广西壮族自治区人类免疫缺陷病毒阳性的女性性工作者抗病毒治疗效果影响因素分析  

Influencing factors of the effect of anti-retroviral therapy in female commercial sex workers with human immunodeficiency virus positive in Guangxi Zhuang Autonomous Region

作　　者：唐俏 谭广杰[2] 黄精华[2] 唐帅[2] 沈智勇[2] 邹云锋 周月姣[2] 蒋俊俊 Tang Qiao;Tan Guangjie;Huang Jinghua;Tang Shuai;Shen Zhiyong;Zou Yunfeng;Zhou Yuejiao;Jiang Junjun(Guangxi Key Laboratory of AIDS Prevention and Treatment,School of Public Health,Guangxi Medical University,Nanning 530021,China;Institute of HIV/AIDS Prevention and Control,Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention,Nanning 530028,China)

机构地区：[1]广西医科大学公共卫生学院&广西艾滋病防治研究重点实验室,南宁530021 [2]广西壮族自治区疾病预防控制中心艾滋病防制所,南宁530028

出　　处：《中华传染病杂志》2021年第9期528-535,共8页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金(81960602);国家科技重大专项(2018ZX10715008)。

摘　　要：目的了解广西壮族自治区人类免疫缺陷病毒(human immunodeficiency virus,HIV)抗体阳性女性性工作者(female commercial sex workers,CSW)接受抗反转录病毒治疗(anti-retroviral therapy,ART)情况及其治疗效果的影响因素。方法本研究采用回顾性队列研究方法。纳入2009年1月1日至2018年12月31日广西壮族自治区各市级和县级疾病预防控制中心报告至广西壮族自治区疾病预防控制中心的661例接受ART的HIV阳性CSW,收集患者的人口学信息和临床资料,包括婚姻状况、既往史、治疗6~12个月是否出现艾滋病相关疾病、服药和CD4^(+)T淋巴细胞计数等情况。分析接受6~12个月ART后的病毒学效果和免疫学效果。采用logistic回归模型分析HIV阳性CSW接受6~12个月ART后病毒学失败和免疫学失败的影响因素。结果661例HIV阳性CSW中,50例(7.6%)出现病毒学失败,80例(12.1%)出现免疫学失败,13例(2.0%)既出现病毒学失败也出现免疫学失败,85例(12.9%)有性病史。多因素logistic回归分析结果显示,未婚[调整后的比值比(adjusted odds ratio,aOR)=3.298,95%可信区间(confidence interval,CI)1.285~8.461],ART后6~12个月出现艾滋病相关疾病(aOR=4.391,95%CI 1.555~12.402)和最近7 d漏服药物(aOR=3.731,95%CI 1.942~7.166)是出现病毒学失败的危险因素。与基线CD4^(+)T淋巴细胞计数<200.00/μL相比,基线CD4^(+)T淋巴细胞计数为350.00~<500.00/μL(aOR=3.543,95%CI 1.631~7.701)和≥500.00/μL(aOR=2.358,95%CI 1.002~5.547)是出现免疫学失败的危险因素。结论广西壮族自治区HIV阳性CSW抗病毒治疗效果较好,病毒学失败率和免疫学失败率均较低。婚姻状况、基线CD4^(+)T淋巴细胞计数、ART后6~12个月出现艾滋病相关疾病,以及最近7 d漏服药物是影响抗病毒治疗6~12个月效果的因素。Objective To investigate the effect and influencing factors of anti-retroviral therapy(ART)in human immunodeficiency virus(HIV)-positive female commercial sex workers(CSW)in Guangxi Zhuang Autonomous Region.Methods A retrospective cohort study was used in this study.A total of 661 HIV-positive CSW receiving ART from the Guangxi Zhuang Autonomous Region′s municipal and county-level Centers for Disease Control and Prevention(CDC)reported to Guangxi Zhuang Autonomous Region CDC from January 1,2009 to December 31,2018 were included.The demographic information of the patients,marital status,past medical history,acquired immunodeficiency syndrome(AIDS)-related diseases after six to 12 months of ART,medications,CD4^(+)T lymphocytes,virological and immunological effects after receiving ART for six to 12 months were collected.Logistic regression model was used to analyze the influencing factors of virological failure and immunological failure of HIV-positive CSW after six to 12 months of ART.Results Among 661 HIV-positive CSW,50(7.6%)cases experienced virological failure,80(12.1%)cases experienced immunological failure,and 13(2.0%)had both virological failure and immunological failure.There were 85 cases(12.9%)who had a history of sexually transmitted diseases.Multivariate logistic regression analysis showed that unmarried(adjusted odds ratio(aOR)=3.298,95%confidence interval(CI)1.285 to 8.461),AIDS-related diseases after six to 12 months of ART(aOR=4.391,95%CI 1.555 to 12.402)and missed medications in the last seven days(aOR=3.731,95%CI 1.942 to 7.166)were risk factors for virological failure.Compared with CD4^(+)T lymphocytes<200.00/μL at baseline,350.00≤CD4^(+)T lymphocytes<500.00/μL(aOR=3.543,95%CI 1.631 to 7.701)and CD4^(+)T lymphocytes≥500.00/μL(aOR=2.358,95%CI 1.002 to 5.547)were risk factors for immunological failure.Conclusions HIV-positive CSW in Guangxi Zhuang Autonomous Region have a better treatment effect,with low rates of virological failure and immunological failure.Marital status,baseline CD4^(+)

关 键 词：HIV/AIDS HIV阳性女性性工作者 抗反转录病毒治疗 病毒学失败 免疫学失败 

分 类 号：R512.91[医药卫生—内科学]