美沙酮维持治疗人群中HIV/HCV双重感染者的HCV治疗现状及影响因素

HCV treatment status and the influencing factors among drug users receiving methadone maintenance treatment with HIV and HCV co-infection

目的分析在云南省的美沙酮维持治疗人群中艾滋病病毒（HIV）/丙型肝炎病毒（HCV）双重感染者的HCV治疗现状及影响因素。方法采用方便抽样方法,在昆明市、大理州7个美沙酮维持治疗门诊对HIV/HCV双重感染者开展问卷调查,调查内容主要包括人口学特征、治疗现状、知识知晓和社会支持现状。采用χ2检验作单因素分析,Logistic回归作多因素分析。结果共调查310例HIV/HCV双重感染者,8.1%（25例）接受HCV治疗,80.0%（248例）接受了艾滋病抗病毒治疗（ART）,其中有89.9%（223/248）未接受抗HCV治疗。对285例未接受HCV治疗开展原因调查,76.8%（219例）是由于无法承担医疗费用。对310例作单因素分析显示：年收入、文化程度、HCV知识知晓水平、社会支持、医务人员有无提供过接受HCV治疗建议、是否在接受ART和是否检测过HCV核糖核酸,是影响接受HCV治疗的因素（P〈0.05）。Logistic回归分析结果显示：知晓HCV知识[比值比（OR）=0.376,95%可信区间（CI）：0.150-0.942]、接受过HCV核酸检测（OR=0.407,95%CI：0.168-0.983）的调查对象更容易接受HCV治疗。结论 HIV合并HCV感染者接受HCV治疗比例较低,无法承担医疗费用是最大的阻碍因素。另外患者对疾病的认知程度、医疗服务的接受情况和相关政策,均是影响HIV/HCV双重感染者接受HCV治疗的因素。

Objective To analyze the HCV treatment status and influencing factors among drug users with HIV（acquired immunodeficiency virus）and HCV（hepatitis C virus）co-infection in Yunnan province.Methods During July-December 2016,aquestionnaire investigation was conducted among 310 subjects by convenience sampling in 7 methadone maintenance treatment clinics in Kunming and Dali cities.The main contents of the survey included demographic characteristics,treatment status,knowledge awareness and status of social support.Chi-square test was used as single factor analysis,and logistic regression was used as multifactor analysis.Results The rate of HCV treatment among 310 respondents was 8.1%（25/310）,80.0%（248/310）received HIV antiviral treatment and89.9%（223/248）did not receive HCV treatment in people receiving HIV antiviral treatment.285 cases receiving HCV treatment were investigated and the results showed that 76.8%（219/285）was unable to bear the medical expenses.A result of univariate analysis showed that the annual income HCV knowledge level,social support,and recommendations on HCV treatment by doctors,and HIV treatment or HCV RNA test,education level were the factors HCV treatment（P〈0.05）.Logistic regression analysis showed that the cases aware of HCV（OR=0.376,95%CI：0.150-0.942）,being tested with HCV RNA test（OR =0.407,95%CI：0.168-0.983）,recommended on HCV treatment by doctors（OR=0.343,95%CI：0.105-1.115）were more likely to receive HCV treatment.Conclusion The rate of HCV treatment among people with HIV and HCV co-infection is relatively low,and the main factors is because they cannot offord the medical expenses.In addition,patients′awareness of the disease,acceptance of the medical services and the relative policies are all factors related to HCV treatment among people with HIV and HCV co-infection.