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[2006 - 2019年台州市HIV/AIDS患者抗逆转录病毒治疗的影响因素及其与免疫效果的关联]

[Influencing factors of antiretroviral therapy and its association with immunological effect among HIV/AIDS patients in Taizhou city, 2006-2019].

作者信息

He J Y, Wang S L, Xu Y Y, Shen W W, Ding Y Y, Lin H J, He N, Chen X X

机构信息

Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.

Taizhou Prefectural Center for Disease Control and Prevention, Taizhou 318000, China.

出版信息

Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Dec 10;41(12):2093-2097. doi: 10.3760/cma.j.cn112338-20200611-00833.

Abstract

To analyze influencing factors of instant antiretroviral therapy (ART) and explore associution between strategies of ART and immunological effects among HIV/AIDS patients in Taizhou city during 2006-2019. A retrospective cohort study was conducted on HIV/AIDS patients under ART, and a logistic regression model was used to analyze factors of instant ART. The student -test and chi-square test were used to compare immunological effect of different ART strategies while the Kaplan-Meier method was used to generate a survival curve. A total of 2 971 HIV/AIDS patients were enrolled with 1 786 cases (60.1%) having instant ART strategy. The proportion of instant ART were 77.8% (1 170/1 504) during 2016 to 2019. The treatment success rate of the instant ART group (87.4%, 1 561/1 786) were higher than the delayed ART group (84.4%, 1 000/1 185). The results of multivariate logistic regression model indicated that male (a=1.28, 95: 1.03-1.59), married (a=1.71, 95: 1.33-2.19) and baseline CD(4)(+)T lymphocyte cells (CD(4)) counts ≤200 cells/μl (a=1.60, 95: 1.27-2.02) were factors positively related to instant ART while 31-40 years old (a=0.63, 95: 0.48-0.84), infected through heterosexual transmission(a=0.60, 95: 0.49-0.74) and diagnosed before 2015 (a=0.20, 95: 0.17-0.23) were inversely related to instant ART. The increase of the CD(4)/CD(8) ratio was greater, and the cumulative ART success rate was higher each year in the instant ART group than in the delayed ART group (<0.05). The instant ART strategy has been well implemented in Taizhou city during 2006-2019, and the immunological effect was better in instant ART group. The proportion of instant ART were more than 60.0% among HIV/AIDS patients. Instant ART strategy needs to be strengthened for those who are 31-40 years old, women, unmarried, and infected through heterosexual transmission in an attempt to further increase treatment level and improve treatment effect.

摘要

分析2006 - 2019年台州市艾滋病病毒/艾滋病(HIV/AIDS)患者即刻抗逆转录病毒治疗(ART)的影响因素,并探讨ART策略与免疫效果之间的关联。对接受ART的HIV/AIDS患者进行回顾性队列研究,采用逻辑回归模型分析即刻ART的影响因素。采用t检验和卡方检验比较不同ART策略的免疫效果,同时采用Kaplan - Meier法绘制生存曲线。共纳入2971例HIV/AIDS患者,其中1786例(60.1%)采用即刻ART策略。2016 - 2019年即刻ART的比例为77.8%(1170/1504)。即刻ART组的治疗成功率(87.4%,1561/1786)高于延迟ART组(84.4%,1000/1185)。多因素逻辑回归模型结果显示,男性(α = 1.28,95%CI:1.03 - 1.59)、已婚(α = 1.71,95%CI:1.33 - 2.19)和基线CD4⁺T淋巴细胞(CD4)计数≤200个/μl(α = 1.60,95%CI:1.27 - 2.02)是与即刻ART呈正相关的因素,而31 - 40岁(α = 0.63,95%CI:0.48 - 0.84)、经异性传播感染(α = 0.60,95%CI:0.49 - 0.74)和2015年前确诊(α = 0.20,95%CI:0.17 - 0.23)与即刻ART呈负相关。即刻ART组每年CD4/CD8比值升高幅度更大,累积ART成功率更高(P<0.05)。2006 - 2019年台州市即刻ART策略实施良好,即刻ART组免疫效果更好。HIV/AIDS患者中即刻ART的比例超过60.0%。对于31 - 40岁、女性、未婚及经异性传播感染的患者,需加强即刻ART策略,以进一步提高治疗水平和改善治疗效果。

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