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中国大陆男男性行为者中的艾滋病毒发病率及相关危险因素:一项更新的系统评价和荟萃分析。

HIV incidence and associated risk factors in men who have sex with men in Mainland China: an updated systematic review and meta-analysis.

作者信息

Zhang Wei, Xu Jun-Jie, Zou Huachun, Zhang Jing, Wang Ning, Shang Hong

出版信息

Sex Health. 2016 May 26. doi: 10.1071/SH16001.

Abstract

The national annually reported proportion of men who have sex with men (MSM) among people living with HIV (PLWH) is growing in China. To better inform the public health sector how to improve HIV prevention strategies, it is necessary to understand the current level of HIV incidence and its correlates. Google Scholar, PubMed, Web of Science and three major Chinese electronic publication databases (http://qikan.cqvip.com/, http://g.wanfangdata.com.cn/, http://www.cnki.net/, respectively) were searched for studies reporting HIV incidence. Comprehensive Meta-Analysis (CMA) 2.0 statistical software (Biostat, Inc. Englewood, NJ, USA) was used to calculate the pooled HIV incidence and perform subgroup-analysis to find correlates for HIV seroconversion in Chinese MSM. Random effects modelling was then conducted. Twenty-five eligible studies were included in this meta-analysis. The calculated pooled HIV incidence was 5.61/100 person years (PY), with an increasing trend over time (3.24/100PY, 5.29/100PY, 5.50/100PY in 2005-2008, 2009-2011, 2012-2014 respectively, χ2 test for trend P = 0.04). Subgroup analyses indicated that age <25 years (rate ratio (RR) = 1.85), junior college education and below (RR = 1.87), having ≥ 2 male sexual partners in past 6 months (RR = 2.50), baseline syphilis infection (RR = 2.99), homosexual orientation (RR = 1.91), preferred bottom/versatile roles in anal sexual intercourse (RR = 2.33), and having unprotected anal intercourse in the past 6 months (RR = 2.16) significantly increased the risk for HIV seroconversion (each P < 0.05). Uncircumcised MSM had a marginal statistically significant higher HIV incidence (RR = 3.35, P = 0.051). HIV incidence is still alarmingly high among Chinese MSM. Stronger HIV intervention strategies should be implemented, in particular targeting young, less educated and syphilis-infected MSM.

摘要

在中国,每年报告的男男性行为者(MSM)在艾滋病毒感染者(PLWH)中所占的比例正在上升。为了更好地告知公共卫生部门如何改进艾滋病毒预防策略,有必要了解当前的艾滋病毒发病率水平及其相关因素。在谷歌学术、PubMed、科学网以及三个主要的中国电子出版物数据库(分别为http://qikan.cqvip.com/、http://g.wanfangdata.com.cn/、http://www.cnki.net/)中搜索报告艾滋病毒发病率的研究。使用综合荟萃分析(CMA)2.0统计软件(美国新泽西州恩格尔伍德市的Biostat公司)计算合并的艾滋病毒发病率,并进行亚组分析以找出中国男男性行为者艾滋病毒血清转化的相关因素。然后进行随机效应模型分析。本荟萃分析纳入了25项符合条件的研究。计算得出的合并艾滋病毒发病率为5.61/100人年(PY),且随时间呈上升趋势(2005 - 2008年为3.24/100 PY,2009 - 2011年为5.29/100 PY;2012 - 2014年为5.50/100 PY,趋势χ2检验P = 0.04)。亚组分析表明,年龄<25岁(率比(RR)= 1.85)、大专及以下学历(RR = 1.87)、在过去6个月内有≥2名男性性伴侣(RR = 2.50)、基线梅毒感染(RR = 2.99)、同性恋取向(RR = 1.91)、在肛交中偏好被动/双角色(RR = 2.33)以及在过去6个月内有无保护肛交(RR = 2.16)会显著增加艾滋病毒血清转化的风险(各P < 0.05)。未行包皮环切术的男男性行为者的艾滋病毒发病率略高,具有统计学边缘显著性(RR = 3.35,P = 0.051)。中国男男性行为者中的艾滋病毒发病率仍然高得惊人。应实施更强有力的艾滋病毒干预策略,特别是针对年轻、受教育程度较低和感染梅毒的男男性行为者。

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