Clin Infect Dis：干预疗法能改善婴儿期HIV感染者的性行为安全行为

近日，刊登在国际杂志Clinical Infectious Diseases上的一篇研究报告中，来自国外的研究者指出随着在婴儿期感染HIV的人群逐渐经历青春期以及成年期，在其进行性行为之前，需要对其进行健康行为的引导来避免HIV的传播以及感染。

这项研究中，研究者对330名年轻人进行调查发现，其均有未进行保护措施的性行为，而且这些HIV感染者并没有向自己的性伴侣说明自己的自身情况。当性行为变得在年轻人中非常寻常的时候，研究者就要考虑HIV的感染与传播的问题了。HIV的感染容易增加年轻人健康状况的复杂程度，并且对其自身以及性伴侣的健康都有极大的影响。

及时成功的干预行为有助于预防青春期年轻人感染HIV的高危行为。医生的早期干预会帮助这些年轻人及时作出安全的措施来保护HIV感染者伴侣不受HIV的感染。关键的一步就是告诉年轻人其HIV的感染状况。

这项研究中，18%的参与者在其发生性行为的时候并不知道自己已经感染了HIV。医生和家人必须告知年轻人自己HIV感染的情况和病情状况。研究者发现，有性行为的年轻人机体中HIV的病毒载量较高，大于5000拷贝/ml血液，而且81%的人群机体存在耐药性。这就无疑中增加了耐药性病毒在人群中的传播，以及限制了当前的疗法。研究者认为当前最关键的一步就是及时干预并且告知患病者的HIV感染情况，而且抗病毒疗法可以明显降低患者通过性行为传播HIV的可能性。

后期研究者希望能够开展更多的干预措施来降低青春期HIV感染者病毒的传播并且加强其意识和安全措施的使用。

编译自：Interventions Needed to Promote Healthy Behaviors Among Perinatally HIV-Infected Youth

doi:10.1093/cid/cis816
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Sexual Risk Behavior Among Youth With Perinatal HIV Infection in the United States: Predictors and Implications for Intervention Development

Katherine Tassiopoulos1, Anna-Barbara Moscicki2, Claude Mellins3, Deborah Kacanek4, Kathleen Malee5, Susannah Allison6, Rohan Hazra7, George K. Siberry7, Renee Smith8, Mary Paul9, Russell B. Van Dyke10, George R. Seage III1

Background. Factors associated with initiation of sexual activity among perinatally human immunodeficiency virus (HIV)–infected (PHIV+) youth, and the attendant potential for sexual transmission of antiretroviral (ARV) drug-resistant HIV, remain poorly understood. Methods. We conducted cross-sectional and longitudinal analyses of PHIV+ youth aged 10–18 years (mean, 13.5 years) enrolled in the US-based Pediatric HIV/AIDS Cohort Study between 2007 and 2009. Audio computer-assisted self-interviews (ACASI) were used to collect sexual behavior information. Results. Twenty-eight percent (95% confidence interval [CI], 23%–33%) (92/330) of PHIV+ youth reported sexual intercourse (SI) (median initiation age, 14 years). Sixty-two percent (57/92) of sexually active youth reported unprotected SI. Among youth who did not report history of SI at baseline, ARV nonadherence was associated with sexual initiation during follow-up (adjusted hazard ratio, 2.87; 95% CI, 1.32–6.25). Youth living with a relative other than their biological mother had higher odds of engaging in unprotected SI than those living with a nonrelative. Thirty-three percent of youth disclosed their HIV status to their first sexual partner. Thirty-nine of 92 (42%) sexually active youth had HIV RNA ≥5000 copies/mL after sexual initiation. Viral drug resistance testing, available for 37 of these 39 youth, identified resistance to nucleoside reverse transcriptase inhibitors in 62%, nonnucleoside reverse transcriptase inhibitors in 57%, protease inhibitors in 38%, and all 3 ARV classes in 22%. Conclusions. As PHIV+ youth become sexually active, many engage in behaviors that place their partners at risk for HIV infection, including infection with drug-resistant virus. Effective interventions to facilitate youth adherence, safe sex practices, and disclosure are urgently needed.