Effect of HIV Post-exposure Prophylaxis in Kunming City in 2019
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摘要:
目的 了解2019年昆明市艾滋病病毒（HIV）非职业暴露后预防就诊者的情况及阻断效果，完成28 d疗程的比例及其影响因素，为HIV暴露后预防的广泛应用提供参考。 方法 收集昆明市第三人民医院2019年HIV非职业暴露后预防者的资料进行描述性分析，Logistic回归分析完成28 d疗程的影响因素。 结果 836名HIV非职业暴露后预防就诊者中位年龄32（26，36）岁，男性占4.09%（703例）。明确暴露源是HIV阳性的占6.22%（52例），治疗方案为恩曲他滨替诺福韦 + 多替拉韦或拉替拉韦的比例为77.99%（652）。2 h内就诊的比例为1.55%（13例），2～24 h内就诊的比例为64.358%（538例）。完成28 d服药疗程者占78.23%（654例）。有职业的就诊者顺利完成28 d疗程的比例高于没有职业的就诊者（OR = 1.676，P = 0.005）；男性就诊者更容易完成28 d疗程（OR = 0.481，P = 0.001）。有检测结果或者电话告知检测结果的519例中有1人检测HIV为阳性。 结论 HIV非职业暴露后预防以男性为主，多数不能明确暴露源是否为HIV阳性。降低暴露后预防药物的费用有利于提高28 d服药完成率，加强宣传教育提高就诊的及时有效性有助于提高阻断成功率，减少传播。 Abstract:Objective To understand the treatment status and effect of HIV post-exposure prophylaxis in Kunming city in 2019. The proportion of the 28-day course completed and the influencing factors. It provides a reference for the wide application of HIV post-exposure prophylaxis. Methods Descriptive analysis was carried out on the data of HIV post-exposure prophylaxis in kunming city in 2019. Logistic analysis of factors affecting the completion of 28 days of treatment. Results The average age of 872 patients of HIV post-exposure prophylaxis was 32 （26, 36） years. Men accounted for 81.99%. Only 10.09% of people identified the infection source person with HIV. The proportion of patients with treatment FTC + DTG/RAL was 78.56%. The proportion of patients within 2 h was 2.87%, the proportion of patients within 2 h to 24 h was 63.88%. 78.56% completed the 28-day course. Unemployed, inactive and student patients were less likely to complete the 28-day course （OR = 1.668, P = 0.012）; It is clear that patients who knew the infection source person with HIV infection are more likely to complete a 28-day course of treatment （OR = 0.166, P < 0.001）. Only one of the 544 people who had test results or called then tested positive for HIV. Conclusion HIV post-exposure prophylaxis treatment is predominantly male, most do not know if the infection source person with HIV. Increasing economic income and identifying infection status are beneficial to increasing drug completion rate. At the same time, publicity and education should be strenghened to improve the timeliness and effectiveness of medical treatment. -
Key words:
- HIV /
- Exposure /
- Prevention /
- Blockade
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表 1 暴露后预防人群基本情况
Table 1. Basic characteristics of post-exposure prophylaxis
项目 人数（n） 构成比（%） 暴露方式 男男性行为暴露源HIV阳性 24 2.87 男男性行为暴露源感染情况不明 330 39.47 异性性行为暴露源HIV阳性 9 1.07 异性性行为暴露源感染情况不明 445 53.23 被HIV阳性者抓伤、咬伤 19 2.27 其他 9 1.07 服药方案 恩曲他滨替诺福韦 + 多替拉韦 617 73.8 恩曲他滨替诺福韦 + 拉替拉韦 35 4.18 替诺福韦拉米夫定 + 多替拉韦 53 6.34 艾考恩丙替片 131 15.67 发生高危行为到就诊的时间间隔 2 h内（包括2 h） 13 1.55 2～24 h 538 64.35 25～48 h 206 24.64 49～72 h 74 8.85 72 h以上 5 0.59 
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表 2 暴露后预防是否完成28 d疗程影响因素变量赋值
Table 2. Completion of 28-day treatment variable assignment of post-exposure prophylaxis
变量 变量赋值 年龄 1 = 20岁及以下，2 = 21～49岁，3 = 50岁及以上 性别 1 = 男*，2 = 女 职业 1 = 无职业*，2 = 有职业 MSM 1 = 是*，2 = 否 高危行为到就诊的时间 1 = 12 h及以下*，2 = 13 h～24 h，3 = 24 h及以上 是否明确暴露源HIV阳性 1 = 是*，2 = 否 是否完成28 d疗程 1 = 否*，2 = 是 注：*为参考类别。
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表 3 暴露后预防完成28 d疗程影响因素分析
Table 3. Analysis of influencing factors of 28-day treatment of post-exposure prophylaxis
因素 B Wald χ2 OR值 95%CI P 职业 0.516 7.784 1.676 1.166～2.409 0.005* 性别 −0.732 11.498 0.481 0.315～0.734 0.001* 常数项 41.44 0 9.93E + 17 0.997 *P < 0.05。
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