HIV and Syphilis Co-Infection Increasing among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis

BackgroundThis study aims to estimate the magnitude and changing trends of HIV, syphilis and HIV-syphilis co-infections among men who have sex with men (MSM) in China during 2003–2008 through a systematic review of published literature. Methodology/Principal FindingsChinese and English literatures were searched for studies reporting HIV and syphilis prevalence among MSM from 2003 to 2008. The prevalence estimates were summarized and analysed by meta-analyses. Meta-regression was used to identify the potential factors that are associated with high heterogeneities in meta-analysis. Seventy-one eligible articles were selected in this review (17 in English and 54 in Chinese). Nationally, HIV prevalence among MSM increased from 1.3% during 2003–2004 to 2.4% during 2005–2006 and to 4.7% during 2007–2008. Syphilis prevalence increased from 6.8% during 2003–2004 to 10.4% during 2005–2006 and to 13.5% during 2007–2008. HIV-syphilis co-infection increased from 1.4% during 2005–2006 to 2.7% during 2007–2008. Study locations and study period are the two major contributors of heterogeneities of both HIV and syphilis prevalence among Chinese MSM. Conclusions/SignificanceThere have been significant increases in HIV and syphilis prevalence among MSM in China. Scale-up of HIV and syphilis screening and implementation of effective public health intervention programs should target MSM to prevent further spread of HIV and syphilis infection.背景：本研究旨在通过系统综述已发表文献，估算2003至2008年中国男男性行为者（men who have sex with men, MSM）人群中人类免疫缺陷病毒（HIV）、梅毒（syphilis）及HIV-梅毒共感染的流行规模与变化趋势。方法与主要结果：检索中英文文献，筛选2003至2008年报告男男性行为者HIV与梅毒感染率的相关研究。通过荟萃分析（meta-analysis）对感染率估算结果进行汇总与分析，并采用荟萃回归（meta-regression）识别导致荟萃分析出现高异质性的潜在影响因素。本综述最终纳入71篇符合标准的文献（其中英文文献17篇，中文文献54篇）。全国层面数据显示，男男性行为者的HIV感染率从2003-2004年的1.3%升至2005-2006年的2.4%，并进一步增长至2007-2008年的4.7%；梅毒感染率从2003-2004年的6.8%升至2005-2006年的10.4%，至2007-2008年达13.5%；HIV-梅毒共感染率则从2005-2006年的1.4%升至2007-2008年的2.7%。研究地点与研究周期是影响中国男男性行为者HIV与梅毒感染率异质性的两大主要因素。结论与意义：中国男男性行为者的HIV与梅毒感染率均已出现显著上升。应扩大HIV与梅毒筛查规模，并针对男男性行为群体实施有效的公共卫生干预项目，以遏制HIV与梅毒感染的进一步传播。