美沙酮维持治疗海洛因成瘾者中HIV新发感染原因病例对照研究

A case-control study on the causes of new HIV infection among heroin addicts attendees at the methadone maintenance treatment clinics

目的 了解参加美沙酮维持治疗（MMT）的海洛因成瘾者治疗期间感染HIV的原因及其影响因素.方法 在参加MMT海洛因成瘾者随访队列中,采用巢式病例对照研究的方法,1∶1匹配选择治疗期间感染和未感染HIV的海洛因成瘾者作为研究对象,调查其一般情况、毒品使用、性行为、服用美沙酮及心理状况,采用单因素和多因素分析方法,分析与感染HIV相关的因素.结果 调查参加MMT的海洛因成瘾者108名,其中54人新感染HIV.男性76人,女性32人;汉族95人,其他民族13人;参加MMT前吸毒平均时间（12.1±5.0）年.感染HIV的54人中,33人通过注射吸毒感染,12人通过性行为感染,9人不确定感染途径.多因素分析结果提示,参加MMT前吸毒时间长（≥10年,OR=20.9,95％CI：1.62 ～ 269.34,P=0.02）、最近半年与他人共用过注射器（OR=276.7,95％CI：5.65～ ＞999.99,P＜0.01）会增加感染HIV的风险,治疗依从性好（≥0.5,OR=0.07,95％CI：0.42 ～ 0.87,P=0.04）、和家人住在一起（OR=0.002,95％CI：＜0.001～0.94,P＜0.01）会降低感染风险.结论 共用注射器吸毒行为仍然是参加MMT的海洛因成瘾者感染HIV的主要危险行为.增加对海洛因成瘾者的家庭社会支持,提高参加MMT的依从性,减少参加MMT期间注射吸毒行为可以降低HIV感染的风险.

Objective To explore the routes and factors associated with HIV new infection of heroin addicts who had been attending the methadone maintenance treatment （MMT） program.Methods A 1 ∶ 1 nested case-control study was implemented with the cases （new HIV infections） and controls （HIV negative） selected from the treatment cohort of China MMT clients.Questionnaire was developed to collect information on demographic characters,behaviours on drug use,sexual behaviour,daily dosage of methadone intake,adherence to MMT,and psychological problems.Univariate analysis and multivariate condition logistic regression were used to identify factors associated with HIV infection.Results 108 （54 paired） clients on MMT were recruited,with 76 males and 32 females.Among them,95 were Han Chinese and 13 were minorities,with average time of drug use as 12.1 ± 5.0 years.Among 54 new HIV infections,33 were infected through sharing needles,12 were throuth sexual contact and 9 unidentified.Results from multivariate condition logistic regression indicated that having longer duration of heroin use before on MMT （More than 10 years vs.less than 10 years,OR=20.9,95%CI：1.62-269.34,P=0.02）,shared needles in the last 6 months （OR=276.7,95% CI：5.65-〉999.99,P〈0.01） were risk factors while better adherence （More than 0.5 vs.less than 0.5,OR=0.07,95%CI：0.42-0.87,P=0.04） and living with families （OR=0.002,95% CI：0.001-0.94,P〈0.01） were protective factors.Conclusion Sharing needles was the main route of HIV new infection among those clients that were on MMT.Factors as having received more support from both family and community,improvement of adherence to MMT,reducing the frequency of injection etc.,could reduce the risk of HIV infection among those MMT clients.