Predictors of antiretroviral therapy initiation: a cross-sectional study among Chinese HIV-infected men who have sex with men.
Predictors of antiretroviral therapy initiation: a cross-sectional study among Chinese HIV-infected men who have sex with men.
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DOI：
10.1186/s12879-015-1309-x
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发表时间：
2015-12-15
影响因子：
3.7
通讯作者：
Qian HZ
中科院分区：
文献类型：
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作者：
Liu Y;Ruan Y;Vermund SH;Osborn CY;Wu P;Jia Y;Shao Y;Qian HZ
早期开始抗逆转录病毒治疗（ART）对于实现HIV病毒抑制和减少传播至关重要。与其他HIV感染者相比，中国男男性行为者（MSM）HIV感染者开始ART的可能性更小。我们评估了中国男男性接触者开始ART治疗的预测因素。2010-2011年，在中国北京的MSM中进行了横断面研究。我们检查了在参与调查之前被诊断为HIV感染的亚组中ART的启动情况。Logistic回归模型拟合，以评估社会人口和行为因素与ART启动。2010/2011年国家艾滋病毒治疗指南的合格标准是CD 4细胞计数<350个细胞/μL或世界卫生组织（世卫组织）临床III/IV期。在238名合格的HIV感染者中，HIV感染的中位持续时间为15个月（范围：31天至12岁）; 62在103例CD 4计数<350个细胞/μL的男性中，38例（26.1%）已开始ART治疗，（36.9%）开始抗逆转录病毒疗法。（校正比值比[aOR]：2.50; 95%置信区间[CI]：1.07-5.87），HIV感染持续时间较长（aOR：10.71; 95% CI：3.66-31.32）和梅毒合并感染（aOR：2.58; 95% CI：1.04-6.37）与开始ART的可能性较高相关。在135名CD 4计数≥350个细胞/μL的男性中，24名（18%）开始接受抗逆转录病毒治疗。（aOR：4.21; 95%CI：1.60-11.06），HIV感染持续时间较长（aOR：22.4; 95% CI：2.79-180），年龄较大（aOR：1.26; 95%CI：1.1-1.44），北京户口（aOR：4.93; 95% CI：1.25-19.33），存在艾滋病样临床症状（aOR：3.97; 95% CI：1.32-14.0）和性传播感染史（aOR：4.93; 95% CI：1.25-19.43）与ART开始相关。与没有开始ART的男性相比，接受ART的男性更有可能接受关于ART益处的咨询（96.8%vs66.4%，P = 0 < 0.01），艾滋病污名应对策略（75.8%对65.9%，P = 0.04），心理健康（66.1%对52.9%，P = 0.02），物质使用（46.7%对36.6%，P = 0.04）。我们记录了中国男男性接触者的低ART启动率。在中国，扩大抗逆转录病毒治疗资格和干预措施以改善艾滋病毒护理连续性的政策变化正在进行中。影响评估有助于评估男男性行为者开始抗逆转录病毒治疗的持续障碍。
Early antiretroviral therapy (ART) initiation is crucial to achieve HIV viral suppression and reduce transmission. HIV-infected Chinese men who have sex with men (MSM) were less likely to initiate ART than other HIV-infected individuals. We assessed predictors of ART initiation among Chinese MSM. In 2010–2011, a cross-sectional study was conducted among MSM in Beijing, China. We examined ART initiation within the subgroup who were diagnosed with HIV infection prior to participation in the survey. Logistic regression models were fitted to evaluate socio-demographic and behavioral factors associated with ART initiation. The eligibility criterion in the 2010/2011 national HIV treatment guidelines was CD4 cell count <350 cells/μL or World Health Organization (WHO) clinical stage III/IV. Of 238 eligible HIV-infected participants, the median duration of HIV infection was 15 months (range: 31 days-12 years); 62 (26.1 %) had initiated ART. Among 103 men with CD4 counts <350 cells/μL, 38 (36.9 %) initiated ART. Being married to a woman (adjusted odd ratios [aOR]: 2.50; 95 % confidence interval [CI]: 1.07-5.87), longer duration of HIV infection (aOR: 10.71; 95 % CI: 3.66-31.32), and syphilis co-infection (aOR: 2.58; 95 % CI: 1.04-6.37) were associated with a higher likelihood of ART initiation. Of 135 men with CD4 count ≥350 cells/μL, 24 (18 %) initiated ART. Being married to a woman (aOR: 4.21; 95 % CI: 1.60-11.06), longer duration of HIV infection (aOR: 22.4; 95 % CI: 2.79-180), older age (aOR: 1.26; 95 % CI: 1.1-1.44), Beijing Hukou (aOR: 4.93; 95 % CI: 1.25-19.33), presence of AIDS-like clinical symptoms (aOR: 3.97; 95 % CI: 1.32-14.0), and history of sexually transmitted infections (aOR: 4.93; 95 % CI: 1.25-19.43) were associated with ART initiation. Compared with men who did not initiated ART, those with ART were more likely to receive counseling on benefits of ART (96.8 % vs. 66.4 %, P = 0 < 0.01), HIV stigma coping strategy (75.8 % vs. 65.9 %, P = 0.04), mental health (66.1 % vs. 52.9 %, P = 0.02), and substance use (46.7 % vs. 36.6 %, P = 0.04). We documented low rates of ART initiation among Chinese MSM. Policy changes for expanding ART eligibility and interventions to improve the continuum of HIV care are in progress in China. Impact evaluations can help assess continuing barriers to ART initiation among MSM.