男男性行为者HIV-1急性期感染的干预对策及效果分析

Intervention countermeasures and effect analysis of HIV-1 acute phase infection in MSM population

目的探讨男男性行为者(men who have sex with men, MSM)HIV急性期感染(acute HIV infection, AHI)干预措施的有效性。方法对200例MSM HIV-1急性期感染的药物干预、疗效,以及针对这一特殊群体的日常干预对策及效果进行回顾性分析。结果采取抗病毒治疗综合管理措施后,感染者的病毒抑制率达到97%;除3例失联导致失访外,其余感染者服药的依从性良好;其中26例带性伴进行了HIV检测;所有感染者接受了梅毒检测,对梅毒快速血浆反应素试验(rapid plasma reaction, RPR)阳性感染者进行规范治疗及随访;2例肛周脓肿患者接受了手术治疗;HIV感染者使用安全套的比例有所提高,达到68%;3例轻度抑郁患者经药物治疗后病情好转;76%的感染者参加了心理减压活动。结论针对MSM人群中HIV-1急性期感染者,采取积极的药物治疗能有效抑制HIV,延缓疾病发展。同时根据疾病特点及感染者的个性需求制定个体化的管理方案,结合以互联网为载体的干预措施,能够提高患者对药物治疗的依从性,从而维持长期的病毒抑制,改善患者的生存质量。

Objective To investigate the effectiveness of multi-component intervention for HIV-1 acute infection in men who have sex with men（MSM） population. Methods Multi-component intervention was conducted among 200 MSM with acute HIV infection. The effectiveness of this intervention were retrospectively analyzed. Results Two hundred cases of acute HIV-1 infection in this group had good treatment compliance with a virus suppression rate of 97%.There were no serious adverse reactions and immune reconstitution syndrome. Twenty-six of them were tested for HIV with their sexual partners and 3 people lost contact. All patients received syphilis test. RPR-positive patients underwent standardized treatment and follow-up. Two patients with perianal abscess underwent surgery. The use rate of condom in HIV infected patients was increased to 68%. Three patients with mild depression were improved after treatment. 76% of the patients participated in psychological decompression activities. Conclusion According to the disease characteristics and personal needs, case management model is applied to the people with HIV-1 infection in the MSM population. Internet-based interventions, peer educators and integrated care services play a key role in promoting acute-phase antiretroviral therapy adherence and achieving long-lasting viral suppression.