对自愿咨询检测中心的中国男男性行为者中的急性 HIV 感染进行筛查。
Screening acute HIV infections among Chinese men who have sex with men from voluntary counseling & testing centers.
机构信息
Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No.1 Hospital of China Medical University, Shenyang, Liaoning, China.
出版信息
PLoS One. 2011;6(12):e28792. doi: 10.1371/journal.pone.0028792. Epub 2011 Dec 14.
BACKGROUND
Recent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking.
METHODOLOGY/PRINCIPAL FINDINGS: An open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5-7.9) and 7.1 (95% CI: 5.4-9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of $3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9.
CONCLUSIONS/SIGNIFICANCE: The HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run.
背景
最近的研究表明，识别中国男男性行为者（MSM）中的急性 HIV 感染（AHI）具有重要的公共卫生意义，因为他们的 HIV 传播风险更高。然而，缺乏针对 AHI 筛查的成本效益分析来指导政策制定。
方法/主要发现：在中国东北辽宁省招募了一个 MSM 开放性前瞻性队列。每 10 周采集一次血样和流行病学信息。第三代 ELISA 和快速检测用于 HIV 抗体筛查，WB 用于检测验证。抗体阴性标本用 24 个 mini-pool 核酸扩增检测（NAAT）进行检测。对于 ELISA 阴性但 WB 结果不确定或阳性的标本，单独进行 NAAT 检测，不进行混合检测。对 NAAT 筛查进行成本效益分析。在 22 个月的 1765 名 MSM 的 5344 次随访中，HIV 抗体检测发现 114 例慢性 HIV 感染、24 例血清转换者和 21 例抗体不确定病例。从 21 例抗体不确定和 1606 例抗体阴性病例中，用 NAAT 检测出 29 例急性 HIV 感染。HIV-1 流行率和发病率密度分别为 6.6%（95%CI：5.5-7.9）和 7.1%（95%CI：5.4-9.2）/100 人年。采用 pooled NAAT 和 individual NAAT 策略，每避免一例 HIV 传播，成本为 1480 美元。在 HIV 抗体检测后增加 NAAT 的成本效益比为每获得 1 个质量调整生命年（QALY）增加 3366 美元。NAAT 的投入产出比约为 1∶16.9。
结论/意义：MSM 中的 HIV 感染率仍在以惊人的速度上升。尽管成本不断上升，但将 pooled NAAT 添加到 HIV 抗体筛查中，显著提高了 MSM 中急性 HIV 感染的检出率。从长远来看，加强早期治疗和有针对性的宣传和教育计划，可以降低 HIV 传播的风险并节省医疗资源。
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