艾滋病抗病毒治疗对配偶间人类免疫缺陷病毒传播的影响分析

摘要：目的  了解艾滋病抗病毒治疗对单阳配偶间人类免疫缺陷病毒（HIV）传播的影响。方法  采取回顾性队列研究的方法，选择百色市2005～2014年797例艾滋病患者及其未感染HIV的配偶为研究对象，根据患者接受抗病毒治疗状态分为治疗组和未治疗组随访观察阴性配偶的HIV转归，按患者不同年随访时间和基线特征分别计算阴性配偶每100人年HIV阳转率，并运用COX比例风险模型来评估治疗的风险比，运用Kaplan-Meier分析HIV阴性配偶仍保持阴性的概率。结果  在HIV血清结果不一致的797例阳性配偶中，治疗组与未治疗组患者分别为487例和310例，平均年龄分别为（41.234±12.326）和（36.903±12.267）岁，基线CD4+ T淋巴细胞计数分别为（222.856±145.112）和（514.900±233.792）个/mm3，中位随访时间分别为29（IQR：15～46）和31个月（IQR：18～52），两组均以男性、18～44岁、高中以下化程度、已婚、农民及农民工、壮族和异性性途径感染为主。随访期间共33例阴性配偶发生HIV阳转，阳转率为1.414/100人年，其中治疗组HIV阳转12例，阳转率为0.881/100人年，非治疗组HIV阳转21例，阳转率为2.159/100人年，经抗病毒治疗后配偶间HIV传播的危险性降低68.2%[AHR=0.318，（95%CI：0.125，0.807）]，但抗病毒治疗对配偶间HIV传播的保护性作用有统计学意义仅是随访的第2年[AHR=0.157，（95%CI：0.031，0.786）]。结论  在当前社会环境下，抗病毒治疗对预防配偶间HIV传播作用显著，但这种保护作用的持久性在桂西少数民族山区乃至发展中国家仍需进一步观察和研究，才能更好地推广治疗即预防的公共卫生策略。

Effect of antiviral therapy on prevention of HIV transmission between spouses

Abstract: Objective To understand the effect of antiviral therapy on HIV transmission among serodiscordant partners. Methods In this retrospective cohort study, 797 cases of serodiscordant partners in Western Guangxi Baise City between 2005 and 2014 were selected for the study. The annual rate and baseline characteristics of HIV infection were analyzed in the HIV negative partners during follow-up, and stratified by treatment status of the partients. The HIV positive rate of the HIV negative partners was calculated in 100 person per year. COX proportional hazard model was used to estimate relative risks between the treatment and untreated groups. Kaplan-Meier analysis was used to calculate the probabilities of the HIV-negative partners remaining negative. Results In the 797 HIV-positive spouses with inconsistent serum results, there were 487 in the treated group and 310 patients in the untreated group, In the the treated group and the untreated group, the average age was (41.234 ± 12.326) years and (36.903 ± 12.267) years respectively, the mean baseline CD4+ count was (222.856 ± 145.112) cells/mm3 and (514.900 ± 233.792) cells/mm3 respectively, the median follow-up time was 29 months (IQR:15-46) and 31 months (IQR: 18-52) respectively. The two groups mainly included the male patients of 18-44 years with or without high-school education, being married, farmers or migrant workers, Zhuang nationality and heterosexual infection. During the follow-up period, a total of 33 HIV-negative spouses became HIV-positive, the positive rate was 1.414/100 person per year, among which 12 cases in the treatment group had seroconversion, the positive rate was 0.881/100 person per year and 21 cases in the untreated group had seroconversion, the positive rate was 2.159/100 person per year. There was an overall reduction of 68.2% in the risk of HIV transmission after antiretroviral treatment [adjusted HR = 0.318 (95% CI: 0.125, 0.807) ]. The treatment was significantly protective only in the second year of follow-up [adjusted HR = 0.157 (95% CI: 0.031, 0.786)], but not in the first year or in subsequent years. Conclusions In the real social environment, antiretroviral therapy has significant effect on prevention of HIV transmission among serodiscordant couples. However, the persistence of this protective effect in western Guangxi minority areas and even developing countries still need further observation and study, to better promote treatment-as-prevention of public health strategies.