Duan Song, Yang Yue-cheng, Han Jing, Yang Shun-sheng, Yang Ying-bo, Long Yu-cun, Li Guo-qiang, Yin Jin-song, Xiang Li-fen, Ye Run-hua, Gao Jie, Tang Ren-hai, Pang Lin, Rou Ke-ming, Wu Zun-you, He Na
Dehong Center for Disease Control and Prevention, Mangshi, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2011 Dec;32(12):1227-31.
To determine the incidence and risk factors of HIV infection among heroin addicts receiving methadone maintenance treatment (MMT) in Dehong prefecture, Yunnan province.
All heroin addicts who were HIV negative at the initiation of MMT in June 2005 and through June 2011, in Dehong prefecture were included in the cohort analysis. HIV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.
A total of 3154 MMT clinic attendants were qualified for this cohort study. By June 2011, 1023 (32.4%) of them had never received any follow-up HIV testing so were thus referred as loss to follow-up. The other 2131 (67.6%) members had received at least one follow-up HIV testing and were observed for a total of 4615.86 person-years. During the period, 22 new HIV infections or seroconverters were identified, making the overall HIV incidence as 0.48/100 person-years. The HIV incidence was higher among those who were unemployed, never married, self-reported being injecting drug users (IDUs) and HCV positive at entry into the MMT program. None of those who were always negative on follow-up-urine-testing of morphine was discovered as HIV newly infected during the follow-up period. Data from multiple regression analysis under Cox proportional hazard model indicated that after controlling for confounding variables, non-IDUs at the entry point for the MMT program, were less likely to be HIV newly-infected or seroconverted than IDUs (HR = 0.29, 95%CI: 0.11 - 0.76).
MMT program in Dehong prefecture was demonstrated to be fairly effective in reducing HIV transmission through drug use. Those HIV negative attendants at the MMT clinic who were IDUs or keep using drugs during the treatment, were at higher risk of HIV seroconvertion. More efforts were needed to improve the follow-up and HIV testing programs for the MMT clinic attendants.
确定云南省德宏州接受美沙酮维持治疗（MMT）的海洛因成瘾者中HIV感染的发生率及危险因素。
纳入2005年6月至2011年6月在德宏州开始接受MMT时HIV阴性的所有海洛因成瘾者进行队列分析。计算HIV发病率，并使用Cox比例风险回归模型确定相关危险因素。
共有3154名MMT门诊患者符合该队列研究条件。到2011年6月，其中1023人（32.4%）从未接受过任何后续HIV检测，因此被视为失访。其他2131名（67.6%）成员至少接受过一次后续HIV检测，共观察了4615.86人年。在此期间，发现22例新的HIV感染或血清学转换者，使总体HIV发病率为0.48/100人年。在进入MMT项目时，失业、未婚、自我报告为注射吸毒者（IDU）和HCV阳性者的HIV发病率较高。在随访期吗啡尿液检测始终为阴性的人中，随访期间未发现有新感染HIV者。Cox比例风险模型下的多元回归分析数据表明，在控制混杂变量后，MMT项目入组时的非IDU比IDU新感染HIV或发生血清学转换的可能性更小（HR = 0.29，95%CI：0.11 - 0.76）。
德宏州的MMT项目在减少通过吸毒传播HIV方面显示出相当有效。MMT门诊中HIV阴性的IDU或在治疗期间继续吸毒者，HIV血清学转换风险较高。需要做出更多努力来改善MMT门诊患者的随访和HIV检测项目。
