HIV/AIDS患者抗病毒治疗前后不安全性行为变化及影响因素

Factors Associated with Unsafe Sexual Behavior Among HIV/AIDS Patients Pre-and Post-Antiretroviral Treatment

目的了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)患者(简称HIV/AIDS患者)抗病毒治疗(ART)前后不安全性行为变化情况及其影响因素。方法收集云南省玉溪市2009年1月-2014年12月间入组ART者治疗前后随访记录、历史卡片和治疗数据库的相关信息,对不安全性行为发生率进行对比分析。结果 HIV/AIDS患者中988例ART前后1年内分别有70例(7.09%)和147例(14.88%)自述发生过不安全性行为。多因素Logistic回归分析显示:ART前后HIV感染途径为同性性传播者(MSM)和注射吸毒者,较异性性传播者更易发生不安全性行为;相较无配偶者,配偶HIV感染状况为阳性的HIV/AIDS患者ART前后均更易发生不安全性行为;相较入组时CD4^+T细胞<200 cell/μL组,CD4^+T细胞>500 cell/μL的HIV/AIDS患者ART前后均更倾向于不发生不安全性行为。与ART前3个月相比,ART 7～9个月(OR=1.91; 95%CI:1.44～2.37,P<0.05)和10～12个月(OR=2.07; 95%CI:1.71～2.55,P<0.05)不安全性行为发生率较高。CD4分层分析发现>350 cell/μL人群不安全性行为发生率高于<350 cell/μL人群。结论 HIV/AIDS患者接受ART后不安全性行为发生率较高,在为患者提供抗病毒治疗药物和随访时还需加强安全性行为的教育。

Objective To understand the factors associated with unsafe sexual behavior among HIV/AIDS patients before and after antiretroviral treatment(ART). Methods Date were collected from HIV/AIDS patients reporting cards, follow-up records and ART database between 2009 and 2014 in Yunnan province, Yuxi prefecture. The difference of the unsafe sexual behavior among HIV/AIDS patients before and after ART initiation were comparatively analyzed. Results Among 988 HIV/AIDS patients, there were 70 patients(7.09%) and 147 patients(14.88%) self-reported had unsafe sexual behavior before and after ART initiation respectively. Results from the multiple Logistic regression analysis indicated that those infected with HIV through male-to-male contact and intravenous injection were more likely to have unsafe sexual behavior before and after ART than those were infected through heterosexual contact. Those who had a HIV positive partner were more likely to have unsafe sexual behavior before and after ART than single patients. Those patients with CD4^+T cell more than 500 cell/μL groups were more likely had unsafe sexual behavior before and after ART than those with CD4^+ T cell less than 200 cell/μL. Unsafe sexual behavior increased nearly two-fold in 7~9 months(OR=1.91;95% CI:1.44~2.37, P<0.05) and 10~12 months(OR=2.07;95% CI:1.71~2.55, P<0.05) after ART initiation compared with 3 months before ART initiation. The proportions of sexual behavior and unsafe sexual behavior among those patients with CD4^+ T cell more than 350 cell/μL groups were higher than those were less than 350 cell/μL groups. Conclusion The occurrence rate of unsafe sexual behavior among HIV/AIDS patients increased after ART initiation, so safe sex education needs to be strengthened along with the treatment and follow up.