“洞察”抗逆转录病毒治疗策略性时机（START）试验参与者入组时的传播风险行为。
Transmission risk behaviour at enrolment in participants in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial.
作者信息
Rodger A J, Lampe F C, Grulich A E, Fisher M, Friedland G, Phanuphak N, Bogner J R, Pereira L C, Rietmeijer C, Burman W, Phillips A N
机构信息
Research Department of Infection and Population Health, University College London, London, UK.
出版信息
HIV Med. 2015 Apr;16 Suppl 1(0 0):64-76. doi: 10.1111/hiv.12235.
OBJECTIVES
A proportion of HIV-positive people have condomless sex. Antiretroviral treatment (ART) reduces infectiousness, but a substantial proportion of HIV-diagnosed people are not yet on ART. We describe baseline self-reported risk behaviours in ART-naïve Strategic Timing of AntiRetroviral Treatment (START) trial participants.
METHODS
All START participants completed a risk behaviour questionnaire. Data were collected on sociodemographics, lifestyle factors, health and wellbeing status and clinical status. Recent sexual behaviour and HIV transmission beliefs in the context of ART were also assessed. The primary interest was in condomless sex with serodifferent partners (CLS-D) in the past two months.
RESULTS
A total of 4601 of 4685 HIV-positive participants (98%) completed the questionnaire [2559 men who have sex with men (MSM), 803 heterosexual men and 1239 women]. Region of recruitment was Europe/Israel, 33%; South America/Mexico, 25%; Africa, 22%; other, 21%. Median age was 36 years [interquartile range (IQR) 29, 44 years]. Forty-five per cent reported white ethnicity and 31% black ethnicity. Two per cent had HIV viral load < 50 HIV-1 RNA copies/mL. Seventeen per cent (767 of 4601) reported CLS-D; 20% of MSM compared with 10% of heterosexual men and 14% of women. MSM were also more likely to report multiple CLS-D partners. Possible risk limitation measures (reported by more than half of those who had CLS-D) were seropositioning (receptive anal CLS-D only) or withdrawal (insertive anal CLS-D always without ejaculation). CLS-D was more commonly reported by participants from South America/Mexico and North America compared with Europe; among heterosexual men and women CLS-D was also more commonly reported among participants from Africa compared with Europe. Knowledge of ART impact on transmission risk was low.
CONCLUSIONS
A substantial minority recruited to the START study reported CLS-D at baseline. CLS-D reporting was higher in MSM than heterosexuals and varied significantly according to region of recruitment. A substantial proportion of MSM reporting CLS-D appear to take transmission risk limitation measures.
目的
一部分艾滋病毒呈阳性的人有无保护性行为。抗逆转录病毒治疗（ART）可降低传染性，但相当一部分已确诊感染艾滋病毒的人尚未接受抗逆转录病毒治疗。我们描述了初治抗逆转录病毒治疗策略性时机（START）试验参与者的基线自我报告风险行为。
方法
所有START参与者均完成了一份风险行为问卷。收集了社会人口统计学、生活方式因素、健康和幸福状况以及临床状况的数据。还评估了近期性行为以及在抗逆转录病毒治疗背景下的艾滋病毒传播观念。主要关注的是过去两个月内与血清学不同的伴侣发生的无保护性行为（CLS-D）。
结果
4685名艾滋病毒呈阳性的参与者中有4601名（98%）完成了问卷[2559名男男性行为者（MSM）、803名异性恋男性和1239名女性]。招募地区为欧洲/以色列，占33%；南美/墨西哥，占25%；非洲，占22%；其他地区，占21%。中位年龄为36岁[四分位间距（IQR）29，44岁]。45%报告为白人种族，31%报告为黑人种族。2%的人艾滋病毒载量<50拷贝/mL HIV-1 RNA。17%（4601人中的767人）报告有CLS-D；男男性行为者中有20%，异性恋男性中有10%，女性中有14%。男男性行为者也更有可能报告有多个CLS-D伴侣。可能的风险限制措施（超过一半有CLS-D的人报告）是血清学定位（仅接受性肛门CLS-D）或抽出（插入性肛门CLS-D始终不射精）。与欧洲相比，南美/墨西哥和北美的参与者更常报告有CLS-D；在异性恋男性和女性中，与欧洲相比，非洲的参与者也更常报告有CLS-D。对抗逆转录病毒治疗对传播风险影响的了解程度较低。
结论
START研究招募的相当一部分少数参与者在基线时报告有CLS-D。男男性行为者报告CLS-D的比例高于异性恋者，且根据招募地区的不同有显著差异。相当一部分报告有CLS-D的男男性行为者似乎采取了传播风险限制措施。
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