中国中部二线抗逆转录病毒治疗的 HIV/AIDS 患者免疫恢复不佳及相关因素：一项回顾性队列研究。

Suboptimal immune recovery and associated factors among people living with HIV/AIDS on second-line antiretroviral therapy in central China: A retrospective cohort study.

机构信息

The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, China.

Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.

出版信息

J Med Virol. 2022 Oct;94(10):4975-4982. doi: 10.1002/jmv.27944. Epub 2022 Jul 10.

DOI:10.1002/jmv.27944

PMID:35710693

Abstract

The introduction and scale-up of antiretroviral therapy (ART) have contributed to significantly improved patients with acquired immune deficiency syndrome (AIDS) quality of life and prolongs their survival. This has occurred by suppressing viral replication and recovering the CD4 cell count. However, some patients do not normalize their CD4 cell count, despite suppression of the viral load (VL). Patients with suboptimal immune recovery (SIR), as defined by a VL < 400 copies/ml with a CD4 cell count of<200 cells/μl, after ART initiation, exhibit severe immune dysfunction and have a higher risk of AIDS and non-AIDS events. In recent years, People living with HIV/AIDS (PLWHA) with first-line ART failure began to gradually switch to second-line ART. This study aimed to examine the prevalence and factors affecting SIR among PLWHA who switch to second-line ART in rural China. A 1-year retrospective cohort study was conducted among PLWHA who switched to second-line ART between January 2009 and December 2018. All patients with a VL < 400 copies/ml after 1 year of second-line ART were included. SIR was defined as a CD4 cell count <200 cells/μl and a VL < 400 copies/ml after 1 year of second-line ART. The data collected from medical records were analyzed by univariate and multivariate analyses. A total of 5294 PLWHA met the inclusion criteria, 24 died, and 1152 were lost to follow-up after 1 year of second-line ART. Among 4118 PLWHA who were followed up, 3039 with a VL < 400 copies/ml had their data analyzed, and the prevalence of SIR was 13.1%. The patients' mean age at recruitment was 47.6 ± 8.1 years and 45.3% were men. A total of 30.7% of patients were HIV-positive for >8 years and 88.2% were receiving ART before starting second-line ART for >3 years. The mean CD4 cell count was 354.8 ± 238.2 cells/μl. A multivariable analysis showed that male sex, single status (unmarried or divorced), and a low CD4 cell count were risk factors for SIR among PLWHA with second-line ART. The prevalence of SIR among PLWHA who switched to second-line ART in this retrospective cohort study is lower than that in most other studies. Several factors associated with SIR include male sex, marital status, and CD4 cell count levels in PLWHA.

摘要

抗逆转录病毒疗法（ART）的引入和推广显著改善了获得性免疫缺陷综合征（AIDS）患者的生活质量并延长了其生存时间。这是通过抑制病毒复制和恢复 CD4 细胞计数实现的。然而，尽管病毒载量（VL）受到抑制，一些患者的 CD4 细胞计数仍未恢复正常（VL<400 拷贝/ml，CD4 细胞计数<200 个/μl）。在 ART 启动后，具有未优化免疫恢复（SIR）的患者表现出严重的免疫功能障碍，并且 AIDS 和非 AIDS 事件的风险更高。近年来，在中国农村，开始逐渐将一线 ART 失败的 HIV/AIDS 患者（PLWHA）转用二线 ART。本研究旨在研究在中国农村转用二线 ART 的 PLWHA 中 SIR 的流行率和影响因素。对 2009 年 1 月至 2018 年 12 月期间转用二线 ART 的 PLWHA 进行了为期 1 年的回顾性队列研究。所有患者在二线 ART 治疗 1 年后 VL<400 拷贝/ml 被纳入研究。SIR 定义为二线 ART 治疗 1 年后 CD4 细胞计数<200 个/μl 和 VL<400 拷贝/ml。对病历中收集的数据进行了单变量和多变量分析。共有 5294 名 PLWHA 符合纳入标准，其中 24 人死亡，1152 人在二线 ART 治疗 1 年后失访。在 4118 名随访的 PLWHA 中，有 3039 名患者 VL<400 拷贝/ml，其数据进行了分析，SIR 的患病率为 13.1%。招募时患者的平均年龄为 47.6±8.1 岁，45.3%为男性。共有 30.7%的患者 HIV 阳性时间>8 年，88.2%的患者在开始二线 ART 前接受 ART 治疗>3 年。平均 CD4 细胞计数为 354.8±238.2 个/μl。多变量分析显示，男性、单身状态（未婚或离异）和较低的 CD4 细胞计数是 PLWHA 二线 ART 中 SIR 的危险因素。在这项回顾性队列研究中，转用二线 ART 的 PLWHA 中 SIR 的患病率低于大多数其他研究。与 SIR 相关的几个因素包括 PLWHA 的性别、婚姻状况和 CD4 细胞计数水平。