从注射吸毒集中型向自我维持的异性恋 HIV 流行的转变：国际数据中的模式。
Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data.
机构信息
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
出版信息
PLoS One. 2012;7(3):e31227. doi: 10.1371/journal.pone.0031227. Epub 2012 Mar 1.
BACKGROUND
Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics.
METHODS
Fourteen countries that had experienced high seroprevalence (<20%) HIV epidemics among PWID and had reliable data for injection drug use (IDU) and heterosexual cases of HIV or AIDS were identified. Graphs of newly reported HIV or AIDS cases among PWID and heterosexuals were constructed to identify temporal relationships between the two types of epidemics. The year in which newly reported cases among heterosexuals surpassed newly reported cases among PWID, aspects of the epidemic curves, and epidemic case histories were analyzed to assess whether it was "plausible" or "highly unlikely" that the HIV epidemic among PWID might have initiated the heterosexual epidemic in each country.
RESULTS
Transitions have occurred in 11 of the 14 countries. Two types of temporal relationships between IDU and heterosexual HIV epidemics were identified, rapid high incidence transitions vs. delayed, low incidence transitions. In six countries it appears "plausible" that the IDU epidemic initiated a heterosexual epidemic, and in five countries it appears "highly unlikely" that the IDU epidemic initiated a heterosexual epidemic. A rapid decline in incidence among PWID after the peak year of new cases and national income were the best predictors of the "highly unlikely" initiation of a heterosexual epidemic.
DISCUSSION
Transitions from IDU concentrated epidemics to heterosexual epidemics are common in countries with high seroprevalence among PWID though there are distinct types of transitions. Interventions to immediately reduce HIV incidence among PWID may reduce the likelihood that an IDU epidemic may initiate a heterosexual epidemic.
背景
在世界许多地区，注射吸毒仍然是 HIV 流行的主要驱动因素。许多吸毒者（PWID）具有性活跃性，因此 PWID 中高血清阳性率的 HIV 流行可能会引发自我维持的异性传播流行。
方法
确定了 14 个经历过高血清阳性率（<20%）PWID HIV 流行且具有可靠的注射吸毒（IDU）和异性 HIV 或艾滋病病例数据的国家。构建了新报告的 PWID 和异性 HIV 或艾滋病病例的图表，以确定两种类型的流行之间的时间关系。分析了新报告的异性病例超过新报告的 PWID 病例的年份、流行曲线的各个方面以及流行病例史，以评估 PWID 中的 HIV 流行是否“有可能”或“极不可能”引发每个国家的异性流行。
结果
14 个国家中有 11 个发生了转变。确定了 IDU 和异性 HIV 流行之间的两种时间关系，即快速高发转变与延迟低发转变。在六个国家中，IDU 流行引发异性流行似乎“有可能”，而在五个国家中，IDU 流行引发异性流行似乎“极不可能”。PWID 新病例高峰年份后的发病率迅速下降以及国民收入是预测异性流行“极不可能”发生的最佳指标。
讨论
在 PWID 血清阳性率高的国家，从 IDU 集中流行向异性传播流行的转变很常见，但存在不同类型的转变。立即减少 PWID 中 HIV 发病率的干预措施可能会降低 IDU 流行引发异性传播流行的可能性。
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