德宏傣族景颇族自治州成年人HIV/AIDS抗病毒治疗后CD4^(+)T淋巴细胞免疫重建及影响因素分析  

Prevalence and related factors of CD4^(+)T lymphocytes immune recovery among adult HIV/AIDS on antiretroviral therapy in Dehong Dai and Jingpo Autonomous Prefecture

作　　者：俞海亮[1] 杨跃诚 赵燕[1] 曹东冬 金聪[1] 叶润华 曹艳芬 刘雪娇 姚仕堂 陈晨[4] 段松 吴尊友[1] Yu Hailiang;Yang Yuecheng;Zhao Yan;Cao Dongdong;Jin Cong;Ye Runhua;Cao Yanfen;Liu Xuejiao;Yao Shitang;Chen Chen;Duan Song;Wu Zunyou(National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention,Mangshi 678400,China;Department of Public Health,Dehong Dai and Jingpo Autonomous Prefecture People's Hospital,Mangshi 678400,China;Department of Environmental Epidemiology,National Institute of Environmental Health,Chinese Center for Disease Control and Prevention,Beijing 100021,China)

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206 [2]德宏傣族景颇族自治州疾病预防控制中心,芒市678400 [3]德宏傣族景颇族自治州人民医院公共卫生科,芒市678400 [4]中国疾病预防控制中心环境与健康相关产品安全所环境流行病学室,北京100021

出　　处：《中华流行病学杂志》2021年第6期1050-1055,共6页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10721-102)。

摘　　要：目的分析德宏傣族景颇族自治州(德宏州)成年人HIV/AIDS开始抗病毒治疗(ART)后CD4^(+)T淋巴细胞(CD4)纵向变化特征及其影响因素。方法对德宏州2007-2016年开始ART的成年人HIV/AIDS的回顾性队列随访至2018年12月31日。免疫重建良好的定义为HIV/AIDS经ART后CD4恢复至基本正常(>500个/µl),据此将HIV/AIDS分为4个组,采用轨迹分析模型描述和分析每组ART后CD4免疫重建情况,采用多因素logistic回归分析其影响因素。采用SAS 9.4软件进行统计学分析。结果研究对象共7605例HIV/AIDS,开始ART年龄M(P_(25),P_(75))为36(30,43)岁,男性4641例(61.0%),汉族3232例(42.5%),小学及以下文化程度4624例(60.8%),随访时间M(P_(25),P_(75))为6.1(4.1,8.1)年。CD4未恢复正常组、CD4基本恢复正常组、CD4恢复正常组和CD4维持正常组的构成比分别为34.4%(2617)、39.8%(3030)、20.6%(1562)和5.2%(396)。与CD4未恢复正常组作为对照组相比,开始ART年龄<35岁、女性、中学及以上文化程度、性传播感染途径、基线无机会性感染、开始ART时CD4≥200个/µl、含替诺福韦(TDF)标准的ART方案、确诊到开始ART时间<1年是促进HIV/AIDS的CD4免疫重建良好的影响因素。结论德宏州ART后HIV/AIDS的CD4免疫重建情况呈多种状况,在基线CD4较高水平时开始ART有助于CD4恢复至正常水平。建议尽早开始ART,注意随访和关注CD4水平变化。Objective To analyze the longitudinal characteristics of CD4^(+)T lymphocytes(CD4)among the adult HIV/AIDS on antiretroviral therapy(ART)and the related factors.Methods A retrospective cohort of adult HIV/AIDS starting ART in Dehong Dai and Jingpo Autonomous Prefecture(Dehong)in 2007-2016 was followed up to December 31,2018.Group-based trajectory models were utilized to identify CD4 subgroups based on immune recovery(whether and when CD4 reached the average level of>500 cells/μl).The demographics and information at ART baseline were described,and the related factors were analyzed with polytomous logistic regression.The SAS 9.4 software was used for statistical analysis.Results A total of 7605 adults with HIV/AIDS were included,of which the median(P_(25),P_(75))age at ART were 36(30,43)years old,61.0%were male,42.5%were Han nationality,and 60.8%with the education of primary school or below.The follow-up duration M(P_(25),P_(75))was 6.1(4.1,8.1)years.HIV/AIDS in Dehong showed four CD4 trajectory subgroups from low to high:below the average level,primary recovery to a normal level,full recovery to a moderate level,and normal steady level,accounting for 34.4%,39.8%,20.6%,and 5.2%,respectively.When compared with corresponding control groups,age<35 years at ART,female,education of middle school or above,sexual transmission,no opportunistic infection,CD4≥200 cells/μl,baseline regimen with tenofovir(TDF)and time from HIV diagnosis to ART<1 year were the related factors facilitating the higher CD4 subgroups.Conclusions The various CD4 immune recoveries of HIV/AIDS were changing patterns after ART.Starting ART with a high CD4 level was beneficial to CD4 recovery to normal level during the follow-up period.Early initiation of ART and exceptional attention to CD4 immune recovery should be encouraged after the ART.

关 键 词：艾滋病病毒 抗病毒治疗 CD4^(+)T淋巴细胞 免疫重建 轨迹分析模型 

分 类 号：R512.91[医药卫生—内科学]