上海市长宁区HIV/AIDS病人抗病毒治疗开始时间及其影响因素

Time of antiretroviral therapy initiation of HIV/AIDS patients in Changning district, Shanghai and its effect factors

目的了解长宁区2018年3月1日到2019年6月31日新报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)开始抗病毒治疗(ART)的时间及其影响因素。方法对纳入的研究对象在HIV抗体确认阳性结果告知及首次流行病学调查后,进行面对面一对一问卷调查并随访观察其开始ART的时间。结果共调查195名HIV/AIDS病人,平均年龄(32.20±10.35)岁,外省市户籍占70.26%;均为性传播感染,其中90.26%为男男性行为感染;发现即报告为AIDS的60人(30.77%);HIV抗体确认阳性时同时检测CD4+T淋巴细胞计数,均值为(282.80±151.25)个/mm3。26.67%(52例)的病人HIV抗体确认阳性时有不适主诉。对ART完全不了解的占36.41%(71例),有24.62%(48例)的病人知道领取ART药物处。195例病人中确认阳性后6个月内开始ART有168人(86.15%),在研究观察周期内从确认阳性到开始ART的平均时间为(2.44±1.57)个月。6个月后仍未用药的最主要原因是"工作忙,没时间去看病""担心药物不良反应"以及"感觉没有什么不舒服,不需要用药"。通过Logistic回归分析发现本地户籍,有不适主诉的HIV/AIDS病人更有可能较早启动抗病毒治疗。进一步对外地户籍病人进行Logistic回归分析发现,非全职工作以及有不适主诉外地户籍的HIV/AIDS病人更有可能较早启动ART。结论大部分HIV/AIDS病人都能在HIV抗体确诊阳性6个月内进行ART,能否较早启动抗病毒治疗与户籍及是否有不适主诉相关。

Objective To explore the time of antiretroviral therapy(ART)initiation among the HIV/AIDS patients from March 1 st,2018 to June 31 st,2019 in Changning district,Shanghai and its effect factors.Methods A face-to-face and one-to-one questionnaire survey was conducted for those recruited interviewees diagnosed as HIV positive in the study period after their first epidemiological survey and the time of ART initiation was observed.Results 195 HIV/AIDS patients were recruited in the study period.The average age of the subjects were 32.20±10.35 years old;70.26%of them were non-local residences;all of them were infected through sexual transmission,among which 90.27%were infected via homosexual transmission and 60(30.8%)patients were reported as AIDS right after the detection.The average CD4+T lymphocyte count was(282.80±151.25)/mm3 and 26.7%(52 cases)had complaints of discomfort when they were diagnosed as HIV positive.36.41%(71 cases)patients were not aware of ART and only 24.61%(48 cases)knew where to get antiviral medicine and treatment.Among the 195 HIV cases,168(86.15%)started ART within 6 months after HIV diagnosis.The average time for those who started their ART after diagnosis was(2.44±1.57)months.The top three reasons not starting their ART within 6 months were"too busy to visit doctors","concern about the side effects"and"no need to use medicine since there were no symptoms".The logistic regression analysis showed that the HIV/AIDS patients of local residents with no complaints of discomfort were more likely to start ART earlier.Further study indicated that the non-local residents of HIV infection without fulltime jobs and with complaints of discomfort were more likely to start ART earlier.Conclusion Most HIV/AIDS patients will initiate ART within 6 months after HIV positive diagnosis.However,early initiation of ART is related to household registration and complaints of discomfort.