Solomon L, Frank R, Vlahov D, Astemborski J
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Am J Public Health. 1991 Oct;81(10):1285-90. doi: 10.2105/ajph.81.10.1285.
Intravenous drug users (IVDUs) with human immunodeficiency virus (HIV) infection and AIDS often have no health insurance or rely on public programs to finance their health care. We examined the independent contributions of HIV serostatus, clinical symptoms, CD4 cell counts, and health insurance to utilization of health services among 1881 intravenous drug users in Baltimore, Maryland.
Participants in an ongoing natural history study of HIV were informed of HIV serostatus and seropositives were informed of CD4 cell counts; 6 months later, participants were administered a questionnaire concerning self-reported use of health services, insurance coverage, and HIV-related symptoms.
Of 1881 participants, 67% had health insurance (including Medicaid), 48% had at least one outpatient visit, and 12% had at least one inpatient visit within the prior 6 months. The proportion of the study population that was HIV-1 seropositive was 32%. In multivariate analysis, the single most important predictor of health care utilization was the presence of two or more HIV-related clinical symptoms. HIV positive serostatus alone or known low CD4 counts were not significantly associated with use of health care services.
These data suggest that HIV seropositive IVDUs are not receiving recommended preventive care. Additional efforts will be needed to ensure that HIV-seropositive drug users participate in currently recommended protocols for early treatment of asymptomatic HIV-1 infection.
感染人类免疫缺陷病毒（HIV）并患有艾滋病的静脉吸毒者通常没有健康保险，或依赖公共项目来支付其医疗费用。我们研究了HIV血清状态、临床症状、CD4细胞计数和健康保险对马里兰州巴尔的摩市1881名静脉吸毒者医疗服务利用情况的独立影响。
在一项正在进行的HIV自然史研究中，告知参与者其HIV血清状态，向血清阳性者告知其CD4细胞计数；6个月后，向参与者发放一份问卷，询问其自我报告的医疗服务使用情况、保险覆盖情况以及与HIV相关的症状。
在1881名参与者中，67%有健康保险（包括医疗补助），48%在过去6个月内至少有一次门诊就诊，12%在过去6个月内至少有一次住院就诊。研究人群中HIV-1血清阳性的比例为32%。在多变量分析中，医疗服务利用的最重要单一预测因素是存在两种或更多与HIV相关的临床症状。单纯HIV阳性血清状态或已知的低CD4计数与医疗服务使用无显著关联。
这些数据表明，HIV血清阳性的静脉吸毒者未接受推荐的预防性护理。需要做出更多努力，以确保HIV血清阳性吸毒者参与目前推荐的无症状HIV-1感染早期治疗方案。
