2019-2022年湖南省352对HIV单阳家庭ART周期6月及以上先证者致配偶阳转的危险因素研究  

A study on risk factors of 352 HIV single positive family proband(ART≥6 months)leading to positive spouse transfer from 2019 to 2022

作　　者：李秋 刘慧[2] 唐美秀[2] 夏彦昌 何震 陈曦[3] 罗飞 曾灿 杨双波 LI Qiu;LIU Hui;TANG Meixiu;XIA Yanchang;HE Zhen;CHEN Xi;LUO Fei;ZENG Can;YANG Shuangbo(The First People's Hospital of Chenzhou City,Chenzhou 423000,Hunan Province,China;Changsha Medical University,Changsha 410219,Hunan Province,China;Hunan Center for Disease Control and Prevention,Changsha 410028,Hunan Province,China;Changsha Center for Disease Control and Prevention,Changsha 410024,Hunan Province,China;Xiangnan University,Chenzhou 423099,Hunan Province,China;Qiannan College of Ethnic Medicine,Duyun 558000,Guizhou Province,China)

机构地区：[1]郴州市第一人民医院,湖南郴州423000 [2]长沙医学院,长沙410219 [3]湖南省疾病预防控制中心,长沙410028 [4]长沙市疾病预防控制中心,长沙410024 [5]湘南学院,湖南郴州423099 [6]黔南民族医学高等专科学校,贵州都匀558000

出　　处：《预防医学情报杂志》2023年第9期1078-1084,共7页Journal of Preventive Medicine Information

基　　金：湖南省教育厅科学研究项目(项目编号:21C0898);湖南省卫生计生委项目(项目编号:202212055151);湖南省教育厅重点项目(项目编号:22A0657)。

摘　　要：目的 调查并分析艾滋病病毒(HIV)单阳家庭中,导致接受为期6个月及以上抗反转录病毒治疗(ART)患者感染阴性配偶的危险因素。方法 2019年3月至2022年12月,对湖南省长沙市、邵阳市、郴州市352对HIV单阳家庭(先证者ART治疗时间≥6个月)进行随访研究(间隔6个月/次,合计4次,共24个月)。观察阴性配偶阳转情况,比较先证者和阴转阳患者各随访时间点HIV病毒载量和CD4^(+)T淋巴细胞的差异。单因素分析15项因素对阴性配偶阳转的影响;拟合回归方程分析自变量(影响显著的单因素)对因变量(阴性配偶阳转结果)的综合影响,以P<0.05为差异有统计学意义。结果 随访结束时,352例阴性配偶中发生21例阳转(阳转率5.97%)。随着随访时间推移,先证者和阴转阳患者HIV病毒载量均有下降,CD4^(+)T淋巴细胞均有增加,差异均有统计学意义(P均<0.001)。单因素分析:先证者层面4项因素(WHO临床分期、全程ART治疗规范情况、末次HIV病毒载量、末次CD4^(+)T淋巴细胞);阴性配偶层面2项因素(定期体检、行为和饮食习惯自评);配偶双方层面4项因素(结婚年限、性行为频率、性行为保护措施、单方或双方合并性病情况)对阴性配偶阳转的影响有统计学意义(P均<0.05)。回归分析:未坚持每次都用安全套(OR=13.040)、性行为频率>3次/月(OR=10.570)、先证者末次HIV病毒载量≥4.7(OR=8.508)是影响阴性配偶阳转的主要因素。结论 HIV单阳家庭先证者虽有短期ART治疗,但阴性配偶依然有一定阳转比例。规范且长时间ART治疗不仅可控制患者体内病毒载量且增强其免疫功能,保持安全性行为和生殖健康、加强健康关注、和谐家庭关系均有助于降低阴性配偶阳转风险。Objective To investigate and analyze the risk factors for the infection of negative spouses in HIV-positive households in patients receiving antiretroviral therapy(ART)for more than 6 months.Methods From March 2019 to December 2022,a follow-up study was conducted on 352 HIV single positive families(proband ART treatment duration≥6 months)in Changsha,Shaoyang and Chenzhou Cities of Hunan Province(1 time/6 monthes,total 4 times,a total of 24 months).The difference of HIV viral load and CD4^(+)T lymphocytes between positive and negative positive patients at each follow-up time point was observed.The influence of 15 factors on the positive turn of negative e spouse was analyzed by univariate analysis.The regression equation was fitted to analyze the comprehensive influence of the independent t variable(single efactor withsignificant influence)on the dependent variable(negative spouse positive change result).P<0.05 was considered to be statistically significant.Results At the end of follow-up,21 of the 352 negative spouses had positive transformation(positive transformation rate of 5.97%).As the follow-up time went by,HIV viral load decreased and CD4^(+)T lymphocytes increased in both positive and negative transformation patients,the differences were statistically significant(all P<0.001).Univariate analysis showed 4 factors at the level of positive patients(WHO clinical stage,standard status of ART therapy,last HIV viral load,and last CD4^(+)T lymphocytes).Two factors at the negative spouse level(regular physical examination,self-assessment of behavior and eating habits);At the level of both spouses,four factors(marriage years,frequency of sexual behavior,sexual behavior protection n measures,one or both parties with sexually transmitted diseases)had statistically significant effects on the positive turn of negative spouses(all P<0.05).Regression analysis:Failure to use condoms every time(OR=13.040),sexual frequency>3times/month(OR=10.570),the last HIV viral load of positive patients≥4.7(OR=8.508)were the main fa

关 键 词：艾滋病病毒 单阳家庭 抗反转录病毒治疗 先证者 阴性配偶 抗体阳转 危险因素 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]