德宏州饮酒与艾滋病相关高危行为及病程关系的流行病学研究
发布时间：2018-07-18 17:27
【摘要】：研究背景 自上世纪80年代以来,大量研究发现饮酒可导致婚前性行为、多性伴、无保护性行为、性暴力、非意愿妊娠、艾滋病(HIV/AIDS)和其他性传播感染(STIs)等高危性行为和结局的发生。在HIV感染者中,饮酒可加速AIDS疾病进展、降低服药依从性、降低抗病毒治疗效果,进而导致耐药性的产生。然而,我国有关饮酒与酒后高危行为的研究相对较少,有限的研究也主要针对吸毒者、流动人口、女性性工作者(FSWs)和男男性行为者(MSM)等群体,普通社区居民和HIV感染者中相关研究未见报道。 由于社会文化、经济、民族习俗等因素,云南少数民族地区酒精滥用和酒精依赖患病率都远高于同期汉族人群。同时,云南省是我国毒品和HIV/AIDS流行的重灾区,性传播途径自2005年后成为该地区的主要传播途径。前期研究发现该地区无论社区居民还是HIV感染者均呈现相当比例的高危行为,那么饮酒与高危行为是否存在联系,缺乏相关数据。 研究目的 为更加有效地控制德宏傣族景颇族自治州(简称“德宏州”)HIV经性传播的流行趋势,我们进行了此项研究,其具体研究目的为： (1)了解社区男性居民饮酒、酒后性行为发生情况及其影响因素,为该地区普通社区居民艾滋病相关防治策略和措施的制订提供科学依据。 (2)了解HIV感染者饮酒、酒后性行为发生情况及其影响因素,为该地区HIV感染者中艾滋病防治策略和措施的制订提供新的思路。 (3)了解目前接受抗病毒治疗的HIV感染者中饮酒现状及其对治疗依从性和疗效的影响状况,为该地区抗病毒治疗者治疗相关策略和措施的制订提供数据支持。 (4)了解目前未接受抗病毒治疗的HIV感染者中饮酒现状及其对疾病病程的影响状况,为未进行抗病毒治疗者中开展健康教育和治疗相关工作提供参考。 研究方法 (1)社区男性居民饮酒与酒后性行为研究 通过目标抽样,整群抽取德宏州陇川县景罕镇在地理位置上紧密相连的10个村寨,招募村寨中所有符合研究对象纳入标准的常住男性居民参与研究。经知情同意后,在村卫生室的健康咨询室或研究对象的家中,采用结构问卷收集人口学、吸烟行为、饮酒行为、吸毒行为和性行为特征等五部分信息,并抽取其静脉血检测HIV。 (2)HIV感染者饮酒与酒后性行为及抗病毒治疗依从性和疗效关系的流行病学研究 根据德宏州艾滋病疫情管理系统信息,整群抽取德宏州陇川县地理位置相连的2个乡镇,邀请两个乡镇中所有符合研究对象纳入标准的HIV感染者/AIDS病人参与研究。经知情同意后,在村卫生室的健康咨询室或研究对象的家中,采用结构问卷收集人口学、吸烟行为、饮酒行为、吸毒行为、治疗依从性和性行为特征等六部分信息,并抽取其静脉血进行CD4+T淋巴细胞计数和HIV病毒载量(viral load,VL)检测,对其中VL31og10IU/ml的样本,进行耐药性检测。同时,在陇川县CDC艾滋病疫情管理系统中提取监测和治疗等相关信息。 研究结果 (1)社区男性居民饮酒与酒后性行为研究 497名符合纳入标准的男性居民中,有382(76.9%)人提供知情同意并参与了研究。参与研究的382名男性居民中,少数民族占70%,目前在婚者占74.1%,27.5%的人曾经吸毒,95.5%的人有性经历,6.0%的人为HIV阳性。81.2%的研究对象是目前饮酒者,其中55.7%的人初次饮酒年龄小于18岁。目前饮酒者中,44.5%的人为每日饮酒者,31.9%的人近1个月中有高危/极高危饮酒行为。自酿米酒是社区男性居民的主要酒精消费类型。13.5%的目前饮酒者有早晨空腹饮酒习惯,年龄在46-55岁者(OR=34.38,95%CI:3.34-353.99)、有高危/极高危饮酒行为者(OR=3.74,95%CI:1.64-8.56)和曾经吸毒者(OR=3.75,95%CI:1.53-9.22)更易发生早晨空腹饮酒行为。景颇族(OR=1.96,95%CI:1.29.2.97).目前吸烟者(OR=2.09,95%CI:1.28.3.40)和有多性伴史者(OR=1.55,95%CI:0.99-2.42)平均单次饮酒量高。21.6%的研究对象发生过酒后性行为,年龄在26-岁者(OR=3.80,95%CI:1.38-10.52).初次饮酒年龄小于18岁者(OR=2.14,95%CI：1.08-4.22)、有高危/极高危饮酒行为者(OR=1.99,95%CI:1.05-3.76)和曾经吸毒者(OR=2.00,95%CI:1.00-4.01)更易发生酒后性行为。 (2)HIV感染者饮酒与酒后性行为研究 657名符合纳入标准的HIV感染者AIDS病人中,有445(69.3%)人提供知情同意并参与了研究。其中,男性占66.2%,少数民族占82.6%,未婚者占15.4%,96.5%的人有过性行为,55.4%的人曾经吸毒,67.5%的人目前正在接受抗病毒治疗(ART)。研究对象中,65.1%的人为曾经饮酒者,61.5%的人为目前饮酒者。目前饮酒者中,32.4%的人为每天/几乎每天饮酒者,41.2%的人为有害饮酒者。自酿米酒是HIV感染者主要的酒精消费类型。男性(OR=2.76,95%CI:1.03.7.43)、少数民族(OR景颇族=2.21,95%CI：1.06-4.59；OR其他少数民族=3.20,95%CI：1.34-7.62)、受教育年限多者(OR1-6=1.98,95%CI:0.99-3.96；OR≥7=2.35,95%CI：1.09-5.06)和目前未接受抗病毒治疗者(OR=2.69,95%CI：1.67-4.32)近1个月的饮酒量多。26.5%的人在第1次性行为前有饮酒行为,男性(OR=15.08,95%CI：1.70-133.88)、其他少数民族(OR=4.13,95%CI:1.33-12.83)和文盲(OR=3.00,95%CI:1.15-7.83)更易在第1次性行为前饮酒。39.6%的曾经饮酒者在感染HIV后发生过酒后性行为,年龄较小者(OR16-=7.77,95%CI:1.22-49.60,OR26-=2.79,95%CI:1.06-7.35,OR36-=2.96,95%CI:1.57-7.58).有害饮酒者(OR=1.99,95%CI:1.00.3.97)和曾经吸毒者(OR=3.01,95%CI:1.19-7.58)更易发生酒后性行为。56%的吸毒者曾发生过酒后吸毒行为。 (3)抗病毒治疗的HIV感染者饮酒与治疗依从性和治疗效果研究 本研究共招募到307名研究对象,应答率为91.1%(307/337)。其中,男性占61.9%,少数民族占82.7%,目前在婚者占73.6%,74.2%的人受教育年限不足6年。56.0%的研究对象为目前吸烟者,32.6%的人为目前饮酒者,30.0%的人感染HIV后有吸毒史,86.3%的人目前接受一线抗病毒治疗方案。10.4%的研究对象在近1个月服药不依从,文盲(OR=5.90,95%CI:1.39.24.96).饮酒者(OR适量饭酒=4.18,95%CI：1.37-12.77；OR有害饮酒=14.19,95%CI：3.85-52.25)和治疗时间不足6个月者(OR.6=5.27,95%CI:1.78一15.57)更易发生服药不依从。目前饮酒者中,18.0%的人在近1个月因饮酒而漏服药物,目前没有配偶者(OR=27.16,95%CI：4.16-177.25)和有害饮酒者更容易因饮酒而漏服药物。14.5%的研究对象CD4+T淋巴细胞计数不足200/μl,35.7%的人介于200/μl3-350/μl之间,年龄在16-岁者(HR=4.80,95%CI:2.14.10.79).目前吸烟者(HIR=2.44,95%CI：1.15-5.19)、目前未饮酒者(HR=1.86,95%CI:1.19.2.92)、感染HIV后无吸毒史者(HR=1.72,95%CI:1.06.2.78)和治疗初期CD4+T淋巴细胞计数超过200个仙/μl者(HR=3.11,95%CI:2.12.4.57)治疗后其CD4+T淋巴细胞计数更易高于350个/μμ1以上。13.5%的研究对象病毒载量数超过3log10IU/ml,抗病毒治疗初期CD4+T淋巴细胞计数高于200个/μl者(HR=1.42,95%Cl:1.07-1.87)治疗后其VL更易低于检测限。11.9%的人抗病毒治疗失败,近1个月不依从者(OR=9.90,95%CI:2.74.35.77)和治疗时间在7至12个月之间者(OR=3.07,95%CI：1.00-9.48)更容易发生抗病毒治疗失败。抗病毒治疗失败者中的耐药率为60.7%。 (4)未接受抗病毒治疗的HIV感染者饮酒与疾病病程研究 本研究共招募到148名研究对象,应答率为46.3%(148/320)。其中,男性占75.0%,少数民族占82.4%,在婚者占54.7%,受教育年限不足6年者占71.6%。73.6%的研究对象为目前吸烟者,55.4%的人为目前饮酒者,39.2%的人在感染HIV后有吸毒行为。27.2%的研究对象目前的CD4+T淋巴细胞计数不足200/μμ1,26.4%的CD4+T淋巴细胞计数介于200/μμ1到350/μμ1之间。首次CD4+T淋巴细胞计数高于200个/μl者(HR200-350=0.22,95%CI:0.07-0.69;HR≥351=0.11,95%CI:0.05-0.28)其目前CD4+T淋巴细胞计数不易低于200个/μl。24.8%的研究对象的VL大于5log10IU/ml,VL大于3log10IU/ml的研究对象中的耐药率为4.7%。 研究结论 (1)社区男性居民中饮酒情况严重,且酒后性行为发生率高,有必要在普通社区开展相关健康教育,以预防酒精滥用和酒后危险行为的发生。 (2)HIV感染者中饮酒情况普遍,且酒后危险行为发生率高,应在HIV感染中整合相关防治措施,以预防酒精、毒品滥用和HIV传播。 (3)抗病毒治疗者中饮酒情况普遍,饮酒导致不依从发生率高,同时,降低了抗病毒治疗效果,有必要在治疗者中开展饮酒相关健康教育、整合治疗干预措施,以提高抗病毒治疗依从性及治疗效果。 (4)未治疗的HIV感染者中饮酒情况普遍,符合治疗标准者比例高,应采取积极措施预防和控制酒精滥用,尽早将符合治疗条件的对象纳入治疗程序。
[Abstract]:Research background
Since the 80s of the last century, a large number of studies have found that drinking can lead to premarital sex, sexual partners, unprotected sex, sexual violence, unwanted pregnancy, AIDS (HIV/AIDS) and other sexually transmitted infections (STIs) and other high-risk behaviors and outcomes. In HIV infected people, drinking can accelerate the progression of AIDS disease, reduce drug compliance, and reduce resistance. The effect of virus therapy leads to the emergence of drug resistance. However, there are relatively few studies on the high-risk behavior of alcohol and alcohol in our country. The limited research is mainly focused on drug addicts, floating population, female sex workers (FSWs) and male male actors (MSM), and the related research of common community residents and HIV infected people is not reported.
The prevalence of alcohol abuse and alcohol dependence in ethnic minority areas in Yunnan is much higher than that of Han population in the same period due to social culture, economy, national customs and other factors. At the same time, Yunnan province is a major disaster area of drug and HIV/AIDS in China, and the way of sexual transmission has become the main route of transmission in the region since 2005. Community residents or HIV infected persons showed a high proportion of high-risk behaviors, so there was no correlation between alcohol consumption and high-risk behaviors.
research objective
In order to effectively control the epidemic trend of the sexual transmission of the Dehong Dai Jingpo autonomous prefecture ("Dehong state") HIV, we have carried out this study. The specific purpose of this study is to study the purpose of this study.
(1) to understand the drinking of male residents in the community, the occurrence of alcohol sexual behavior and its influencing factors, and to provide a scientific basis for the formulation of AIDS related prevention and control strategies and measures for common community residents in this area.
(2) to understand the drinking of HIV infected people, the occurrence of alcoholic sexual behavior and its influencing factors, and to provide new ideas for the formulation of the strategies and measures for the prevention and control of AIDS among the HIV infected people in this area.
(3) to understand the status of drinking in HIV infected people who are currently receiving antiviral therapy and their influence on the compliance and efficacy of treatment, and to provide data support for the formulation of relevant strategies and measures for the treatment of antiviral agents in this area.
(4) to understand the current status of drinking in HIV infected people who have not received antiviral treatment and their influence on the course of disease, and to provide reference for health education and treatment related work among those who have not been treated with antiviral therapy.
research method
(1) drinking and drinking behavior among male residents in community
Through the target sampling, 10 villages closely connected in the geographical location of Longchuan County of Longchuan County, Dehong, were recruited to recruit all the resident male residents in the village to participate in the study. After informed consent, the structure questionnaire was used to collect demographic data in the health consulting room of the village health room or the home of the research subjects. Smoking, drinking behavior, drug taking behavior and sexual behavior characteristics are five parts of information, and their venous blood is detected by HIV..
(2) epidemiological study on the relationship between alcohol consumption and alcoholic behavior and compliance and efficacy of HIV treatment in patients with HIV infection
According to the information of the AIDS epidemic management system in Dehong, 2 townships connected by the geographical location of Longchuan County, Dehong were selected, and all the two HIV infected patients were invited to participate in the study. After informed consent, the structure was used in the health consulting room of the village health room or the home of the research subjects. Six parts of the information were collected, such as demography, smoking behavior, drinking behavior, drug abuse, treatment compliance and sexual behavior characteristics, and extracting the venous blood for CD4+T lymphocyte count and HIV virus load (viral load, VL), and testing the drug resistance of VL31og10IU/ml samples. At the same time, the management of the epidemic situation of CDC AIDS in Longchuan County. Related information, such as monitoring and treatment, is extracted from the system.
Research results
(1) drinking and drinking behavior among male residents in community
Of the 497 male residents who met the inclusion criteria, 382 (76.9%) provided informed consent and participated in the study. Among the 382 male residents involved in the study, 70% were ethnic minorities, 74.1% were married, 27.5% had drug use, 95.5% had sexual experiences, and 6% of the HIV positive.81.2% subjects were currently drinkers, 55.7% The first drinking age of the people is less than 18 years. Of the current drinkers, 44.5% of the people drink alcohol daily, and 31.9% of the people have high risk / extreme high risk of alcohol consumption in nearly 1 months. The self brewed rice wine is the main alcohol consumption type.13.5% in the community male residents, and the drinkers have the morning fasting habit of drinking in the morning, and the age of 46-55 years old (OR=34.38,95%CI:3.34-353.9 9) high risk / extreme high risk alcohol drinkers (OR=3.74,95%CI:1.64-8.56) and former drug addicts (OR=3.75,95%CI:1.53-9.22) were more likely to have morning fasting drinking behavior. OR=1.96,95%CI:1.29.2.97. Current smokers (OR=2.09,95%CI:1.28.3.40) and multiple sex partners (OR=1.55,95%CI:0.99-2.42) have a higher average amount of.21.6% for single drinking. The subjects had alcohol sexual behavior, the age of 26- years old (OR=3.80,95%CI:1.38-10.52). The initial drinking age was less than 18 years old (OR=2.14,95%CI:1.08-4.22), high risk / extremely high-risk alcohol drinkers (OR=1.99,95%CI:1.05-3.76) and former drug addicts (OR=2.00,95%CI: 1.00-4.01) were more likely to have alcohol sexual behavior.
(2) study on drinking and drinking behavior of HIV infected people
Of the 657 HIV infected AIDS patients who met the inclusion criteria, 445 (69.3%) provided informed consent and participated in the study. Among them, men accounted for 66.2%, ethnic minorities accounted for 82.6%, unmarried persons accounted for 15.4%, 96.5% had sex, 55.4% had drug abuse and 67.5% people were currently receiving antiviral treatment (ART). 65.1% of the subjects were studied. Among the drinkers, 61.5% were the present drinkers. Of the current drinkers, 32.4% were drinkers per day / almost every day and 41.2% were harmful drinkers. Self brewed rice wine was the main alcohol consumption type of HIV infected people. Male (OR=2.76,95%CI:1.03.7.43), OR Jingpo =2.21,95%CI:1.06-4.59; OR other minority =3.2. 0,95%CI:1.34-7.62), people with more years of Education (OR1-6=1.98,95%CI:0.99-3.96; OR > 7=2.35,95%CI:1.09-5.06) and those who had not accepted antiviral therapy (OR=2.69,95%CI:1.67-4.32) for nearly 1 months had a drinking behavior before first sexual behaviors, male (OR=15.08,95%CI:1.70-133.88), and other ethnic minorities (OR=). 4.13,95%CI:1.33-12.83) and illiterate (OR=3.00,95%CI:1.15-7.83) alcohol drinkers who drank.39.6% before first sex were more likely to have drunk sex after the infection of HIV, the younger (OR16-=7.77,95%CI:1.22-49.60, OR26-=2.79,95%CI:1.06-7.35, OR36-=2.96,95%CI:1.57-7.58). Harmful drinkers (OR=1.99,95%CI:1.00.3.97) and once. Drug addicts (OR=3.01,95%CI:1.19-7.58) are more likely to have drunk sex..56% drug users have experienced drug abuse behavior.
(3) alcohol consumption and treatment compliance and treatment efficacy of HIV infected patients with antiviral therapy
A total of 307 subjects were recruited in this study, with a response rate of 91.1% (307/337). Among them, men accounted for 61.9%, minority nationalities accounted for 82.7%, and currently 73.6% were married, 74.2% of those who had less than 6 years of education were currently smokers, 32.6% were currently drinkers, 30% had a history of drug abuse after HIV infection, and 86.3% people were currently accepted. The research object of the first line antiviral therapy program.10.4% is not complying with medication for nearly 1 months, OR=5.90,95%CI:1.39.24.96. Drinkers (OR right amount of rice wine =4.18,95%CI:1.37-12.77; OR harmful drinking =14.19,95%CI:3.85-52.25) and patients with less than 6 months of treatment (OR.6=5.27,95% CI:1.78 15.57) are more likely to take medicine without compliance. Among the drinkers, 18% of the people missed the drug for alcohol drinking for nearly 1 months. At present, no spouses (OR=27.16,95%CI:4.16-177.25) and harmful drinkers were more likely to lose their drug.14.5% by drinking alcohol. The CD4+T lymphocyte count was less than 200/ Mu L, 35.7% were between 200/ mu l3-350/ Mu L, and the age of 16- (HR=4.80,95%CI:2.14.10). .79). The current smokers (HIR=2.44,95%CI:1.15-5.19), the current non drinker (HR=1.86,95%CI:1.19.2.92), the HIV free drug addict (HR=1.72,95%CI:1.06.2.78) and the initial CD4+T lymphocyte counts of more than 200 immortals / L (HR=3.11,95%CI:2.12.4.57) at the initial stage of the treatment are more likely to be higher than 350 / mu 1.13.. The number of viral loads in 5% of the study was more than 3log10IU/ml, and the CD4+T lymphocyte count at the initial stage of antiviral therapy was higher than that of 200 / u l (HR=1.42,95%Cl:1.07-1.87), and its VL was more likely to be less than the detection limit of the detection limit of.11.9%, and the non compliance (OR=9.90,95%CI: 2.74.35.77) and the time of treatment were between 7 and 12 months (OR=3) for nearly 1 months (OR=3). .07,95%CI:1.00-9.48) it is more likely to fail in antiviral treatment. The drug resistance rate in the failure of antiviral treatment is 60.7%.
(4) alcohol consumption and disease duration of HIV infected patients who were not receiving antiviral treatment
A total of 148 subjects were recruited in this study, with a response rate of 46.3% (148/320). Among them, men accounted for 75%, minority nationalities accounted for 82.4%, married persons accounted for 54.7%, and the subjects of less than 6 years of education accounted for the current smokers, 55.4% were drinkers, and 39.2% had the target of drug abuse after HIV infection. The count of the CD4+T lymphocyte counts for the previous 200/ mu 1,26.4% was between 200/ and 350/ mu 1. The first CD4+T lymphocyte count was higher than 200 / mu L (HR200-350=0.22,95%CI:0.07-0.69; HR > 351=0.11,95%CI:0.05-0.28). The present number of CD4+T lymphocyte counts is not easy to be lower than the target of 200 / mu. L was more than 5log10IU/ml, and the resistance rate of the subjects with VL greater than 3log10IU/ml was 4.7%.
research conclusion
(1) the drinking situation of the male residents in the community is serious and the incidence of sexual behavior is high. It is necessary to carry out relevant health education in the common community in order to prevent the abuse of alcohol and the occurrence of dangerous behavior after alcohol.
(2) the prevalence of alcohol consumption in HIV infected people, and the high incidence of dangerous behavior after alcohol, should be integrated in the HIV infection to prevent alcohol, drug abuse and HIV transmission.
(3) the drinking situation in the antiviral treatment is common, drinking leads to the high rate of non compliance, at the same time, it reduces the effect of antiviral therapy. It is necessary to carry out the drinking related health education in the treatment and integrate the treatment intervention, in order to improve the compliance of antiviral treatment and the effect of treatment.
(4) the prevalence of alcohol consumption in the untreated HIV infected people is common, and the proportion of those who meet the standard of treatment is high. Active measures should be taken to prevent and control alcohol abuse, and the treatment procedure should be included as early as possible.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R512.91
本文编号：2132629
[Abstract]:Research background
Since the 80s of the last century, a large number of studies have found that drinking can lead to premarital sex, sexual partners, unprotected sex, sexual violence, unwanted pregnancy, AIDS (HIV/AIDS) and other sexually transmitted infections (STIs) and other high-risk behaviors and outcomes. In HIV infected people, drinking can accelerate the progression of AIDS disease, reduce drug compliance, and reduce resistance. The effect of virus therapy leads to the emergence of drug resistance. However, there are relatively few studies on the high-risk behavior of alcohol and alcohol in our country. The limited research is mainly focused on drug addicts, floating population, female sex workers (FSWs) and male male actors (MSM), and the related research of common community residents and HIV infected people is not reported.
The prevalence of alcohol abuse and alcohol dependence in ethnic minority areas in Yunnan is much higher than that of Han population in the same period due to social culture, economy, national customs and other factors. At the same time, Yunnan province is a major disaster area of drug and HIV/AIDS in China, and the way of sexual transmission has become the main route of transmission in the region since 2005. Community residents or HIV infected persons showed a high proportion of high-risk behaviors, so there was no correlation between alcohol consumption and high-risk behaviors.
research objective
In order to effectively control the epidemic trend of the sexual transmission of the Dehong Dai Jingpo autonomous prefecture ("Dehong state") HIV, we have carried out this study. The specific purpose of this study is to study the purpose of this study.
(1) to understand the drinking of male residents in the community, the occurrence of alcohol sexual behavior and its influencing factors, and to provide a scientific basis for the formulation of AIDS related prevention and control strategies and measures for common community residents in this area.
(2) to understand the drinking of HIV infected people, the occurrence of alcoholic sexual behavior and its influencing factors, and to provide new ideas for the formulation of the strategies and measures for the prevention and control of AIDS among the HIV infected people in this area.
(3) to understand the status of drinking in HIV infected people who are currently receiving antiviral therapy and their influence on the compliance and efficacy of treatment, and to provide data support for the formulation of relevant strategies and measures for the treatment of antiviral agents in this area.
(4) to understand the current status of drinking in HIV infected people who have not received antiviral treatment and their influence on the course of disease, and to provide reference for health education and treatment related work among those who have not been treated with antiviral therapy.
research method
(1) drinking and drinking behavior among male residents in community
Through the target sampling, 10 villages closely connected in the geographical location of Longchuan County of Longchuan County, Dehong, were recruited to recruit all the resident male residents in the village to participate in the study. After informed consent, the structure questionnaire was used to collect demographic data in the health consulting room of the village health room or the home of the research subjects. Smoking, drinking behavior, drug taking behavior and sexual behavior characteristics are five parts of information, and their venous blood is detected by HIV..
(2) epidemiological study on the relationship between alcohol consumption and alcoholic behavior and compliance and efficacy of HIV treatment in patients with HIV infection
According to the information of the AIDS epidemic management system in Dehong, 2 townships connected by the geographical location of Longchuan County, Dehong were selected, and all the two HIV infected patients were invited to participate in the study. After informed consent, the structure was used in the health consulting room of the village health room or the home of the research subjects. Six parts of the information were collected, such as demography, smoking behavior, drinking behavior, drug abuse, treatment compliance and sexual behavior characteristics, and extracting the venous blood for CD4+T lymphocyte count and HIV virus load (viral load, VL), and testing the drug resistance of VL31og10IU/ml samples. At the same time, the management of the epidemic situation of CDC AIDS in Longchuan County. Related information, such as monitoring and treatment, is extracted from the system.
Research results
(1) drinking and drinking behavior among male residents in community
Of the 497 male residents who met the inclusion criteria, 382 (76.9%) provided informed consent and participated in the study. Among the 382 male residents involved in the study, 70% were ethnic minorities, 74.1% were married, 27.5% had drug use, 95.5% had sexual experiences, and 6% of the HIV positive.81.2% subjects were currently drinkers, 55.7% The first drinking age of the people is less than 18 years. Of the current drinkers, 44.5% of the people drink alcohol daily, and 31.9% of the people have high risk / extreme high risk of alcohol consumption in nearly 1 months. The self brewed rice wine is the main alcohol consumption type.13.5% in the community male residents, and the drinkers have the morning fasting habit of drinking in the morning, and the age of 46-55 years old (OR=34.38,95%CI:3.34-353.9 9) high risk / extreme high risk alcohol drinkers (OR=3.74,95%CI:1.64-8.56) and former drug addicts (OR=3.75,95%CI:1.53-9.22) were more likely to have morning fasting drinking behavior. OR=1.96,95%CI:1.29.2.97. Current smokers (OR=2.09,95%CI:1.28.3.40) and multiple sex partners (OR=1.55,95%CI:0.99-2.42) have a higher average amount of.21.6% for single drinking. The subjects had alcohol sexual behavior, the age of 26- years old (OR=3.80,95%CI:1.38-10.52). The initial drinking age was less than 18 years old (OR=2.14,95%CI:1.08-4.22), high risk / extremely high-risk alcohol drinkers (OR=1.99,95%CI:1.05-3.76) and former drug addicts (OR=2.00,95%CI: 1.00-4.01) were more likely to have alcohol sexual behavior.
(2) study on drinking and drinking behavior of HIV infected people
Of the 657 HIV infected AIDS patients who met the inclusion criteria, 445 (69.3%) provided informed consent and participated in the study. Among them, men accounted for 66.2%, ethnic minorities accounted for 82.6%, unmarried persons accounted for 15.4%, 96.5% had sex, 55.4% had drug abuse and 67.5% people were currently receiving antiviral treatment (ART). 65.1% of the subjects were studied. Among the drinkers, 61.5% were the present drinkers. Of the current drinkers, 32.4% were drinkers per day / almost every day and 41.2% were harmful drinkers. Self brewed rice wine was the main alcohol consumption type of HIV infected people. Male (OR=2.76,95%CI:1.03.7.43), OR Jingpo =2.21,95%CI:1.06-4.59; OR other minority =3.2. 0,95%CI:1.34-7.62), people with more years of Education (OR1-6=1.98,95%CI:0.99-3.96; OR > 7=2.35,95%CI:1.09-5.06) and those who had not accepted antiviral therapy (OR=2.69,95%CI:1.67-4.32) for nearly 1 months had a drinking behavior before first sexual behaviors, male (OR=15.08,95%CI:1.70-133.88), and other ethnic minorities (OR=). 4.13,95%CI:1.33-12.83) and illiterate (OR=3.00,95%CI:1.15-7.83) alcohol drinkers who drank.39.6% before first sex were more likely to have drunk sex after the infection of HIV, the younger (OR16-=7.77,95%CI:1.22-49.60, OR26-=2.79,95%CI:1.06-7.35, OR36-=2.96,95%CI:1.57-7.58). Harmful drinkers (OR=1.99,95%CI:1.00.3.97) and once. Drug addicts (OR=3.01,95%CI:1.19-7.58) are more likely to have drunk sex..56% drug users have experienced drug abuse behavior.
(3) alcohol consumption and treatment compliance and treatment efficacy of HIV infected patients with antiviral therapy
A total of 307 subjects were recruited in this study, with a response rate of 91.1% (307/337). Among them, men accounted for 61.9%, minority nationalities accounted for 82.7%, and currently 73.6% were married, 74.2% of those who had less than 6 years of education were currently smokers, 32.6% were currently drinkers, 30% had a history of drug abuse after HIV infection, and 86.3% people were currently accepted. The research object of the first line antiviral therapy program.10.4% is not complying with medication for nearly 1 months, OR=5.90,95%CI:1.39.24.96. Drinkers (OR right amount of rice wine =4.18,95%CI:1.37-12.77; OR harmful drinking =14.19,95%CI:3.85-52.25) and patients with less than 6 months of treatment (OR.6=5.27,95% CI:1.78 15.57) are more likely to take medicine without compliance. Among the drinkers, 18% of the people missed the drug for alcohol drinking for nearly 1 months. At present, no spouses (OR=27.16,95%CI:4.16-177.25) and harmful drinkers were more likely to lose their drug.14.5% by drinking alcohol. The CD4+T lymphocyte count was less than 200/ Mu L, 35.7% were between 200/ mu l3-350/ Mu L, and the age of 16- (HR=4.80,95%CI:2.14.10). .79). The current smokers (HIR=2.44,95%CI:1.15-5.19), the current non drinker (HR=1.86,95%CI:1.19.2.92), the HIV free drug addict (HR=1.72,95%CI:1.06.2.78) and the initial CD4+T lymphocyte counts of more than 200 immortals / L (HR=3.11,95%CI:2.12.4.57) at the initial stage of the treatment are more likely to be higher than 350 / mu 1.13.. The number of viral loads in 5% of the study was more than 3log10IU/ml, and the CD4+T lymphocyte count at the initial stage of antiviral therapy was higher than that of 200 / u l (HR=1.42,95%Cl:1.07-1.87), and its VL was more likely to be less than the detection limit of the detection limit of.11.9%, and the non compliance (OR=9.90,95%CI: 2.74.35.77) and the time of treatment were between 7 and 12 months (OR=3) for nearly 1 months (OR=3). .07,95%CI:1.00-9.48) it is more likely to fail in antiviral treatment. The drug resistance rate in the failure of antiviral treatment is 60.7%.
(4) alcohol consumption and disease duration of HIV infected patients who were not receiving antiviral treatment
A total of 148 subjects were recruited in this study, with a response rate of 46.3% (148/320). Among them, men accounted for 75%, minority nationalities accounted for 82.4%, married persons accounted for 54.7%, and the subjects of less than 6 years of education accounted for the current smokers, 55.4% were drinkers, and 39.2% had the target of drug abuse after HIV infection. The count of the CD4+T lymphocyte counts for the previous 200/ mu 1,26.4% was between 200/ and 350/ mu 1. The first CD4+T lymphocyte count was higher than 200 / mu L (HR200-350=0.22,95%CI:0.07-0.69; HR > 351=0.11,95%CI:0.05-0.28). The present number of CD4+T lymphocyte counts is not easy to be lower than the target of 200 / mu. L was more than 5log10IU/ml, and the resistance rate of the subjects with VL greater than 3log10IU/ml was 4.7%.
research conclusion
(1) the drinking situation of the male residents in the community is serious and the incidence of sexual behavior is high. It is necessary to carry out relevant health education in the common community in order to prevent the abuse of alcohol and the occurrence of dangerous behavior after alcohol.
(2) the prevalence of alcohol consumption in HIV infected people, and the high incidence of dangerous behavior after alcohol, should be integrated in the HIV infection to prevent alcohol, drug abuse and HIV transmission.
(3) the drinking situation in the antiviral treatment is common, drinking leads to the high rate of non compliance, at the same time, it reduces the effect of antiviral therapy. It is necessary to carry out the drinking related health education in the treatment and integrate the treatment intervention, in order to improve the compliance of antiviral treatment and the effect of treatment.
(4) the prevalence of alcohol consumption in the untreated HIV infected people is common, and the proportion of those who meet the standard of treatment is high. Active measures should be taken to prevent and control alcohol abuse, and the treatment procedure should be included as early as possible.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R512.91
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