巴基斯坦Kot Imrana村愛滋病毒嚴重爆發的最新情況
資料來源：刺胳針感染症期刊，2019年3月19日；財團法人台灣紅絲帶基金會編譯
Kot Imrana （Kot Momin）是一個位於巴基斯坦旁遮普省薩戈達哈區的小村莊。在2019年1月由衛生部於薩戈達哈地區總院所進行以聚合酶連鎖反應(PCR) 為基礎的篩檢期間，居住在該村的5,000人中有669人（13.38％）被發現是愛滋病毒陽性。在刺胳針感染症期刊中Muhammad Zaid和Muhammad Sohail Afzal報告說，2018年6月同一村莊的愛滋病盛行率為1.29％。因此，Kot Imrana村的愛滋疫情繼續以警訊式的速率增長且其死亡率高得驚人。在對患者進行訪談時，發現一名庸醫對多名患者使用了相同的注射器，並且他自己也在2018年較晚時期死於愛滋病，導致了數百名愛滋病毒陽性之患者，而以婦女和兒童的盛行率較高。經詳細訪談經該實驗室確診的患者證實，超過96％的愛滋病毒陽性患者並不知道愛滋病毒的傳播方式以及這種威脅生命之病毒所導致的後果。大約15年前，Kot Imrana報告了第一例愛滋病毒感染病例，現在它是巴基斯坦受到最嚴重影響的地區（這個國家有超過1.1億人有被感染的風險），主要是因為它位於旁遮普省，是該國人口最多且人口最稠密的省份。
根據愛滋病控制計畫的數據，在薩戈達哈工作的5,000名庸醫正在向社區傳播病毒。此外，理髮師亦是愛滋病毒傳播的另一個來源，因為他們使用已受污染的剃刀和刀片。有相當一部分患者可能已經透過性行為而感染，但他們不願意討論他們的性關係。根據當地資源，病毒已傳播到附近的村莊，約有900名愛滋病毒感染者居住在薩戈達哈。與愛滋病毒/愛滋病相關的歧視和污名是另一個危險因素，它使得在社會保守地區要消除愛滋病毒成為一個挑戰，例如在巴基斯坦和其他發展中國家和未開發國家。
來自巴基斯坦拉合爾基因組分子診斷和研究中心實驗室的數據顯示，開伯爾.普赫圖赫瓦省之馬爾丹地區的愛滋病毒盛行率正在增加。從這一趨勢來看，我們可以得出結論，在舍庫普拉、拉合爾、費薩拉巴德等地以及在薩戈達哈附近超過50多個的村莊，以及在馬爾丹郊區的50多個農村和城市地區，都是巴基斯坦愛滋病毒感染的潛在熱點。
這情景顯示，在巴基斯坦一般民眾中愛滋病毒的整體盛行率是被低估的。巴基斯坦政府的國家愛滋病控制方案必須制定創新的策略並開展提高認知的運動，透過增加篩檢、治療和諮詢等機會的獲得來控制愛滋病毒。 Kot Imrana的這種愛滋病流行疫情是前所未有的，僅在6個月內從1.29％的盛行率擴大到13.38％。關注這一高傳播地區迫切地需要正確地實施以實證為基礎的預防策略，以控制疫情並減少病毒的傳播。
An update on the severe outbreak of HIV in Kot Imrana, Pakistan
Kot Imrana (Kot Momin) is a small village located in the district of Sargodha in Punjab province, Pakistan. During PCR-based screening by The Health Department at District Headquarter Hospital, Sargodha, in January 2019, 669 (13.38%) of the 5000 people who live in the village were found to be HIV-positive. In this journal, Muhammad Zaid and Muhammad Sohail Afzal reported that the prevalence of HIV in the same village in June, 2018, was 1.29%. The HIV epidemic in Kot Imrana, therefore, continues to grow at an alarming rate with a substantially high mortality. Upon interviewing patients, a quack was found to have used the same syringe on multiple patients, and he himself died of AIDS later in 2018, leaving hundreds of patients HIV-positive. Prevalence was found to be higher in women and children. The detailed interviews of patients who visit our laboratory confirmed that more than 96% of HIV-positive patients were unaware of the modes of transmission of HIV and the consequences of this life-threatening virus. The first case of HIV was reported in Kot Imrana around 15 years ago and now it is the most heavily affected region of Pakistan (a country in which more than 110 million people are at risk of infection), largely because it is located in Punjab, the largest and the most densely populated province of the country.
According to AIDS control programme data, 5,000 quacks working in Sargodha are transmitting the virus to the community. Additionally, barbers are the other source of HIV transmission because they use
contaminated razors and blades. A substantial proportion of patients might have acquired the infection sexually, but they were reluctant in discussing their sexual relationships. According to local resources, the virus has been spread to nearby villages and about 900 HIV carriers are living in Sargodha. Discrimination and stigma associated with HIV/AIDS is another risk factor that makes elimination of HIV a challenge in socially conservative settings, such as Pakistan and other developing and under-developed countries.
Laboratory data from Genome Centre for Molecular Based Diagnostics and Research, Lahore, Pakistan, showed an increased prevalence of HIV in the Mardan region of the Khyber Pakhtunkhwa province. From this trend, we can conclude that Sheikhupura, Lahore, Faisalabad, and more than 50 villages in the vicinity of Sargodha, as well as more than 50 rural and urban areas in the outskirts of Mardan, are potential hotspots of HIV infection in Pakistan.
Scenarios suggest that the overall prevalence of HIV in the general population is underreported in Pakistan. The National AIDS Control Programme of the Government of Pakistan must develop innovative strategies and launch awareness campaigns to control HIV through increased access to screening, treatment, and counselling. This HIV epidemic in Kot Imrana is unprecedented, having expanded from a prevalence of 1.29% to one of 13.38% in just 6 months. Focus on this high transmission area is urgently needed for the proper implementation of evidence-based prevention strategies to control the epidemic and reduce the transmission of virus.
www.thelancet.com/infection Vol 19 March 2019
