分析美沙冬門診靜脈注射藥癮個案之HIV盛行率及相關危險因子

根據台灣疾病管制局的登錄資料統計，本國籍人口感染愛滋病毒(Human Immunodeficiency Virus, HIV)危險因子前三名為異性間性行為、同性間性行為及靜脈注射藥癮者。台灣靜脈注射藥癮個案之HIV感染率，由2003年的9.3%、2004年的40.8% 至2005年的71.6%，突發HIV感染達到高峰。為了減緩靜脈注射藥癮個案感染HIV，政府提出「替代療法計畫」，以口服美沙冬藥物替代注射海洛因，期望降低感染HIV的風險。經研究統計約80 %靜脈注射藥癮者未感染HIV，而靜脈注射藥癮者的知識、行為及態度影響感染HIV的風險與機率。本論文的研究主旨為評估美沙冬門診靜脈注射藥癮個案HIV盛行率及相關危險因子，我們從台北市立聯合醫院美沙冬門診收錄406位靜脈注射藥癮個案進行抽血檢驗HIV及問卷訪談。問卷是針對靜脈注射藥癮個案基本特性、毒品使用行為、性行為及HIV認知做整體性評估。若訪談個案為HIV陽性，會查詢個案一年內最近一次cluster of differentiation 4(CD4)、HIV 病毒量(viral load)檢驗紀錄，以評估免疫功能的影響。結果顯示，在年齡分項上，每增長一歲感染到HIV風險會下降5%。在婚姻分項上，離婚的靜脈注射藥癮個案感染到HIV的風險較沒離婚者高2.04倍。在藥物劑量分項上，曾有藥物過量經驗的靜脈注射藥癮個案感染到HIV的風險比不曾有過藥物過量者高2.51倍。在HIV認知分項上，相信有疫苗可以預防愛滋病之錯誤觀念的靜脈注射藥癮個案，感染到HIV風險較觀念正確者高2.5倍。在免疫功能方面，同是接受抗病毒藥治療的愛滋病感染者，非靜脈注射藥癮者之CD4數值大於 350 cells/mm3的比例會比靜脈注射藥癮者高15.1% (p=0.02)；同是沒有接受抗病毒藥治療的愛滋病感染者，非靜脈注射藥癮者其體內HIV 病毒量大於10,000 copies/ml的比例會比靜脈注射藥癮者高37.3% (p=<0.001)。綜合以上結果，本研究發現年齡較年輕、離婚的靜脈注射藥癮者、有藥物過量史及對於HIV錯誤知識為靜脈注射藥癮者感染HIV的危險因子。而非靜脈注射藥癮者身體的免疫力會比靜脈注射藥癮者好，其體內的HIV病毒量也會比靜脈注射藥癮者高。其成果將可協助醫療資源之分配決策、減少醫療浪費、減輕國家財政負擔，並擬定防治措施。

關鍵字

美沙冬；靜脈注射藥癮；愛滋病；病毒量

並列摘要

According to the statistics published by the Taiwan CDC (Centers for Disease Control), the top three risk factors of Human Immunodeficiency Virus (HIV) infection in Taiwan are listed as heterosexual sex, homosexual sex and injection drug user (IDU). The rate of HIV infection in IDUs has exploded in Taiwan since 2005. It was 9.3% in 2003, then increased to 40.8% in 2004, and peaked at 71.6% in 2005. In order to slow down the HIV infection in IDUs, the government worked out a "replacement therapy program" which is taking oral methadone instead of injecting heroin to reduce the risk of HIV infection. The statistics of studies showed that approximately 80% of the IDUs are not infected with HIV, but the IDUs' knowledge, behavior, and attitude contribute to the risk and probability of HIV infection. The aim of this study is to assess the HIV prevalence and the related risk factors of methadone outpatients of IDUs. In this study, the HIV blood testings were performed from 406 IDU cases presented at the Taipei City Hospital. All made related interviews and questionnaires. The questionnaire is aimed at the holistic assessment of the basic characteristics of IDUs, drug use behavior, sexual behavior and knowledge of HIV risk. When the cases interviewed were HIV-positive, the last time inspection records of cluster of differentiation 4 (CD4) and HIV viral load within one year were used to assess the impact of the immune functions. The results found that with every one-year growth of the age, the risk of the HIV infection will decline 5%. The risks of HIV infection in the divorced IDUs' are 2.04 times higher than those without divorced. A 2.51-fold increase in the risk of HIV infection was found in the drug overdose among IDUs than those without drug overdose. The IDUs who believe there is a vaccine for AIDS prevention, their risks of HIV infection are 2.5 times higher than those who have correct understanding of HIV. The AIDS-infected individuals who receiving antiviral therapy, the proportion of CD4 counts greater than 350 cells/mm3 is 15.1% higher in the non-IDUs than the IDUs (p = 0.02). However, the proportion of patients whose HIV viral loads over 10,000 copies/ml is 37.3% higher in the non-IDUs without antiviral treatment than the IDUs (p?T0.001). Therefore, this findings indicate that the IDUs with younger age, divorce, drug overdose history and incorrect understanding of HIV are the risk factors for HIV infection. The immune function is better in the non-IDUs than IDU, but the HIV viral road is higher than IDU. In respect of the outcome can be used to determine the allocation of medical resources, reduce wastes of medical resource, relieve the load of health insurance, and to assist in formulating the prevention and control measures.

並列關鍵字

Methadone ； Injection Drug User ； HIV ； CD4 ； Viral load

參考文獻

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國際替代計量

分析美沙冬門診靜脈注射藥癮個案之HIV盛行率及相關危險因子

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