Li J, Tang H L, Han J, Xu J, Shen Z Y, Lai W W, Shi Y H, Sun D Y, Ni M J, Mao Y R
Division of Integrated Prevention and Evaluation, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Institute for AIDS Control and Prevention, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Nov 10;37(11):1497-1502. doi: 10.3760/cma.j.issn.0254-6450.2016.11.013.
To understand the HIV transmission and associated factors in newly reported HIV infected couples before diagnosis. The information about newly reported HIV infected couples in Yunnan, Guangxi, Sichuan, Henan and Xinjiang provinces (autonomous region) were collected from National HIV/AIDS Information System from 2011 to 2014. The infection order of the sero-concordant couples were determined. Logistic regression model was used to analyze the HIV transmission between couples and identify the associated factors. Cochran-Armitage trend analysis was conducted to understand the annual sero-concordant couple proportion. A total of 48 931 HIV cases in couples were included in this study, among whom 12 051(24.6%) were sero-concordant couples, indicating HIV transmissions occurred between them. Multivariate logistic regression analysis showed that those who were females (=1.98, 95%: 1.89-2.08), aged >45 years (45-59 yrs: =1.32, 95% : 1.23-1.42; >60 yrs: =1.72, 95% : 1.58-1.86), had educational level of middle school education or below (illiteracy and primary school: =1.33, 95%: 1.23-1.44; middle school: =1.19, 95% : 1.10-1.28), were farmers or migrate workers (=1.23, 95% : 1.17-1.30), were infected through injecting drug use or heterosexual intercourse (injecting drug use: =1.33, 95% : 1.03-1.72; heterosexual intercourse: =3.65, 95% : 2.89-4.61), had CDT cells of <500 cells/μl (<200 cells/μl: =5.05, 95%: 4.62-5.52; 200-349 cells/μl: =3.58, 95%: 3.26-3.93; 350-500 cells/μl: =2.14, 95%: 1.94-2.36), reported unprotected sexual behaviors (=1.56, 95% : 1.49-1.64), were more likely to infect their couples before diagnosis. The HIV transmission proportion between couples before diagnosis decreased significantly from 28.9% (2 631/9 102) in 2011 to 25.5% (3 009/11 787) in 2014 among those infected through heterosexual intercourse. The proportion of HIV transmission between couples before diagnosis varied among different populations. Behavior intervention and early HIV test promoting are needed to prevent HIV transmission between couples before diagnosis in populations at high risk for HIV infection. HIV infection cases should be included in the HIV care system after diagnosis as early as possible.
了解新报告的HIV感染夫妇在诊断前的HIV传播情况及相关因素。收集2011年至2014年云南省、广西壮族自治区、四川省、河南省和新疆维吾尔自治区新报告的HIV感染夫妇的信息，这些信息来自国家HIV/AIDS信息系统。确定血清学一致夫妇的感染顺序。采用Logistic回归模型分析夫妇间的HIV传播情况并确定相关因素。进行Cochran-Armitage趋势分析以了解年度血清学一致夫妇比例。本研究共纳入48931例夫妇HIV病例，其中12051例（24.6%）为血清学一致夫妇，表明他们之间发生了HIV传播。多因素Logistic回归分析显示，女性（比值比=1.98，95%可信区间：1.89 - 2.08）、年龄>45岁（45 - 59岁：比值比=1.32，95%可信区间：1.23 - 1.42；>60岁：比值比=1.72，95%可信区间：1.58 - 1.86）、教育程度为初中及以下（文盲和小学：比值比=1.33，95%可信区间：1.23 - 1.44；初中：比值比=1.19，95%可信区间：1.10 - 1.28）、为农民或农民工（比值比=1.23，95%可信区间：1.17 - 1.30）、通过注射吸毒或异性性行为感染（注射吸毒：比值比=1.33，95%可信区间：1.03 - 1.72；异性性行为：比值比=3.65，95%可信区间：2.89 - 4.61）、CD4+T细胞<500个/μl（<200个/μl：比值比=5.05，95%可信区间：4.62 - 5.52；200 - 349个/μl：比值比=3.58，95%可信区间：3.26 - 3.93；350 - 500个/μl：比值比=2.14，95%可信区间：1.94 - 2.36）、报告有不安全性行为（比值比=1.56，95%可信区间：1.49 - 1.64）的患者在诊断前更有可能感染其配偶。在通过异性性行为感染的人群中，诊断前夫妇间的HIV传播比例从2011年的28.9%（2631/9102）显著下降至2014年的25.5%（3009/11787）。诊断前夫妇间的HIV传播比例在不同人群中有所差异。对于HIV感染高危人群，需要进行行为干预并促进早期HIV检测，以预防诊断前夫妇间的HIV传播。HIV感染病例诊断后应尽早纳入HIV关怀系统。
