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九个欧洲国家内移民后 HIV 获得水平较高。

High levels of postmigration HIV acquisition within nine European countries.

机构信息

aNational Centre for Epidemiology, Instituto de Salud Carlos III, Madrid bUniversidad Complutense de Madrid cCIBERESP, Instituto de Salud Carlos III, Madrid, Spain dResearch Department of Infection and Population Health, University College London, London, UK eDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece fDepartment of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium gDepartment of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam hDepartment of Internal Medicine, Center of Infectious Diseases and Immunology, Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands iDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal jClinic for Infectious Diseases, Bern University Hospital, Bern, Switzerland kDepartment of Infectious Diseases, Medical Clinic II, University Clinic Frankfurt, Frankfurt am Main lDepartment of Medicine I, Bonn University Hospital, Bonn, Germany mUnit of Infectious Diseases and Assistance, Coordination and Territorial Integration for Migrants' Emergency, Civico-Benfratelli Hospital, Palermo, Italy nEuropean AIDS Treatment Group, Brussels, Belgium. *Fiona Burns and Julia del Amo are both senior coauthors.

出版信息

AIDS. 2017 Sep 10;31(14):1979-1988. doi: 10.1097/QAD.0000000000001571.

DOI:10.1097/QAD.0000000000001571

PMID:28857779

Abstract

OBJECTIVE

We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe.

DESIGN

To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics.

METHODS

The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression.

RESULTS

Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57-67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year.

CONCLUSION

A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.

摘要

目的

我们旨在估计欧洲 HIV 阳性移民中后天感染 HIV 的比例。

设计

为了接触到 HIV 阳性移民，我们设计了一项在 HIV 诊所进行的横断面研究。

方法

该研究于 2013 年 7 月至 2015 年 7 月在 57 家诊所（9 个欧洲国家）进行，针对的是过去 5 年内被诊断出且在国外出生的 18 岁以上的个体。电子问卷辅以临床数据，以 15 种语言中的任何一种填写。通过结合有关移民和患者特征的广泛信息的贝叶斯方法来估计后天感染 HIV 的比例。通过拟合到自然史数据的二元线性混合模型来估计从血清转换开始的 CD4 细胞计数和 HIV-RNA 轨迹。使用加权逻辑回归分析后天感染风险因素。

结果

在 2009 名参与者中，46%为男男性接触者，三分之一分别来自撒哈拉以南非洲和拉丁美洲及加勒比地区。在东道国的中位时间为 8 年。后天感染 HIV 的比例为 63%（95%置信区间：57-67%）；男男性接触者中为 72%，异性恋男性和女性中分别为 58%和 51%。来自拉丁美洲和加勒比地区的移民和来自撒哈拉以南非洲的移民中后天感染 HIV 的比例分别为 71%和 45%。与后天感染 HIV 相关的因素在异性恋女性和男男性接触者中分别为移民时的年龄、在东道国的停留时间和 HIV 诊断年份，而在异性恋男性中则为在东道国的停留时间和 HIV 诊断年份。