Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
National Institute on Drug Dependence, Peking University, Beijing100191, China.
Int J Environ Res Public Health. 2020 Jul 29;17(15):5483. doi: 10.3390/ijerph17155483.
Heavy drug users was a global consensus high-risk population of HIV infection. However, the specific impact of drug on HIV infection has not yet been established. Depressants and stimulants were most widely used drugs in mainland China, and mix use of the two drugs was also serious. We assessed the HIV infection rate and trends in heavy drug users by analyzing data from the National Dynamic Management and Control Database for Drug Users (NDMCDDU). All heavy drug users with HIV test results in NDMCDDU from 2008 to 2016 were grouped into depressants only group (DOG), stimulants only group (SOG), and both depressants and stimulants group (DSG). We used joinpoint regression to examine trends of HIV infection rates. Multivariable logistic regression was used to examine factors related to HIV infection. A total of 466,033 heavy drug users with 9522 cases of HIV infection were included in this analysis. HIV infection rate was estimated at 2.97% (95% CI 2.91-3.04%) of 265,774 users in DOG, 0.45% (95% CI 0.42-0.49%) of 140,895 users in SOG, and 1.65% (95% CI 1.55-1.76%) of 59,364 users in DSG. In DOG, a U-shaped curve of HIV infection rate decreased from 3.85% in 2008 to 2.19% in 2010 (annual percent change (APC) -12.9, 95% CI -19.3--6.0, < 0.05), then increased to 4.64% in 2016 (APC 8.3, 95% CI 6.1-10.4, < 0.05) was observed. However, SOG and DSG showed consistent increases from 0.15% in 2008 to 0.54% in 2016 (APC 8.2, 95% CI 4.8-11.8, < 0.05) and from 0.78% in 2008 to 2.72% in 2016 (APC 13.5, 95% CI 10.7-16.4, < 0.05), respectively. HIV infection rate of DOG in the southwest region presented a U-shaped trend. All groups showed significant increases in HIV infection in east and central regions. The U-shaped curve for HIV infection rate among DOG users and consistent increases among SOG and DSG users implies drug abuse is still a critical focus of HIV infection in China. It is urgently needed to reassess the effectiveness of current strategies on HIV prevention and control among drug users.
吸毒者是全球公认的艾滋病毒感染高危人群。然而，药物对艾滋病毒感染的确切影响尚未确定。在中国内地，镇静剂和兴奋剂是使用最广泛的药物，两者的混合使用也很严重。我们通过分析中国国家药物滥用监测中心全国药物滥用动态管理数据库（NDMCDDU）中的数据，评估了吸毒者中的艾滋病毒感染率及其趋势。将 2008 年至 2016 年 NDMCDDU 中所有艾滋病毒检测结果呈阳性的吸毒者分为仅使用镇静剂组（DOG）、仅使用兴奋剂组（SOG）和同时使用镇静剂和兴奋剂组（DSG）。我们使用 Joinpoint 回归分析来检测艾滋病毒感染率的趋势。使用多变量逻辑回归分析与艾滋病毒感染相关的因素。 共纳入 466033 名吸毒者，其中 9522 例艾滋病毒感染。在 DOG 组中，艾滋病毒感染率估计为 265774 名使用者中的 2.97%（95%CI 2.91-3.04%），在 SOG 组中，艾滋病毒感染率估计为 140895 名使用者中的 0.45%（95%CI 0.42-0.49%），在 DSG 组中，艾滋病毒感染率估计为 59364 名使用者中的 1.65%（95%CI 1.55-1.76%）。在 DOG 组中，艾滋病毒感染率呈 U 型曲线，从 2008 年的 3.85%下降到 2010 年的 2.19%（APC-12.9，95%CI-19.3--6.0，<0.05），然后在 2016 年上升至 4.64%（APC8.3，95%CI 6.1-10.4，<0.05）。然而，SOG 和 DSG 则呈现出从 2008 年的 0.15%持续上升到 2016 年的 0.54%（APC8.2，95%CI 4.8-11.8，<0.05）和从 2008 年的 0.78%上升到 2016 年的 2.72%（APC13.5，95%CI 10.7-16.4，<0.05）。DOG 组在西南地区的艾滋病毒感染率呈 U 型趋势。各组在东部和中部地区的艾滋病毒感染率均呈显著上升趋势。DOG 使用者中艾滋病毒感染率的 U 型曲线和 SOG 及 DSG 使用者中持续上升的趋势表明，药物滥用仍是中国艾滋病毒感染的一个关键焦点。迫切需要重新评估当前针对吸毒者的艾滋病毒预防和控制策略的有效性。
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