2012—2017年广西HIV-1单阳家庭阳性配偶未接受抗病毒治疗影响因素分析

目的 了解HIV-1单阳家庭阳性配偶未接受抗病毒治疗情况及相关影响因素。 方法 从国家艾滋病防治基本信息系统中下载数据库,采用回顾性研究方法,利用Cox比例风险模型分析2012—2017年报告的单阳家庭阳性配偶/固定性伴抗病毒治疗情况及未治疗的影响因素。 结果 截至2017年12月31日,纳入分析的研究对象为13 191例,HIV-1单阳家庭阳性配偶/固定性伴抗病毒治疗率为86.65/100人年。Cox回归结果显示:2013—2017年治疗率是2012年的1.17～1.54倍(95%CI:1.09～1.65);女性是男性的1.07倍(95%CI:1.01～1.13);≥50岁组是18～49岁组的0.50～0.87倍(95%CI:0.46～0.91);同居是已婚有配偶的0.89倍(95%CI:0.81～0.97);壮族是汉族的1.06倍(95%CI:1.02～1.11);初中及以上文化程度是小学及以下的1.13～1.24倍(95%CI:1.08～1.33);最近一次CD4细胞计数为≥200个/μl组是<200个/μl组的0.45～0.95倍(95%CI:0.42～1.00),CD4未检测组是<200个/μl组的0.28倍(95%CI:0.24～0.33);样本来源于医疗机构、婚/孕/产检、其他,分别是咨询检测的0.91倍(95%CI:0.87～0.96)、0.78倍(95%CI:0.72～0.84)、0.72倍(95%CI:0.65～0.79)。 结论 为进一步提高单阳配偶抗病毒治疗率,控制单阳家庭内传播,应根据影响治疗的相关因素制定针对性应对策略,切实做好治疗动员工作,重点关注老年人、低文化程度者以及CD4 细胞计数较高者,引导患者及早进行抗病毒治疗。

Factors affecting sero-positive partners failing to receive antiretroviral therapy among HIV-1 sero-discordant couples in Guangxi, 2012-2017

Objective To understand the situation and related influencing factors of sero-positive partners failing to receive antiretroviral therapy (ART) in HIV-1 sero-discordant couples in Guangxi from 2012 to 2017. Methods Data were collected from the National Basic Information System for HIV/AIDS Prevention and Control. Retrospective study method and cause-specific Cox proportional hazard models were used to analyze the situation of sero-positive partners or fixed sexual partners receiving ART and the factors affecting them failing to receive ART in HIV-1 sero-discordant couples in Guangxi during 2012-2017. Results A total of 13,191 cases were enrolled in this study as of December 31, 2017, and the rate of receiving ART in sero-positive partners or fixed sexual partners in HIV-1 sero-discordant couples was 86.65 per 100 person-years. Results from Cox proportional hazard models revealed that the related factors and AHRs for ART rate appeared as:HIV positive confirmation in 2013-2017 (vs. 2012, AHR=1.17-1.54, 95%CI:1.09-1.65), females (vs. males, AHR=1.07, 95%CI:1.01-1.13), the group aged ≥50 years (vs. the group aged 18-49 years, AHR=0.50-0.87, 95%CI:0.46-0.91), cohabitants (vs. the married,AHR=0.89, 95%CI:0.81-0.97), Zhuang ethnic group (vs. Han ethnic group,AHR=1.06, 95%CI:1.02-1.11), junior high school education level or above (vs. primary school or below, AHR=1.13-1.24, 95%CI:1.08-1.33), the group with recent CD4 count ≥ 200 cells/μl (vs. the group with recent CD4 count < 200 cells/μl , AHR=0.45-0.95, 95%CI:0.42-1.00), the group without CD4 cell testing (vs. the group with CD4 count < 200 cells/μl, AHR=0.28, 95%CI:0.24-0.33), and samples from medical institutions (vs. HIV voluntary counseling and testing (VCT), AHR=0.91, 95%CI:0.87-0.96), from premarital check-up/pregnancy testing/ prenatal examination (vs. VCT, AHR=0.78, 95%CI:0.72-0.84) and from other sources (vs. VCT, AHR=0.72, 95%CI:0.65-0.79). Conclusions Corresponding strategies should be made based on the related factorsinfluencing ARTso as to further improve the ART rate in sero-positive partners and control HIV-1 transmission in HIV-1 sero-discordant couples. We should make effortsto mobilize patients to receive ART,pay special attention to the elderly, people with low educational background and those with high CD4 cell count, and guide patients to receive ART as early as possible.