非对现有证据的系统综述显示确有必要,否则不应该再开展新的临床试验去比较四联与三联疗法。当然,本系统综述并不排除当有新的抗逆转录病毒药物种类出现时包含该类药物的四联疗法比三联疗法更好的可能性。

Filtration efficiency of face masks against aerosolized surrogate SARS-CoV-2 at different social distances

The coronavirus disease 2019(COVID-19)pandemic is an unpreedented global event.It has become clear that COVID-19 is transmitted by virus-containing droplets(>5μm)and aerosols(<5μm),and that all human exhalatory activities(e.g.,breathing,speaking,singing,shouting,coughing,and sneezing)result in the emission of suspended droplets/aerosols of various sizes.As an example,COVID-19 patients exhale millions of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA copies into the air per hour[1].SARS-CoV-2-laden aerosols play a profound role in disease transmission,as they can linger and remain viable in the air for a long duration(~16 h)[2]and travel a long distance(~4.8 m)due to their smaller size[3].

Strategic options for syphilis control in Papua New Guineae impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model

Objectives:Papua New Guinea(PNG)has among the highest rates of sexually transmitted infections(STIs)globally and is committed to reducing their incidence.The Syphilis Interventions Towards Elimination(SITE)model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios.Methods:SITE is a dynamical model of syphilis transmission among adults 15-49 years.Individuals are divided into nine groups based on sexual behaviour and into six stages of infection.The model was calibrated to PNG using data from routine surveillance,biobehavioural surveys,research studies and program records.Inputs included syphilis prevalence,risk behaviours,intervention coverage and service delivery unit costs.Scenarios compared different interventions(clinical treatment,contact tracing,syphilis screening,and condom promotion)for incidence and cost per infection averted over 2021-2030.Results:Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35%in 2020 to 60%from 2023 onwards reduced estimated incidence over 2021-2030 by 55%,compared to a scenario assuming constant coverage at 2019-2020 levels.The introduction of contact tracing in 2020,assuming 0.4 contacts per symptomatic person treated,reduced incidence over 2021-2030 by 10%.Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3e16%depending on the target population.Scaling-up clinical,symptom-driven treatment and contact tracing had the lowest cost per infection averted,followed by condom promotion and periodic screening of female sex workers and men who have sex with men.Conclusions:PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions.SITE is a useful tool countries can apply to inform national STI programming and resource allocation.

Independent and Interactive Effects of Environmental Conditions on Aerosolized Surrogate SARS-CoV-2-Beijing,China,June to September 2020

Summary What is already known about this topic?Environmental factors such as temperature and humidity play important roles in the transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)via droplets/aerosols.What is added by this report?Higher relative humidity(61%–80%),longer spreading time(120 min),and greater dispersal distance(1 m)significantly reduced SARS-CoV-2 pseudovirus loads.There was an interaction effect between relative humidity and spreading time.What are the implications for public health practice?The findings contribute to our understanding of the impact of environmental factors on the transmission of SARS-CoV-2 via airborne droplets/aerosols.