2009-2016年湖北省武汉市吸毒人群艾滋病病毒、梅毒和丙型肝炎感染状况及其影响因素分析
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摘要
目的分析2009—2016年湖北省武汉市艾滋病监测哨点吸毒人群艾滋病病毒(HIV)、梅毒、丙型肝炎(丙肝)感染状况和变化趋势。方法 2009—2016年每年4—6月,采用国家统一制定的问卷对武汉市哨点中监管场所和社区吸毒者、美沙酮门诊最近1个月吗啡尿检阳性者开展连续横断面调查,并采集调查对象血液标本进行HIV、梅毒和丙肝病毒(HCV)抗体检测。结果 2009—2016年共监测6 408名毒品使用者。HIV抗体阳性率平均为0.73%,维持在较低水平;梅毒为5.07%;HCV为54.35%,维持在较高水平。不同来源及特征的吸毒人群感染情况不同。多元logistic回归分析显示,外省户籍(OR=4.183,95%CI:1.670～10.476,P=0.002)、其他民族(OR=7.754,95%CI:2.537～23.703,P=0.000)、曾共用针具(OR=5.908,95%CI:2.906～12.009,P=0.000)、监管场所来源吸毒人员(OR=2.468,95%CI:1.054～5.783,P=0.038)是感染HIV的危险因素。女性(OR=2.705,95%CI:2.116～3.457,P=0.000)、有注射毒品史(OR=1.567,95%CI:1.133～2.165,P=0.007)、社区来源吸毒人员(OR=3.000,95%CI:2.265～3.973,P=0.000)是感染梅毒的危险因素。而女性(OR=1.135,95%CI:1.151～1.583,P=0.000)、本省(OR=1.439,95%CI:1.208～1.713,P=0.000)、传统毒品和混合毒品使用者(OR=3.643,95%CI:2.975～4.462,P=0.000;OR=3.454,95%CI:2.616～4.561,P=0.000)、有注射毒品史(OR=4.381,95%CI:3.777～5.082,P=0.000)、监管场所来源吸毒人员(OR=2.075,95%CI:1.809～2.381,P=0.000)是感染HCV的危险因素。结论武汉市吸毒人群整体HCV抗体阳性率较高,新型毒品使用者比例呈上升趋势。在继续做好美沙酮维持治疗的同时需进一步调查当前吸毒人群HIV、梅毒和丙肝感染现况并分析影响因素。
Objective To understand the prevalence of HIV infection,syphilis and hepatitis C and related risk factors in drug users under sentinel surveillance in Wuhan during 2009–2016 and provide evidence for the improvement of HIV infection,syphilis and hepatitis C surveillance and behavior intervention in this population.Methods A consecutive crosssectional survey with uniformed questionnaire was conducted in drug uses selected in custody facilities and communities as well as urine morphine positive persons who visiting methadone maintenance treatment clinics in last month during the annual sentinel surveillance between April and June,and basic demographic information and blood samples were collected from them.Results A total of 6 408 drug users were included in the analysis.The prevalence rates of HIV infection,syphilis and hepatitis were 0.73%(low),5.07% and 54.35%(high),respectively.The prevalence differed in drug users with different demographic characteristics.Multivariate analysis indicated that HIV infection related risk factors included living in other provinces originally(OR=4.183,95%CI:1.670–10.476,P=0.002),other ethnic group(OR=7.754,95%CI:2.537–23.703,P=0.000),syringe sharing(OR=5.908,95%CI:2.906–12.009,P=0.000) and being drug user in custody facility(OR=2.468,95%CI:1.054–5.783,P=0.038).Syphilis infection related risk factors included being female(OR=2.705,95%CI:2.116–3.457,P=0.000),injecting drug use(OR=1.567,95%CI:1.133–2.165,P=0.007) and being drug user in community(OR=3.000,95%CI:2.265–3.973,P=0.000).Hepatitis C virus infection related risk factors included being female(OR=1.135,95%CI:1.151–1.583,P=0.000),living in Hubei province(OR=1.439,95%CI:1.208–1.713,P=0.000),being traditional drug user or mixed drug user(OR=3.643,95%CI:2.975–4.462,P=0.000;OR=3.454,95%CI:2.616–4.561,P=0.000),injecting drug use(OR=4.381,95%CI:3.777–5.082,P=0.000) and being drug user in custody facility(OR=2.075,95%CI:1.809–2.381,P=0.000).Conclusion The hepatitis C virus infection rate in drug users was high in Wuhan,and the proportion of new type drug users was in increase.It is necessary to continue the improvement of methadone maintenance treatment and further investigate the prevalence of HIV infection,syphilis and hepatitis C and influencing factors in drug users.
Objective To understand the prevalence of HIV infection,syphilis and hepatitis C and related risk factors in drug users under sentinel surveillance in Wuhan during 2009–2016 and provide evidence for the improvement of HIV infection,syphilis and hepatitis C surveillance and behavior intervention in this population.Methods A consecutive crosssectional survey with uniformed questionnaire was conducted in drug uses selected in custody facilities and communities as well as urine morphine positive persons who visiting methadone maintenance treatment clinics in last month during the annual sentinel surveillance between April and June,and basic demographic information and blood samples were collected from them.Results A total of 6 408 drug users were included in the analysis.The prevalence rates of HIV infection,syphilis and hepatitis were 0.73%(low),5.07% and 54.35%(high),respectively.The prevalence differed in drug users with different demographic characteristics.Multivariate analysis indicated that HIV infection related risk factors included living in other provinces originally(OR=4.183,95%CI:1.670–10.476,P=0.002),other ethnic group(OR=7.754,95%CI:2.537–23.703,P=0.000),syringe sharing(OR=5.908,95%CI:2.906–12.009,P=0.000) and being drug user in custody facility(OR=2.468,95%CI:1.054–5.783,P=0.038).Syphilis infection related risk factors included being female(OR=2.705,95%CI:2.116–3.457,P=0.000),injecting drug use(OR=1.567,95%CI:1.133–2.165,P=0.007) and being drug user in community(OR=3.000,95%CI:2.265–3.973,P=0.000).Hepatitis C virus infection related risk factors included being female(OR=1.135,95%CI:1.151–1.583,P=0.000),living in Hubei province(OR=1.439,95%CI:1.208–1.713,P=0.000),being traditional drug user or mixed drug user(OR=3.643,95%CI:2.975–4.462,P=0.000;OR=3.454,95%CI:2.616–4.561,P=0.000),injecting drug use(OR=4.381,95%CI:3.777–5.082,P=0.000) and being drug user in custody facility(OR=2.075,95%CI:1.809–2.381,P=0.000).Conclusion The hepatitis C virus infection rate in drug users was high in Wuhan,and the proportion of new type drug users was in increase.It is necessary to continue the improvement of methadone maintenance treatment and further investigate the prevalence of HIV infection,syphilis and hepatitis C and influencing factors in drug users.
引文
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[12]赵金仙,陈黎跃,李世福,等.传统毒品对新型毒品使用人群HIV,HCV,梅毒感染的影响分析[J].中国皮肤性病学杂志,2016,30(5):477-481.DOI:10.13735/j.cjdv.1001-7089.201505146.Zhao JX,Chen LY,Li SF,et al.Impact of traditional narcotics on the infections of HIV,HCV and syphilis in the subjects using new narcotics[J].Chin J Dermatovenereol,2016,30(5):477-481.DOI:10.13735/j.cjdv.1001-7089.201505146.
[13]樊盼英,丁国伟,王俊杰,等.新型毒品滥用者的高危性行为和HIV传播风险的定性研究[J].中国艾滋病性病,2015,21(1):48-50.DOI:10.13419/j.cnki.aids.2015.01.015.Fan PY,Ding GW,Wang JJ,et al.A quality study on high risk sexual behaviors and HIV transmission among club drug abusers[J].Chin J AIDS STD,2015,21(1):48-50.DOI:10.13419/j.cnki.aids.2015.01.015.
[2]葛琳,李东民,李培龙,等.2010-2015年中国艾滋病哨点监测人群HIV、梅毒和HCV感染状况分析[J].疾病监测,2017,32(2):111-117.DOI:10.3784/j.issn.1003-9961.2017.02.008.Ge L,Li DM,Li PL,et al.Population specific sentinel surveillance for HIV infection,syphilis and HCV infection in China,during2010-2015[J].Dis Surveill,2017,32(2):111-117.DOI:10.3784/j.issn.1003-9961.2017.02.008.
[3]普丽芳,苏迎盈,王桂香,等.云南省开远市美沙酮门诊在治者HIV、HCV感染现状分析[J].中华流行病学杂志,2015,36(8):829-831.DOI:10.3760/cma.j.issn.0254-6450.2015.08.013.Pu LF,Su YY,Wang GX,et al.Prevalence of HIV and HCVinfections in patients receiving methadone maintenance treatment in Kaiyuan,Yunnan[J].Chin J Epidemiol,2015,36(8):829-831.DOI:10.3760/cma.j.issn.0254-6450.2015.08.013.
[4]张薇,彭国平,姚璇,等.2010-2013年湖北省艾滋病和丙肝哨点监测人群丙型肝炎病毒感染状况分析[J].热带医学杂志,2015,15(9):1269-1271,1291.Zhang W,Peng GP,Yao X,et al.Analysis on HCV prevalence among the populations in the HIV and HCV sentinel surveillance from 2010 to 2013 in Hubei province[J].J Trop Med,2015,15(9):1269-1271,1291.
[5]金洁,罗艳,陈珺芳,等.杭州市吸毒人群艾滋病、梅毒和丙肝感染状况及影响因素分析[J].预防医学,2018,30(3):248-252,256.DOI:10.19485/j.cnki.issn2096-5087.2018.03.008.Jin J,Luo Y,Chen JF,et al.Prevalence of HIV,Syphilis and HCVand their risk factors among drug users in Hangzhou[J].Prev Med,2018,30(3):248-252,256.DOI:10.19485/j.cnki.issn2096-5087.2018.03.008.
[6]Sun Y,Norris JL,Zang C,et al.Incidence of hepatitis C virus infection in patients on hemodialysis:a systematic review and Meta-analysis[J].Hemodial Int,2013,17(4):532-541.DOI:10.1111/j.1542-4758.2012.00761.x.
[7]葛琳,王岚,丁正伟,等.中国2010-2012年丙型肝炎哨点5类监测人群HCV感染状况分析[J].中国艾滋病性病,2013,19(11):812-815.DOI:10.13419/j.cnki.aids.2013.11.011.Ge L,Wang L,Ding ZW,et al.Analysis on HCV prevalence among 5 kinds of populations in HCV sentinel surveillance during2010-2012 in China[J].Chin J AIDS STD,2013,19(11):812-815.DOI:10.13419/j.cnki.aids.2013.11.011.
[8]郭燕,周宁,李佳,等.天津市2011-2015年吸毒人群行为特征及性传播疾病感染率调查[J].中华流行病学杂志,2016,37(2):202-205.DOI:10.3760/cma.j.issn.0254-6450.2016.02.010.Guo Y,Zhou N,Li J,et al.Behaviors on drug-abuse and prevalence of sexually transmitted diseases among drug users in Tianjin,China,from 2011 to 2015[J].Chin J Epidemiol,2016,37(2):202-205.DOI:10.3760/cma.j.issn.0254-6450.2016.02.010.
[9]葛琳,崔岩,王璐,等.2012年全国艾滋病哨点吸毒人群血清学和性行为特征分析[J].中华流行病学杂志,2014,35(2):121-123.DOI:10.3760/cma.j.issn.0254-6450.2014.02.004.Ge L,Cui Y,Wang L,et al.Study on the characteristics of serology and sexual behavior among drug users at the HIV sentinel surveillance sites in 2012[J].Chin J Epidemiol,2014,35(2):121-123.DOI:10.3760/cma.j.issn.0254-6450.2014.02.004.
[10]丁力,姚恩龙,张唯义,等.2010-2014年云南省红河哈尼族彝族自治州吸毒哨点人群艾滋病相关行为变化和流行趋势分析[J].疾病监测,2015,30(11):911-916.DOI:10.3784/j.issn.1003-9961.2015.11.006.Ding L,Yao EL,Zhang WY,et al.Sentinel surveillance for prevalence of AIDS related risk behaviors in drug users in Honghe,Yunnan,2010-2014[J].Dis Surveill,2015,30(11):911-916.DOI:10.3784/j.issn.1003-9961.2015.11.006.
[11]李宁,王晓卫,聂玉刚,等.河南省2011-2015年艾滋病哨点吸毒人群HCV感染状况及影响因素分析[J].中华流行病学杂志,2016,37(6):821-825.DOI:10.3760/cma.j.issn.0254-6450.2016.06.016.Li N,Wang XW,Nie YG,et al.HCV infection status and related risk factors in drug users under HIV sentinel surveillance in Henan province,2011-2015[J].Chin J Epidemiol,2016,37(6):821-825.DOI:10.3760/cma.j.issn.0254-6450.2016.06.016.
[12]赵金仙,陈黎跃,李世福,等.传统毒品对新型毒品使用人群HIV,HCV,梅毒感染的影响分析[J].中国皮肤性病学杂志,2016,30(5):477-481.DOI:10.13735/j.cjdv.1001-7089.201505146.Zhao JX,Chen LY,Li SF,et al.Impact of traditional narcotics on the infections of HIV,HCV and syphilis in the subjects using new narcotics[J].Chin J Dermatovenereol,2016,30(5):477-481.DOI:10.13735/j.cjdv.1001-7089.201505146.
[13]樊盼英,丁国伟,王俊杰,等.新型毒品滥用者的高危性行为和HIV传播风险的定性研究[J].中国艾滋病性病,2015,21(1):48-50.DOI:10.13419/j.cnki.aids.2015.01.015.Fan PY,Ding GW,Wang JJ,et al.A quality study on high risk sexual behaviors and HIV transmission among club drug abusers[J].Chin J AIDS STD,2015,21(1):48-50.DOI:10.13419/j.cnki.aids.2015.01.015.