背景：
隨著高效能抗反轉錄病毒治療的進步，HIV感染者之預期壽命逐漸延長，HIV感染已由過去高度致死性疾病轉變為可長期控制之慢性健康狀態。然而，HIV感染者在長期病程中可能面臨物質使用、精神疾病、睡眠相關疾病及神經認知功能變化等健康問題，進而影響工具性日常生活活動。駕駛是一項需要注意力、反應速度、判斷能力及動作協調之複雜活動，因此HIV感染者之長期健康狀態與機動車輛碰撞風險之關聯，值得進一步探討。
目的：本研究的目的包括：（1）比較HIV感染者與非HIV感染者之機動車輛碰撞風險；（2）探討HIV感染者合併物質使用、精神疾病及睡眠相關疾病等臨床與行為健康因素與碰撞風險之關聯；以及（3）比較HIV感染者診斷前後之機動車輛碰撞風險變化。
方法：
本研究使用臺灣健保資料、死因統計資料及警政署交通事故資料。目的（1）與（2）的研究使用回溯性世代研究設計納入2012至2020年期間HIV感染之盛行與發生個案，並自全民健保承保檔中依年齡、性別進行1：4配對選取非HIV感染者。主要結果變項為事故發生時身分為汽車或機車駕駛者之機動車輛碰撞事件。研究採用Cox比例風險模型估計HIV感染者相較於非HIV感染者之風險比，並進行性別、年齡分層及風險因子組合分析。目的（3）採自我配對研究納入2015至2018年首次診斷之HIV感染者，比較其診斷前三年與診斷後三年之碰撞事件率，並以卜瓦松迴歸模型估計事件率比。
結果：
回溯性世代研究共納入33,841名HIV感染者及135,364名非HIV感染者。HIV感染者之機動車輛碰撞發生率為每100人年3.48人，高於非HIV感染者之3.22人。多變項校正後，HIV感染者之碰撞風險仍顯著高於非HIV感染者（HR=1.071，95% CI=1.044-1.099）。分層分析顯示，男性HIV感染者中以31-50歲（HR=1.070，95% CI=1.030-1.111）及51-75歲（HR=1.278，95% CI=1.147-1.424）族群風險增加較明顯，女性HIV感染者則以31-50歲族群風險增加最為明顯（HR=1.663，95% CI=1.396-1.981），且女性之相對風險增加幅度較男性更為突出。在風險因子組合分析中，HIV感染者若合併物質使用或精神疾病，其碰撞風險較高，睡眠相關疾病單獨存在時未呈現較高風險，但若與物質使用同時存在，碰撞風險則明顯升高。自我配對研究共納入8,467名HIV感染者，結果顯示診斷後三年之碰撞事件率未顯著高於診斷前三年，點估計略低但未達統計顯著差異（RR=0.956，95% CI=0.881-1.037）。
結論：
本研究提供臺灣族群層級之實證資料，顯示HIV感染者相較於非HIV感染者具有較高之機動車輛碰撞風險，但整體風險增加幅度有限，且此風險在特定性別、年齡層及合併物質使用、精神疾病或多重風險因子者中較為明顯。自我配對分析未發現HIV診斷後短期內碰撞風險顯著上升，提示世代研究中觀察到之較高風險，可能部分反映HIV感染者長期健康狀態、行為健康因素及日常功能變化所累積形成之風險。未來HIV長期照護可納入物質使用、精神疾病、睡眠相關疾病及日常功能評估，以作為交通安全風險辨識與照護介入之參考。

With advances in highly active antiretroviral therapy, HIV infection has gradually become a chronic and manageable health condition. However, people living with HIV may experience long-term health problems, including substance use, psychiatric illness, sleep-related diseases, and neurocognitive changes, which may affect instrumental activities of daily living and driving safety. This study examined motor vehicle collision risk among people living with HIV in Taiwan using nationwide population-based data.
The retrospective cohort study included 33,841 people living with HIV and 135,364 non-HIV individuals. The motor vehicle collision incidence rate was 3.48 per 100 person-years among people living with HIV and 3.22 per 100 person-years among non-HIV individuals. After multivariable adjustment, people living with HIV had a significantly higher collision risk than non-HIV individuals （HR = 1.071, 95% CI = 1.044–1.099）. The increased risk was more evident among men aged 31–50 years （HR = 1.070, 95% CI = 1.030–1.111）, men aged 51–75 years （HR = 1.278, 95% CI = 1.147–1.424）, and women aged 31–50 years （HR = 1.663, 95% CI = 1.396–1.981）. In the self-matched analysis, 8,467 people living with HIV were included. The collision risk during the three years after diagnosis was slightly lower than that before diagnosis, but the difference was not statistically significant （RR = 0.956, 95% CI = 0.881–1.037）. These findings suggest that people living with HIV have a slightly but significantly higher risk of motor vehicle collision, particularly among specific sex and age groups and those with clinical or behavioral risk factors.

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