澳大利亚HIV观察数据库中HIV阳性患者新发性传播感染的相关危险因素：一项前瞻性队列研究。

Risk factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study.

作者信息

Mulhall B P, Wright S T, De La Mata N, Allen D, Brown K, Dickson B, Grotowski M, Jackson E, Petoumenos K, Foster R, Read T, Russell D, Smith D J, Templeton D J, Fairley C K, Law M G

机构信息

The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

University of Sydney, Camperdown, NSW, Australia.

出版信息

HIV Med. 2016 Sep;17(8):623-30. doi: 10.1111/hiv.12371. Epub 2016 Mar 28.

DOI:10.1111/hiv.12371

PMID:27019207

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4987183/

Abstract

OBJECTIVES

We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI).

METHODS

The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis.

RESULTS

There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval (CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio (aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection (aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure (aHR 0.2; 95% CI 0.1-0.6; P < 0.001).

CONCLUSIONS

In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.

摘要

目的

我们从澳大利亚HIV观察数据库（AHOD）中的10家性健康诊所建立了一个HIV阳性个体亚组。本研究的目的是评估可能与新发性传播感染（STI）相关的人口统计学和其他因素。

方法

队列随访时间为2010年3月至2013年3月，纳入至少接受过一次STI筛查的患者。我们采用生存分析方法确定首次新发并确诊的STI感染（衣原体、淋病、梅毒或尖锐湿疣）的时间。评估的因素包括性别、年龄、HIV暴露方式、AHOD入组年份、乙肝或丙肝合并感染、随时间变化的CD4细胞计数、随时间变化的HIV RNA病毒载量以及既往STI诊断情况。

结果

在1015人年的随访中观察到110例首次新发STI诊断，粗发病率为每100人年10.8例[95%置信区间（CI）9.0 - 13.0]。与新发STI风险增加独立相关的因素包括年龄较小[≥50岁与30 - 39岁相比，调整后风险比（aHR）0.4；95%CI 0.2 - 0.8；P < 0.0001]；既往STI感染（aHR 2.5；95%CI 1.6 - 3.8；P < 0.001），以及异性传播与男男性行为（MSM）作为可能的暴露途径相比（aHR 0.2；95%CI 0.1 - 0.6；P < 0.001）。