基于人群的法国 HIV-1 发病率，2003-2008 年：建模分析。

Population-based HIV-1 incidence in France, 2003-08: a modelling analysis.

机构信息

Institut de Veille Sanitaire, Saint-Maurice, France.

出版信息

Lancet Infect Dis. 2010 Oct;10(10):682-7. doi: 10.1016/S1473-3099(10)70167-5. Epub 2010 Sep 9.

DOI:10.1016/S1473-3099(10)70167-5

PMID:20832367

Abstract

BACKGROUND

Routine national incidence testing with enzyme immunoassay for recent HIV-1 infections (EIA-RI) has been done in France since January, 2003. From the reported number of HIV infections diagnosed as recent, and accounting for testing patterns and under-reporting, we aimed to estimate the incidence of HIV infection in France in 2003-08.

METHODS

We analysed reports from the French National Institute for Public Health Surveillance for patients who were newly diagnosed with HIV between January, 2003, and December, 2008. Missing data were imputed with multiple imputation. Patients were classified with non-recent or recent infection on the basis of an EIA-RI test, which was calibrated with serial measurements from HIV seroconverters from the French ANRS-PRIMO cohort. We used an adapted stratified extrapolation approach to calculate the number of new HIV infections in men who have sex with men (MSM), injecting drug users (IDUs), and heterosexual men and women by nationality. Population sizes were obtained from the national census and national behavioural studies.

FINDINGS

After accounting for under-reporting, there were 6480 (95% CI 6190-6780) new diagnoses of HIV infection in France in 2008. We estimate that there were 6940 (6200-7690) new HIV infections in 2008, suggesting an HIV incidence of 17 per 100 000 person-years. In 2008, there were 3550 (3040-4050) new infections in heterosexuals (incidence of 9 per 100 000 person-years), 3320 (2830-3810) in MSM (incidence of 1006 per 100 000 person-years), and 70 (0-190) in IDUs (incidence of 86 per 100 000 person-years). Overall HIV incidence decreased between 2003 and 2008 (p<0·0001), but remained comparatively high and stable in MSM.

INTERPRETATION

In France, HIV transmission disproportionately affects certain risk groups and seems to be out of control in the MSM population. Incidence should be tracked to monitor transmission dynamics in the various population risk groups and to help to target and assess prevention strategies.

FUNDING

French National Institute for Public Health Surveillance (InVS) and French National Agency for Research on AIDS and Viral Hepatitis (ANRS).

摘要

背景

自 2003 年 1 月以来，法国一直在进行常规的全国 HIV-1 近期感染酶免疫测定（EIA-RI）检测。根据报告的近期诊断 HIV 感染人数，并考虑到检测模式和漏报情况，我们旨在估计 2003-08 年法国 HIV 感染的发病率。

方法

我们分析了法国国家公共卫生监测研究所报告的 2003 年 1 月至 2008 年 12 月期间新诊断为 HIV 的患者的数据。对于缺失的数据，我们使用多重插补法进行了插补。根据 EIA-RI 检测结果，患者被分为近期或非近期感染，EIA-RI 检测结果经过法国 ANRS-PRIMO 队列中 HIV 血清转换者的连续测量进行了校准。我们使用一种改良的分层外推方法，按国籍计算男男性行为者（MSM）、注射吸毒者（IDU）和异性恋男女的新 HIV 感染人数。人口规模从全国人口普查和全国行为研究中获得。

结果

在考虑到漏报后，2008 年法国有 6480 例（95%CI6190-6780）新诊断的 HIV 感染。我们估计 2008 年有 6940 例（6200-7690）新 HIV 感染，提示 HIV 发病率为每 100000 人年 17 例。2008 年，异性恋者中有 3550 例（3040-4050）新感染（发病率为每 100000 人年 9 例），MSM 中有 3320 例（2830-3810）（发病率为每 100000 人年 1006 例），IDU 中有 70 例（0-190）（发病率为每 100000 人年 86 例）。2003 年至 2008 年间，总体 HIV 发病率下降（p<0·0001），但 MSM 中的发病率仍然相对较高且稳定。