根据自我报告的抗逆转录病毒治疗情况和病毒载量状态，分析HIV感染者的性行为。
Sexual behaviour among people with HIV according to self-reported antiretroviral treatment and viral load status.
作者信息
Lampe Fiona C
机构信息
Research Department of Infection and Population Health, University College London, London, UK.
出版信息
AIDS. 2016 Jul 17;30(11):1745-59. doi: 10.1097/QAD.0000000000001104.
OBJECTIVE
To assess, among people with HIV, the association of self-reported antiretroviral treatment (ART) and viral load status with condomless sex with an HIV-serodifferent partner (CLS-D).
DESIGN
Cross-sectional study of 3258 HIV-diagnosed adults in the United Kingdom, 2011-2012.
METHODS
CLS-D in the past 3 months and self-reported ART/viral load were ascertained by questionnaire. Clinic-recorded viral load was documented. HIV-transmission risk sex (CLS-D-HIV-risk) was defined as CLS-D together with either not on ART or clinic-recorded viral load more than 50 copies/ml.
RESULTS
Of 3178 participants diagnosed more than 3 months ago, 2746 (87.9%) were on ART, of whom self-reported viral load was '50 copies/ml/ or less/undetectable' for 78.4%; 'more than 50 copies/ml/detectable' for 8.3%; 'do not know/missing' for 13.3%. CLS-D prevalence was 14.9% (326/2189), 6.4% (23/360) and 10.7% (67/629) among men who have sex with men, heterosexual men and women, respectively. Among men who have sex with men, CLS-D prevalence was 18.8% among those not on ART; 15.2% among those on ART with undetectable self-reported viral load; 9.8% among those on ART without undetectable self-reported viral load. Compared with 'on ART with undetectable self-reported viral load', prevalence ratios (95% confidence interval) adjusted for demographic/HIV-related factors were: 0.66 (0.45, 0.95) for 'on ART without undetectable self-reported viral load', and 1.08 (0.78, 1.49) for 'not on ART' (global P = 0.021). Among heterosexual men and women (combined), ART/self-reported viral load was not associated with CLS-D [corresponding adjusted prevalence ratios: 1.14 (0.73, 1.79) for 'on ART without undetectable self-reported viral load'; 0.88 (0.44, 1.77) for 'not on ART', P = 0.77]. CLS-D-HIV-risk prevalence was 3.2% among all participants; 16.1% for 'not on ART'; 0.6% for 'on ART with undetectable self-reported viral load; 4.2% for 'on ART without undetectable self-reported viral load.'
CONCLUSION
Use of ART was not associated with increased prevalence of CLS-D, and was associated with greatly reduced prevalence of HIV-transmission risk sex.
目的
在感染艾滋病毒的人群中，评估自我报告的抗逆转录病毒治疗（ART）及病毒载量状态与与艾滋病毒血清学不同的伴侣发生无保护性行为（CLS-D）之间的关联。
设计
2011年至2012年对英国3258名已确诊感染艾滋病毒的成年人进行的横断面研究。
方法
通过问卷调查确定过去3个月内的CLS-D以及自我报告的ART/病毒载量情况。记录临床检测的病毒载量。将艾滋病毒传播风险性行为（CLS-D-HIV-risk）定义为CLS-D且未接受ART治疗或临床检测的病毒载量超过50拷贝/毫升。
结果
在3178名3个月前确诊的参与者中，2746人（87.9%）接受了ART治疗，其中自我报告病毒载量为“50拷贝/毫升及以下/不可检测”的占78.4%；“超过50拷贝/毫升/可检测”的占8.3%；“不知道/缺失”的占13.3%。男男性行为者、异性恋男性和女性中CLS-D的患病率分别为14.9%（326/2189）、6.4%（23/360）和10.7%（67/629）。在男男性行为者中，未接受ART治疗者的CLS-D患病率为18.8%；自我报告病毒载量不可检测的接受ART治疗者中患病率为15.2%；自我报告病毒载量可检测的接受ART治疗者中患病率为9.8%。与“自我报告病毒载量不可检测的接受ART治疗者”相比，经人口统计学/艾滋病毒相关因素调整后的患病率比值（95%置信区间）为：“自我报告病毒载量可检测的接受ART治疗者”为0.66（0.45，0.95），“未接受ART治疗者”为1.08（0.78，1.49）（总体P=0.021）。在异性恋男性和女性（合并）中，ART/自我报告的病毒载量与CLS-D无关[相应的调整后患病率比值：“自我报告病毒载量可检测的接受ART治疗者”为1.14（0.73，1.79）；“未接受ART治疗者”为0.88（0.44，1.77），P=0.77]。所有参与者中CLS-D-HIV-risk的患病率为3.2%；“未接受ART治疗者”为16.1%；“自我报告病毒载量不可检测的接受ART治疗者”为0.6%；“自我报告病毒载量可检测的接受ART治疗者”为4.2%。
结论
使用ART与CLS-D患病率增加无关，且与艾滋病毒传播风险性行为的患病率大幅降低有关。
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