中国异性恋人群感染 HIV 的风险：系统评价和荟萃分析。
Heterosexual risk of HIV infection in China: systematic review and meta-analysis.
机构信息
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China.
出版信息
Chin Med J (Engl). 2011 Jun;124(12):1890-6.
BACKGROUND
Heterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples.
METHODS
A systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission.
RESULTS
Eleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95%CI 0.74 - 2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95%CI 0.09 - 2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95%CI 0.19 - 2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95%CI 0.00 - 4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95%CI 0.62 - 2.26) per 100 PY).
CONCLUSIONS
Transmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.
背景
异性性接触已成为中国的主要传播途径。最近的研究报告显示，资源有限国家异性传播风险存在高度异质性。本研究旨在总结中国血清不一致夫妇中 HIV 传播的风险。
方法
对中国血清不一致夫妇异性 HIV 传播的观察性研究进行了系统评价和荟萃分析。两位审查员使用中国国家知识基础设施（CNKI）、中国医学文献数据库（CMCC）和 Medline 数据库进行文献检索。使用随机效应模型计算每 100 人年（PY）的累积传播估计值。Meta 回归分析和按研究设计、传播方向和抗逆转录病毒治疗（ART）可及性时期进行的亚组分析用于评估与传播相关的因素。
结果
确定了 11 项符合条件的研究，共报告了 11984 对夫妇和 405 例 HIV 传播事件。HIV 阳性个体向异性伴侣传播的风险为每 100 PY 1.68（95%CI 0.74-2.62）。Meta 回归分析中研究设计未达到统计学意义。女性向男性传播的估计值为每 100 PY 1.11（95%CI 0.09-2.14），男性向女性传播的估计值为每 100 PY 1.43（95%CI 0.19-2.68）。中国国家免费抗逆转录病毒治疗计划实施前的估计值（每 100 PY 2.13（95%CI 0.00-4.63））高于实施后的估计值（每 100 PY 1.44（95%CI 0.62-2.26））。
结论
中国的传播估计值低于其他发展中国家，但高于发达国家。需要研究更好地定义中国异性血清不一致夫妇中 HIV 二次传播率以及相关行为、治疗依从性和与健康相关的风险因素。
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