男性HIV感染者抗病毒治疗后自然性行为的HIV传播风险观察  

An observation on the risk of HIV transmission through natural sex in male patients with HIV infection af⁃ter ART

作　　者：朱郇荣[1] 李宝金[2] 李凌华[3] ZHU Xunrong;LI Baojin;LI Linghua(Department of Urology,Guangzhou Eighth People′s Hospital,Guangzhou 510070,China;不详)

机构地区：[1]广州市第八人民医院泌尿科,广州510070 [2]广州市第八人民医院外科,广州510070 [3]广州市第八人民医院感染病中心,广州510070

出　　处：《实用医学杂志》2021年第6期751-754,共4页The Journal of Practical Medicine

基　　金：国家十三五科技重大专项课题(编号:2018ZX10302103-002,2017ZX10202102-003-004);广州市科技创新委员会健康医疗协同创新重大计划课题(滚动)项目(编号:201803040002)。

摘　　要：目的评估男性单方HIV阳性的夫妇或伴侣因生育目的进行自然性交传播HIV的风险。方法 58对男性HIV单阳夫妇或伴侣在男方已接受高效联合抗病毒治疗(ART)超过一年,外周血和精液HIV-1 RNA检测均<20拷贝/m L,CD4~+T淋巴细胞计数>250 cells/μL情况下以生育为目的,进行无安全套性行为。女方事前被告知HIV感染的风险及规避方法且暴露前后均未服用预防药,于每个月排卵期无安全套性生活2~3次,不超过6个月。于最后一次性生活后3、6、12、18个月检测HIV抗体(化学发光法或金标法)。结果接受ART 12~48月(中位数18个月)的58例HIV阳性男性[年龄23~45岁,平均(31.6±4.9)岁],其外周血和精液各至少1次HIV-1 RNA <20拷贝/m L,CD4~+T淋巴细胞计数平均(518.4±167.4)cells/μL,较ART前CD4~+计数[平均(310.7±130.6)cells/μL]明显增高(t=10.281,P <0.001),与性伴侣进行无套性行为3~6个月(中位数6个月),所有女方检测HIV抗体均阴性,其中4例自然怀孕,2例出生孩子检测HIV抗体均阴性。结论 ART治疗成功的男性HIV感染者通过性行为传染给异性伴侣HIV的风险相当低。Objective To explore the risk of transmission of HIV through unprotected sexual intercourse for childbearing purpose in married or unmarried serodiscordant couples in which the male partner has tested posi⁃tive for HIV.Methods The male partners of 58 couples had received antiretroviral therapy(ART)for more than one year.Under the condition of HIV⁃1 RNA being<20 copies/mL and CD4+T lymphocyte count>250 cells/μL,the couples who desired to have children had vaginal intercourse without condoms.The female partners were informed in advance the risk of HIV infection and the prevention methods and did not take prophylactic medications before and after sexual contact.They had sex without condom use 2 to 3 times during the period of ovulation for less than 6 months,and HIV antibodies were tested 3,6,12,and 18 months after their last sexual intercourse.Results 58 HIV⁃positive male patient[ages from 23 to 45 years,an average age of(31.6±4.9)years]received ART for 12 to 48 months(a median of 18 months).HIV⁃1 RNA was less than 20 copies/mL in peripheral blood and in semen at least once.The average count of CD4+T⁃lymphocyte(518.4±167.4)cells/μL after the therapy was markedly greater than the baseline[(310.7±130.6)cells/μL,t=10.281,P<0.001].All the patients had unprotected sex with their partners for 3 to 6 months(median:6 months).All the female partners were tested negative for HIV antibodies and 4 of them became pregnant.Two infants were tested negative for HIV antibodies.Conclusions Men who are successfully treated with ART have a relatively low risk of passing HIV to his hetero⁃sexual partner by sex.

关 键 词：HIV感染者 性途径传播 单阳夫妇 

分 类 号：R512.91[医药卫生—内科学]