Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kean, Thailand.
J Int AIDS Soc. 2023 Feb;26(2):e26064. doi: 10.1002/jia2.26064.
INTRODUCTION: Young adults with perinatally acquired HIV (YA-PHIV) are facing transitions to adult life. This study assessed health risk behaviours (including substance use), mental health, quality of life (QOL) and HIV treatment outcomes of Thai YA-PHIV. METHODS: A cross-sectional study was conducted in Thai YA-PHIV aged 18-25 years who were enrolled in a prospective cohort study at five tertiary paediatric HIV care centres in Thailand. Study data were obtained through face-to-face interviews from November 2020 to July 2021. Assessments were performed for alcohol use (Alcohol Use Disorders Identification Test; AUDIT), smoking (Fagerstrom Test for Nicotine Dependence), drug/substance use (Drug Abuse Screening Test; DAST-10), depression (Patient Health Questionnaire for Adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder; GAD-7) and QOL (World Health Organization QOL Brief-Thai). HIV treatment outcomes were extracted from the National AIDS Program database. RESULTS: Of 355 YA-PHIV, 163 (46%) were males: their median age was 21.7 (interquartile range, IQR 20.2-23.5) years. There were 203 YA-PHIV (58%) who reported ever having sex; 141 (40%) were sexually active in the past 6 months, of whom 86 (61%) reported 100% condom use. Overall, 49 (14%) met the criteria for harmful alcohol use; 28 (7.9%) were alcohol dependent. Sixty (17%) were current smokers and 37 (11%) used drugs/substances. The frequency of moderate up to severe symptoms for depression was 18% and for anxiety was 9.7%. Their overall QOL was good in 180 (51%), moderate in 168 (47%) and poor in five (1.4%). There were 49 YA-PHIV (14%) with CD4 <200 cells/mm and 85 (24%) with virologic non-suppression (HIV-RNA >200 copies/ml). On multivariate analyses, the highest education at the primary to high school or vocational school levels (adjusted odds ratio [aOR] 2.02, 95% CI 1.40-3.95, p 0.04), harmful alcohol use (aOR 2.48, 95% CI 1.24-4.99, p 0.01), alcohol dependence (aOR 3.54, 95% CI 1.51-8.31, p <0.01) and lifetime suicidal attempt (aOR 2.66, 95% CI 1.11-6.35, p 0.03) were associated with non-suppression. CONCLUSIONS: Regular screening for alcohol use and mental health, including suicidality, would be useful to identify YA-PHIV who need more intensive psychosocial support or referral services to ensure they can achieve and maintain a high QOL into adult life.
引言：患有围生期获得性 HIV（YA-PHIV）的年轻人正面临着向成年生活的过渡。本研究评估了泰国 YA-PHIV 的健康风险行为（包括药物使用）、心理健康、生活质量（QOL）和 HIV 治疗结果。 方法：在泰国的五家三级儿科 HIV 护理中心，对年龄在 18-25 岁之间的前瞻性队列研究中招募的泰国 YA-PHIV 进行了横断面研究。研究数据通过面对面访谈于 2020 年 11 月至 2021 年 7 月收集。评估包括酒精使用（酒精使用障碍识别测试；AUDIT）、吸烟（尼古丁依赖 Fagerstrom 测试）、药物/物质使用（药物滥用筛查测试；DAST-10）、抑郁（青少年患者健康问卷；PHQ-A）、焦虑（广泛性焦虑障碍；GAD-7）和 QOL（世界卫生组织 QOL 简短-泰语）。从国家艾滋病计划数据库中提取 HIV 治疗结果。 结果：在 355 名 YA-PHIV 中，有 163 名（46%）为男性：他们的中位年龄为 21.7 岁（四分位距，IQR 20.2-23.5）。有 203 名 YA-PHIV（58%）报告曾经发生过性行为；141 名（40%）在过去 6 个月内有过性行为，其中 86 名（61%）报告 100%使用避孕套。总体而言，49 名（14%）符合有害酒精使用标准；28 名（7.9%）酒精依赖。60 名（17%）为当前吸烟者，37 名（11%）使用药物/物质。中度至重度抑郁症状的发生率为 18%，焦虑症状的发生率为 9.7%。他们的整体 QOL 良好的有 180 名（51%），中等的有 168 名（47%），差的有 5 名（1.4%）。有 49 名 YA-PHIV（14%）的 CD4<200 个细胞/mm，85 名（24%）的病毒载量未抑制（HIV-RNA>200 拷贝/ml）。在多变量分析中，最高教育水平为小学至职业学校（调整后的优势比[aOR] 2.02，95%CI 1.40-3.95，p<0.01）、有害酒精使用（aOR 2.48，95%CI 1.24-4.99，p<0.01）、酒精依赖（aOR 3.54，95%CI 1.51-8.31，p<0.01）和终生自杀企图（aOR 2.66，95%CI 1.11-6.35，p<0.01）与未抑制有关。 结论：定期筛查酒精使用和心理健康，包括自杀意念，对于识别需要更强化的心理社会支持或转介服务的 YA-PHIV 很有用，以确保他们能够实现并保持成年后的高生活质量。
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