抗病毒治疗对抗-HIV阳性美沙酮维持治疗者吸毒和高危性行为的影响

Impacts of antiretroviral treatment on drug use and high risk sexual behaviors among HIV-positive MMT clients

目的了解抗病毒治疗（ART）对美沙酮维持治疗（MMT）门诊抗-HIV阳性吸毒人员高危性行为和吸毒行为的影响。方法采用横断面调查方法，于2014年6—8月对云南省红河州和德宏州5个县（市）的MMT门诊的HIV感染者进行问卷调查，包括参加ART及未参加ART者，收集其人口学特征、参加ART情况、参加MMT情况、艾滋病性病相关行为学特征等内容。对过去3个月与固定性伴发生无保护性行为（UPS）和偷吸毒品的相关因素进行logistic回归分析。结果纳入分析的328例调查对象中，参加ART组202例，未参加ART组126例。调查对象在过去3个月与固定性伴UPS发生率为40．1％（61／152），过去3个月偷吸毒品行为发生率为57．6％（189／328）。多因素分析显示：年龄〈35岁（OR=3．57，95％C／：1．23～10．37）、有生育愿望（OR=4．47，95％Chl．49～13．41）、固定性伴为HIV感染者（OR=4．62，95％CI：1.80～11．86）、参加MMT〈5年（OR=2．92，95％CI：14～7．53）是过去3个月发生UPS的危险因素，认同不管病毒载量高低都需要使用安全套（OR=0.14，95％CI：0.04．0．51）是保护因素。汉族（OR=0.46，95％CI：0．24～0．89）、自我感觉健康状况好（OR=0．39，95％CI：0．18～0．851、参加ART（OR=0．32，95％CI：0．17～0．60）是过去3个月偷吸毒品的保护因素；过去3个月与吸毒的朋友打过交道（OR=4．41，95％CI：2．31-8．29）、在门诊有过漏服药经历（OR=3．47，95％CI：1．92—6．29）、认为当前服药剂量需适当增加（0R=13．92，95％CI：3．24—59．93）是偷吸毒品的危险因素。结论ART不会引起MMT门诊HIV感染者UPS和偷吸毒品行为增加，应鼓励其参加ART，同时给予配套的宣传教育，预防交叉感染和耐药菌株的出现。

Objective To explore the impacts of antiretroviral treatment on drug use and high risk sexual behaviors among HIV-positive MMT clients. Methods A cross-sectional study was conducted in patients undergoing ART（ART-experienced） and patients not undergoing ART（ART-naive） attending MMT in 5 clinics in Yunnan Honghe and Dehong prefectures in 2014. A questionnaire was designed to collect socio-demographic characteristics, ART and MMT information and sexual and drug use behaviors within 3 months before the investigation was conducted. Logistic regression analysis was conducted to identify the predictors for drug use and risky sexual behaviors. Results A total of 328 cases were included in the analysis, among which 202 were ART-experienced and 126 were ART-naive. Among 152 respondents who were sexually active, 61 （40.1%） reported having unprotected sex（UPS） with their regular partners in the prior 3 months. A total of 57.6%（189/328） of the respondents used drugs in the prior 3 months. Multiple logistic regression analysis revealed that younger than 35 years old（OR=3.57, 95%CI： 1.23-10.37）, fertility desire （OR=4.47, 95%CI：1.49-13.41）, partner being HIV-positive（OR=4.62, 95%CI：1.80-11.86）, length of MMT attendance less than 5 years（OR=2.92,95%CI：1.14-7.53）, agreed that it was necessary to use condom no matter the viral load is high or low（OR=0.14, 95%CI：0.04-0.51） were protective factors of UPS in the prior 3 months. Multiple logistic regression analysis revealed that being Han （OR=0.46, 95%CI：0.24-0.89）, feeling having good health status （OR=0.39, 95% CI： 0.18-0.85）, being enrolled in ART（OR=0.32, 95%CI：0.17- 0.60） were protective factors for drug use in the prior three months, having contact with drug using friends （OR=4.41, 95% CI：2.31- 8.29）, having experience of missing an MMT dose（OR=3.47, 95% CI：1.92- 6.29）, and not satisfied with current MMT dose（OR=13.92,95%CI：3.24-59.93） were risk factors for drug use during the prior three months. Conclusion ART was not associated with risky sexual behavior and drug use in the prior 3 months in this population. Future interventions should promote ART among this population, and provide education at the same time to prevent the emergence of cross infections and drug-resistant strains.