广东省HIV感染产妇孕期使用抗艾滋病病毒药物的影响因素

Influencing factors of use of anti-HIV drugs during pregnancy among HIV-infected mothers in Guangdong

目的分析广东省人类免疫缺陷病毒(HIV)感染产妇孕期使用抗艾滋病病毒药物预防母婴传播的影响因素,为改进相应工作提供依据。方法对广东省项目登记的2007年1月-2015年6月活产分娩的1 365例HIV感染产妇及其新生儿调查数据进行多因素Logistic回归分析。结果有50.26%(686/1 365)的HIV感染产妇在孕期使用了抗艾滋病病毒药物。孕次多(OR=0.794)、孕期确认HIV感染(OR=0.277)、配偶或性伴HIV感染(OR=0.644)、择期剖宫产(OR=0.314)、孕期随访次数多(1~2次OR=0.205、3~5次OR=0.115、>5次OR=0.085)、孕期检测过乙肝抗体(OR=0.307)、丈夫嫖娼(OR=0.143)、新生儿低出生体质量(OR=0.355)的服药比例较高;产时确认HIV感染(OR=9.912)、艾滋病检测后无咨询(OR=4.276)、丈夫未检测HIV或状态不详(OR=3.063、OR=2.302)、初次产检孕周>28周(OR=2.867)、出生孕周较大(33~36周OR=11.090、37~40周OR=10.912、41~42周OR=22.872)的不服药风险较高。结论较高的孕产期保健依从性、及时随访和咨询、较好的经济条件、丈夫参与度高可有效提高HIV感染产妇孕期抗艾滋病病毒药物的使用率。

Objective To analyze the influencing factors of effect of use of anti-HIV drugs during pregnancy in prevention of AIDS mother-to-child-transmission among HIV-infected mothers in Guangdong,provide a basis for improving corresponding work. Methods A multivariate logistic regression model was used to analyze the investigation data of neonates born by 1 365 HIV-infected mothers in Guangdong from January 2007 to June 2015. Results Among 1 365 HIV-infected mothers,686 cases（ 50. 26%） used anti-HIV drugs during pregnancy. The application rates of anti-HIV drugs were high among the HIV-infected mothers with more gravida（ OR = 0. 794）,confirmed HIV infection during pregnancy（ OR = 0. 277）,HIV infection of spouse/sex partner（ OR = 0. 644）,selective caesarean section（ OR =0. 314）,more follow-up times during pregnancy（ 1-2 times： OR = 0. 205; 3-5 times： OR = 0. 115; 5 times： OR = 0. 085）,HBV antibody detection during pregnancy（ OR = 0. 307）,commercial sex behavior of husband（ OR = 0. 143）,neonatal low birth weight（ OR =0. 355）. The risks of no medication were high among the mothers with confirmed intrapartum HIV infection（ OR = 9. 912）,no consultation after HIV detection（ OR = 4. 276）,lack or unknown status of HIV detection of husband（ OR = 3. 063,OR = 2. 302）,undergoing prenatal examination for the first time28 gestational weeks（ OR = 2. 867）,high gestational weeks（ 33-36 weeks： OR = 11. 090; 37-40 weeks：OR = 10. 912; 41-42 weeks： OR = 22. 872）. Conclusion High compliance of antenatal care,timely follow-up and consultation,good economic status,and more husband participation can effectively increase the use rate of anti-HIV drugs during pregnancy among HIV-infected mothers.