云南省德宏州静脉注射毒品者HIV新发感染率及其危险因素研究

目的 了解云南省德宏州静脉注射毒品者(IDU)中HIV新发感染率及其危险因素.方法 2004年10月招募HIV检测阴性的245名IDU进入队列,启动IDU人群艾滋病流行病学队列研究,于2006年底进行第一次随访检测确定HIV发病率.自2007年1月起,不断纳入新发现的HIV阴性的IDU,扩大流行病学研究队列,并每半年进行一次有关毒品使用和性行为等暴露因素的随访调查,同时血清学检测确定HIV新发感染率.结果 截止2008年底,共招募入组760名IDU,至少随访1次者有540人,累积观察1153.6人年,新发现HIV感染者47人,HIV新发感染率为4.07/100人年,其中2004-2006年为4.45/100人年,2007年为4.50/100人年,2008年为2.54/100人年.随访期间,研究对象中IDU比例和HIV新发感染率均有显著下降.Cox比例风险回归模型多因素分析显示,景颇族风险比(HR)=2.56,95%CI:1.06～6.19]和除傣族以外的其他少数民族(HR=3.26,95%CI:0.89～11.96)的HIV感染风险高于汉族;随访期间注射毒品但未共针者(HR=2.27,95%CI:0.98～5.25)以及有共针注射毒品行为者(HR=5.27,95%CI:2.25～12.34)的HIV感染风险高于随访期间没有注射毒品者.结论 云南省德宏州既往IDU人群中注射吸毒的比例和HIV新发感染率近4年来均呈现下降趋势.共用注射器吸毒仍是IDU人群HIV感染的最重要的危险因素,不同民族IDU的HIV感染风险不同.

Incidence and risk factors on HIV infection among injection drug users in Dehong prefecture area of Yunnan province

Objective To determine the incidence and risk factors on HIV infection among injection drug users(IDU)in Dehong prefecture area of Yunnan province.Methods An epidemiological cohort of HIV-negative IDU had been developed and followed since October,2004.HIV new infections and related behaviors had been investigated every six months.Results By the end of 2008,760 HIV-negative IDU had been recruited and followed for a total of 1153.6 person-years.47 new HIV infections were identified,with an overall incidence of 4.07/100 person-years during the follow-up period.The HIV incidence was 4.45/100 person-years during 2004-2006,4.50/100 person-years in 2007 and 2.54/100 person-years in 2008.Both the behavior of drug injection and the HIV incidence among the cohort had substantially decreased during the follow-up period.Multiple regression analysis using Cox proportional hazard model indicated that people with Jing-po ethnicity(Hazard ratio,HR=2.56,95% CI:1.06-6.19)and other minorities except for Dai(HR=3.26,95% CI:0.89-11.96)were at higher risk for HIV infection than the people with Han ethnicity.People injecting drugs with(HR=2.21,95%CI:0.98-5.25)or without(HR=5.27,95%CI:2.25-12.34)needle sharing were at higher risk for HIV infection than those reporting having no drug injection behavior during the follow-up period.Conclusion Both the behavior of drug injection and the HIV incidence among former IDU in Dehong prefecture area of Yunnan province had been decreasing during the four years.However,needle sharing remained the most important risk factor for HIV new infection among IDUs.IDUs with different ethnicities seemed to have different risks towards HIV infection.