Liu Yu, Ruan Yuhua, Vermund Sten H, Osborn Chandra Y, Wu Pingsheng, Jia Yujiang, Shao Yiming, Qian Han-Zhu
Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
BMC Infect Dis. 2015 Dec 15;15:570. doi: 10.1186/s12879-015-1309-x.
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.
尽早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，感染HIV的中国男男性行为者（MSM）开始接受ART的可能性较小。我们评估了中国MSM中开始接受ART的预测因素。
2010年至2011年，在中国北京对MSM进行了一项横断面研究。我们在参与调查前被诊断为HIV感染的亚组中检查了ART的启动情况。采用逻辑回归模型评估与ART启动相关的社会人口学和行为因素。2010/2011年国家HIV治疗指南中的资格标准是CD4细胞计数<350个/μL或世界卫生组织（WHO）临床分期III/IV。
在238名符合条件的HIV感染参与者中，HIV感染的中位持续时间为15个月（范围：31天至12年）；62人（26.1%）开始接受ART。在103名CD4细胞计数<350个/μL的男性中，38人（36.9%）开始接受ART。与女性结婚（调整后的优势比[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）以及合并梅毒感染（aOR：2.58；95% CI：1.04 - 6.37）与开始接受ART的可能性较高相关。在135名CD4细胞计数≥350个/μL的男性中，24人（18%）开始接受ART。与女性结婚（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）、拥有北京户口（aOR：4.93；9 5% CI：1.25 - 19.33）、存在类似艾滋病的临床症状（aOR：3.97；95% CI：1.32 - 14.0）以及有性传播感染史（aOR：4.93；95% CI：1.25 - 19.43）与开始接受ART相关。与未开始接受ART的男性相比，开始接受ART的男性更有可能接受关于ART益处的咨询（96.8%对66.4%，P = 0 < 0.01）、HIV耻辱应对策略（75.8%对65.9%，P = 0.04）、心理健康（66.1%对52.9%，P = 0.02）以及药物使用（46.7%对36.6%，P = 0.04）。
我们记录了中国MSM中较低的ART启动率。中国正在进行扩大ART资格的政策变革以及改善HIV连续护理的干预措施。影响评估有助于评估MSM中开始接受ART的持续障碍。
