2012—2017年经性传播感染HIV青少年抗病毒治疗及时性及影响因素
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摘要
目的了解经性传播青少年艾滋病病毒(HIV)感染者的及时启动抗病毒治疗(ART)情况,并探讨其影响因素。方法回顾2012—2017年全国9 862例经性传播感染HIV青少年ART启动时的基线资料,确证阳性后30天内启动ART定义为及时ART,分析及时启动ART情况及其影响因素。结果 9 862例青少年感染者中,44.07%及时启动ART,中位启动时间14天(7～21天)。多因素Logistic回归分析表明,年龄较小者(15～17岁)[比值比(OR)=1.452,95%可信区间(CI):1.321～1.596]、CD4~+ T淋巴细胞(简称CD4细胞)<200个/μL者(OR=1.607,95%CI:1.414～1.825)和2016—2017年期间(OR=2.310,95%CI:2.017～2.645)更可能及时启动ART,男男性行为者(MSM)(OR=0.800,95%CI:0.718～0.891)更可能延迟启动ART。结论重点推动MSM、CD4细胞计数较高和较大年龄青少年感染者及时启动ART,可提高HIV感染青少年人群的治疗及时性,以降低其发病死亡风险和传染性。
Objective To understand the immediate antiretroviral therapy among adolescents with HIV infection through sexual transmission, and analyze its related predictors. Methods From 2012 to 2017, a total of 9 862 HIV-infected adolescents through sexual transmission across China received ART, whose baseline data at ART initiation were collected and used for the retrospective analysis of immediate ART and its related predictors. Results Among the 9 862 cases, 44.07% initiated immediate ART, of which the median interval time was 14 days(7-21 days). Multivariate logistic regression analysis showed that those with age between 15-17(OR=1.452,95% CI:1.321-1.596), CD4 count<200/μL(OR=1.607,95% CI:1.414-1.825), and infection diagnosed between 2016-2017(OR=2.310,95% CI:2.017-2.645) were more likely to initiate immediate ART, while MSM(OR=0.800,95% CI:0.718-0.891) adolescent patients were more likely to delay their treatment. Conclusion Immediate ART should be promoted among HIV-infected MSM, esp. those with high CD4 count and older adolescents to reduce their risk of morbidity, mortality and HIV transmission.
Objective To understand the immediate antiretroviral therapy among adolescents with HIV infection through sexual transmission, and analyze its related predictors. Methods From 2012 to 2017, a total of 9 862 HIV-infected adolescents through sexual transmission across China received ART, whose baseline data at ART initiation were collected and used for the retrospective analysis of immediate ART and its related predictors. Results Among the 9 862 cases, 44.07% initiated immediate ART, of which the median interval time was 14 days(7-21 days). Multivariate logistic regression analysis showed that those with age between 15-17(OR=1.452,95% CI:1.321-1.596), CD4 count<200/μL(OR=1.607,95% CI:1.414-1.825), and infection diagnosed between 2016-2017(OR=2.310,95% CI:2.017-2.645) were more likely to initiate immediate ART, while MSM(OR=0.800,95% CI:0.718-0.891) adolescent patients were more likely to delay their treatment. Conclusion Immediate ART should be promoted among HIV-infected MSM, esp. those with high CD4 count and older adolescents to reduce their risk of morbidity, mortality and HIV transmission.
引文
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[3] Cohen MS,Chen YQ,McCauley M,et al.Prevention of HIV-1 infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[4] Cohen MS,Chen YQ,McCauley M,et al.Antiretroviral Therapy for the Prevention of HIV-1 Transmission[J].N Engl J Med,2016,9(375):830-839.
[5] Joint United Nations Programme on HIV/AIDS.90-90-90:An ambitious treatment target to help end the AIDS epidemic[R].Geneva:Joint United Nations Programme on HIV/AIDS,2014.
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[8] 杨淑娟,王启兴,姚永娜,等.四川省凉山彝族自治州2011—2014年15～24岁人群HIV新发感染监测分析[J].中国艾滋病性病,2017,23(9):829-832.
[9] 韩梅,张维,欧阳琳,等.1999—2015年重庆市青少年人群HIV感染状况分析[J].中国艾滋病性病,2016,22(7):522-524.
[10] Sithole Z,Mbizvo E,Chonzi P,et al.Virological failure among adolescents on ART,Harare City,2017-a case-control study[J].BMC Infect Dis,2018,18(1):469.
[11] 谢年华,吴斯,许骏,等.武汉市男男性行为者扩大HIV检测和治疗的效果分析[J].中国艾滋病性病,2018,24(4):361-364.
[12] 鲍燕,沈冰,顾凯侃,等.上海市静安区218例男男性行为者感染HIV后早期抗病毒治疗的可接受性调查[J].中国艾滋病性病,2018,24(4):353-356.
[13] 罗珊霞,杨冬菊,黄霞,等.HIV感染者与AIDS患者感知歧视影响因素的横断面调查[J].中国循证医学杂志,2018,18(6):560-564.
[14] 黄玉满,沈智勇,万孝玲,等.广西艾滋病感染者/患者抗病毒治疗及时性影响因素分析[J].中国热带医学,2017,17(11):1089-1092,1101.
[15] Zhao Y,Wu Z,McGoogan JM,et al.Immediate Antiretroviral Therapy Decreases Mortality Among Patients With High CD4 Counts in China:A Nationwide,Retrospective Cohort Study[J].Clin Infect Dis,2018,66(5):727-734.
[16] 中国疾病预防控制中心性病艾滋病预防控制中心.国家免费艾滋病抗病毒药物治疗手册[M].北京:人民卫生出版社,2016.
[17] 张雪,徐小元.HIV/HCV合并感染者中两类抗病毒药物相互作用的研究[J].传染病信息,2017,30(6):327-330.
[18] 蒋莹莹,张晓慧,郑素军.HCV感染者抗病毒治疗前后免疫状态的变化[J].临床肝胆病杂志,2018,34(2):403-406.
[19] Nyesigire RE,Bajunirwe F,Kiwanuka J.Anaemia in HIV-infected children:severity,types and effect on response to HAART[J].BMC Pediatr,2012(12):170.
[2] Zhao Y,Wu Z,McGoogan JM,et al.Nationwide cohort study of antiretroviral therapy timing:treatment dropout and virological failure in China,2011-2015[J].Clin Infect Dis,2018,68(1):43-50.
[3] Cohen MS,Chen YQ,McCauley M,et al.Prevention of HIV-1 infection with early antiretroviral therapy[J].N Engl J Med,2011,365(6):493-505.
[4] Cohen MS,Chen YQ,McCauley M,et al.Antiretroviral Therapy for the Prevention of HIV-1 Transmission[J].N Engl J Med,2016,9(375):830-839.
[5] Joint United Nations Programme on HIV/AIDS.90-90-90:An ambitious treatment target to help end the AIDS epidemic[R].Geneva:Joint United Nations Programme on HIV/AIDS,2014.
[6] Koenig SP,Dorvil N,Devieux JG,et al.Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV:A randomized unblinded trial[J].PLoS Med,2017,14(7):e1002357.
[7] 许洁霜,钱序.青少年和青年友好服务[J].中国妇幼卫生杂志,2012,3(6):332-340.
[8] 杨淑娟,王启兴,姚永娜,等.四川省凉山彝族自治州2011—2014年15～24岁人群HIV新发感染监测分析[J].中国艾滋病性病,2017,23(9):829-832.
[9] 韩梅,张维,欧阳琳,等.1999—2015年重庆市青少年人群HIV感染状况分析[J].中国艾滋病性病,2016,22(7):522-524.
[10] Sithole Z,Mbizvo E,Chonzi P,et al.Virological failure among adolescents on ART,Harare City,2017-a case-control study[J].BMC Infect Dis,2018,18(1):469.
[11] 谢年华,吴斯,许骏,等.武汉市男男性行为者扩大HIV检测和治疗的效果分析[J].中国艾滋病性病,2018,24(4):361-364.
[12] 鲍燕,沈冰,顾凯侃,等.上海市静安区218例男男性行为者感染HIV后早期抗病毒治疗的可接受性调查[J].中国艾滋病性病,2018,24(4):353-356.
[13] 罗珊霞,杨冬菊,黄霞,等.HIV感染者与AIDS患者感知歧视影响因素的横断面调查[J].中国循证医学杂志,2018,18(6):560-564.
[14] 黄玉满,沈智勇,万孝玲,等.广西艾滋病感染者/患者抗病毒治疗及时性影响因素分析[J].中国热带医学,2017,17(11):1089-1092,1101.
[15] Zhao Y,Wu Z,McGoogan JM,et al.Immediate Antiretroviral Therapy Decreases Mortality Among Patients With High CD4 Counts in China:A Nationwide,Retrospective Cohort Study[J].Clin Infect Dis,2018,66(5):727-734.
[16] 中国疾病预防控制中心性病艾滋病预防控制中心.国家免费艾滋病抗病毒药物治疗手册[M].北京:人民卫生出版社,2016.
[17] 张雪,徐小元.HIV/HCV合并感染者中两类抗病毒药物相互作用的研究[J].传染病信息,2017,30(6):327-330.
[18] 蒋莹莹,张晓慧,郑素军.HCV感染者抗病毒治疗前后免疫状态的变化[J].临床肝胆病杂志,2018,34(2):403-406.
[19] Nyesigire RE,Bajunirwe F,Kiwanuka J.Anaemia in HIV-infected children:severity,types and effect on response to HAART[J].BMC Pediatr,2012(12):170.