Download 2008年广州市艾滋病防治 工作概况

Increasing HIV epidemic among men who
have sex with men in Guangzhou, China
- epidemiological and molecular evidences
Ming Wang1, Huifang Xu1, Fei Zhong1,
Zhigang Han1, Fang Wen1, Jinkou Zhao2.
1 Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou.
2 The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva.
Introduction
• The HIV pandemic is one of the most significant public health
challenges of the 21st century in the world.
• With 33.4 million people worldwide currently infected, and with
2.7 million new infected in 2008 alone.
Trend of reported HIV/AIDS in China
1985-2008
70000
60000
50000
40000
30000
20000
AIDS
HIV/AIDS
年
0
份
10000
85-88 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
3
0
2
3
5
23
29
52
38 126 136 230 233 714 1028 6120 12652 7550 7909 10742 14509
22
171
299
216
261
274
531
1567 2649 3343 3306 4677 5201 8219 9732 21691 47606 40711 44070 48161 60081
Introduction
• The HIV epidemic in China is driven by some high-risk
populations, such as injecting drug users (IDU) and men
who have sex with men (MSM).
• In recent years, the predominant route of transmission
has shifted from blood exchange (e.g. IDU) to sexual
behavior.
• Some studies have reported the rapid increase of HIV
prevalence among MSM in Asia in recent years.
Bangkok: 17.3% (2003) to 28.3% (2005)
Pune: 18.9% (2002)
Beijing: 0.4% (2004) to 5.2% (2006)
Introduction
• Guangzhou is the capital city of Guangdong, a southern
province in mainland China, and is remarkable for its
rapid economic growth.
• Three studies of HIV infection among MSM in
Guangzhou:
2003 1.7% ( 2/121 )
2004 0.0% ( 0/201)
2006 1.7% ( 7/409 )
• Indicating the possible increase in HIV infection among
MSM in Guangzhou.
Objectives
• To investigate the trend of HIV epidemic among MSM in
Guangzhou, by case-based surveillance system (CBSS),
sentinel surveillance, and other surveys.
• To identify potential risk factors driving the HIV epidemic
among MSM.
Methods - CBSS
• Since 1986, a case-based surveillance system (CBSS) in
China has collected data on persons infected with HIV,
including demographic characteristics and transmission
categories.
• To assess recent trends in HIV infection among MSM in
Guangzhou, we analyzed CBSS data from 1986 - 2009.
Methods - sentinel surveillance
• Sentinel surveillance is a type of surveillance activity in
which specific facilities such as offices of certain health
care providers, hospitals or clinics across a geographical
region are designated to collect data about HIV infection
among high-risk populations.
• MSM sentinel surveillance in Guangzhou
2003, 2004, 2005, 2006 convenience sampling
2008 respondent-driven sampling
2009 snowball sampling
2010 respondent-driven and snowball sampling
Methods -
Respondent-Driven Sampling
• Respondent-Driven Sampling (RDS): Adjusted snowball
sampling
• Each seed is given three coded coupons to recruit his
peers.
• Persons who present with a valid coupon and who is
eligible can be enrolled, and, in turn, given three
recruitment coupons to give to their peers.
• A primary incentive, including a gift and 20 Yuan cash
was given for participation in the interview and the
provision of five ml blood for serological testing.
• A secondary incentive, 10 Yuan cash was given for
every additional recruitment of MSM peers.
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
Methods - cohort study
Dynamic cohort: retrospective and prospective
Established from Mar. 2009.
Follow-up every 3-6 months
Test HIV and syphilis antibody to calculate incidence
density.
• Collect information of serological and behavioral
changes.
•
•
•
•
Methods - subtype and drug resistance
• 154 sera were randomly selected from HIV-1 positive
samples between 2006 and 2009
• Segments of env , gag and pol genes were amplified
using RT-PCR
• PCR products were sequenced
• Genotyping was conducted by phylogenetic analysis of
segments of env and gag genes
• Mutations drug resistance was confirmed by comparing
acquired sequences of pol gene with Stanford HIV Drug
Resistance Database ( http://hivdb.stanford.edu )
Results - case reporting
• First HIV case reporting in 1986, now in phase of rapid rising.
• In 2009, reporting 1697 PLHA cases, with 775 AIDS cases, 195 deaths.
• Cumulatively, reporting 9419 PLHA cases, with 2332 AIDS cases, 839
deaths.
AIDS报告数
HIV/AIDS死亡数
5,000
1,000
4,500
900
4,000
800
3,500
700
3,000
600
2,500
500
2,000
400
1,500
300
1,000
200
500
100
0
0
年
1986
1990
1992
1994
1996
1998
2000
2002
2004
2006
广州市1986-2009年HIV/AIDS报告数,AIDS报告数,死亡数
2008
AIDS报告数 ,HIV/AIDS死亡数
HIV/AIDS报告数
HIV/AIDS报告数
Cumulative reporting case number of MSM in Guangzhou,
between 2006 and 2009
例
广州历年MSM病例报告数
200
180
189
160
140
120
117
100
80
60
40
20
11
24
2006
2007
0
First MSM HIV case was reported in 2000.
2008
2009
年
• The number of MSM PLHA was estimated to be 1704, by using the
Workbook method in 2009.
347 MSM PLHA who
have known their HIV
state till 2009.
The tip of the iceberg!
Figure Proportion of routes of HIV transmission among case reporting in
Guangzhou (2004 – 2009)
100%
90%
注射毒品
80%
职业暴露
70%
异性传播
同性传播
60%
输血/血制品
50%
其他
40%
母婴传播
30%
采血(浆)
20%
采供血/采血(浆)
不详
10%
性接触 + 注射毒品
0%
2004
2005
2006
2007
2008
2009
Results - sentinel surveillance
• The HIV prevalence among MSM was 1.7% in 2006, 5.2% in
2008, and 7.7% in 2010.
广州市历年高危人群HIV感染率
12
HIV感染率（%）
10
8
CSW
IDU
MSM
6
4
2
0
2003
2004
2005
2006
2007
2008
2009
2010
Results -
characteristics of MSM
• It was estimated that in 2009, there were about 48,213
sexually active MSM.
1.1
12.9
49.2
36.8
<20岁
20-岁
30-岁
40-岁
未婚
已婚
同居
离异/丧偶
初中或以下
高中/中专
24.5
12.1
大专或以上
15.3
45.0
51.1
30.5
21.5
寻找性伴的场所类型分布
5.5
5.9
8.9
11.7
68.0
酒吧
桑拿
公园
网络
其他
UAI, having receptive anal sex and current syphilis
infection are significant factors associated with HIV
infection.
Table Factors associated with HIV infection
Factors
AOR
95%CI
5.1
1.3-19.8
Insertive (1)
1.0
-
Receptive (0)
6.2
1.3-29.4
Both (1&0)
2.0
0.4-9.8
8.3
2.3-30.6
UAI（无保护性行为）
Role of anal sex（性角色）
Current syphilis infection
（现症梅毒）
Results –
cohort study
• The HIV incidence among MSM was estimated to be 1.01~3.67/100
person-year, by using multiple estimating methods.
• In the cohort study (N=324) in 2009, the HIV incidence density was
3.67/100 person-year and the retention rate was 75.9%.
Results -
Subtype
• The HIV subtype B and two circulating recombinant forms,
CRF01_AE and CRF07_BC, had been identified from 154
samples collected from 2006 to 2009 , and CRF01_AE was the
main subtype.
2006
Subtype
2007
2008
2009
N
%
N
%
N
%
N
%
B
2
22.22
2
20.00
10
11.90
9
17.65
CRF01_AE
5
55.56
6
60.00
40
47.62
26
50.98
CRF07_BC
1
11.11
1
10.00
28
33.33
16
31.37
Untyped*
1
11.11
1
10.00
6
7.14
0
0.00
Total
9
100.00
10
100.00
84
100.00
51
100.00
*Target genes were not amplified
Results -
Drug Resistance
• 69 segments of pol gene were successfully
acquired from 84 untreated samples reported in
2008.
• Resistance to multiple drug was identified from 1
subtype B sample.
• Other samples from two recombinant forms are
susceptible to NRTI, NNRTI and PI.
Conclusions
• A rapid increase of HIV epidemic among MSM in
Guangzhou exists.
• The potential risk of resistance transmission has been
present.
• Targeted interventions with VCT and STI services are
needed to address the epidemic, with a focus on such
subgroups as those of with current syphilis and UAI.
• Behavioral intervention through the internet should be
explored and VCT in MSM community should be
enhanced to increase case detection and to prevent
secondary HIV transmission.
Thank you！