Liu X H, Zhu Q Y, Su J M, Meng Q, Zhou X J, Shen Z Y, Tang Z Z, Yang W M, Ruan Y H, Shao Y M
Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2018 Sep 10;39(9):1216-1221. doi: 10.3760/cma.j.issn.0254-6450.2018.09.014.
To investigate the effect of baseline CD(4)(+) T cell count (CD(4)) on drop-out of antiretroviral therapy (ART) in HIV infected persons. Retrospective cohort was conducted in this study. HIV infected persons aged≥18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System, with follow-up conducted till May 30, 2016. Cause-specific Cox proportional hazard models were used to evaluate effect of different CD(4) on the drop-out of ART in the HIV infected persons. A total of 58 502 eligible study participants were included in this retrospective cohort study. The average drop-out ratio was 4.8/100 person-years. After controlling the following baseline covariates: age, sex, marital status, route of HIV infection, WHO clinical stage before ART, initial/current ART regiment, ART regiment adjustment, and year of initiating ART for potential confounding, the adjusted of drop-out for HIV infected persons with 200- cells/μl, 351-cells/μl and ≥500 cells/μl were 1.110 (95: 1.053-1.171, <0.001), 1.391 (95: 1.278-1.514, <0.001) and 1.695 (95: 1.497-1.918, <0.001), respectively, in risk for drop-out compared with those with baseline CD(4)<200 cells/μl. Among the HIV infected persons, 56.0 (1 601/2 861) of drug withdrawal was due to poor compliance with medication. With the increase of baseline CD(4) when initiating ART, the risk for the drop-out in HIV infected persons increased significantly. To further reduce the drop-out of ART, it is important to take CD(4) into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.
探讨基线CD4+T淋巴细胞计数（CD4）对HIV感染者抗逆转录病毒治疗（ART）中断的影响。本研究采用回顾性队列研究。从国家综合艾滋病信息系统抗逆转录病毒治疗数据库中选取2008年至2015年在广西壮族自治区首次接受免费ART且年龄≥18岁的HIV感染者，随访至2016年5月30日。采用病因特异性Cox比例风险模型评估不同CD4水平对HIV感染者ART中断的影响。本回顾性队列研究共纳入58502名符合条件的研究参与者。平均中断率为4.8/100人年。在控制年龄、性别、婚姻状况、HIV感染途径、ART前WHO临床分期、初始/当前ART方案、ART方案调整以及开始ART年份等基线协变量以消除潜在混杂因素后，基线CD4为200 - 细胞/μl、351 - 细胞/μl和≥500细胞/μl的HIV感染者的调整后ART中断风险分别为1.110（95%CI：1.053 - 1.171，P<0.001）、1.391（95%CI：1.278 - 1.514，P<0.001）和1.695（95%CI：1.497 - 1.918，P<0.001），与基线CD4<200细胞/μl者相比。在HIV感染者中，56.0%（1601/2861）的停药是由于服药依从性差。随着开始ART时基线CD4的升高，HIV感染者的中断风险显著增加。为进一步降低ART中断率，在开始ART时考虑CD4水平并加强治疗依从性的健康教育以及对医护人员的培训很重要。
