河南省抗病毒治疗艾滋病患者生存状况及影响因素  

Survival status and influencing factors of AIDS patients with antiretroviral therapy in Henan province

作　　者：袁源[1] 闫江舟[1] 薛秀娟[1] 刘佳[1] 张向兵[1] 刘春华[1] 张国龙 YUAN Yuan;YAN Jiangzhou;XUE Xiujuan;LIU Jia;ZHANG Xiangbing;LIU Chunhua;ZHANG Guolong(Henan Center for Disease Control and Prevention,Zhengzhou,Henan 450016,China)

机构地区：[1]河南省疾病预防控制中心性病艾滋病防治研究所,河南郑州450016

出　　处：《河南预防医学杂志》2022年第1期36-39,77,共5页Henan Journal of Preventive Medicine

基　　金：河南省医学科技攻关计划联合共建项目(2018020524)。

摘　　要：目的了解河南省抗病毒治疗艾滋病患者生存状况及影响因素,为延长艾滋病患者生存期提供依据。方法通过2003-2016年在河南省确山县2003-2008年开始抗病毒治疗艾滋病患者中开展的前瞻性研究队列,每半年随访一次,收集观察对象人口学资料、治疗信息、CD4+T淋巴细胞(CD4)计数、病毒载量和基因型耐药情况等信息,采用Cox比例风险回归模型分析抗病毒治疗患者生存的影响因素。结果297例患者累计随访2840.67人年,平均随访时间为11.08(QR:7.67~12.17)年,死亡88例,死亡密度为3.10/100人年。Cox回归分析显示:研究对象的死亡风险因素中,开始抗病毒治疗的年龄≥50岁是18~34岁者的1.94倍(95%CI:1.02~3.69),治疗前CD4计数<350个/μL是≥350个/μL的2.65倍(95%CI:1.45~4.84),初始抗病毒一线治疗含去羟肌苷(DDI)方案是含拉米夫定(3TC)方案的4.96倍(95%CI:1.19~20.62),未更换含克力芝(LPV/r)的二线治疗方案是更换此方案者的23.89倍(95%CI:12.25~46.61),抗病毒治疗后≥24个月发生耐药和治疗<24个月发生耐药是未发生耐药者的2.28倍(95%CI:1.11~4.67)和2.66倍(95%CI:1.61~4.41)。结论年龄大、治疗前CD4计数低、未换二线治疗方案及治疗后早期发生耐药是长期抗病毒治疗患者的死亡危险因素。在提高抗病毒治疗及时性、依从性及科学换药的同时要加强抗病毒治疗患者的耐药监测,尤其是关注治疗早期的耐药发生,降低艾滋病患者的死亡率。Objective To understand the survival status and influencing factors of AIDS patients on long-term antiretroviral therapy in Queshan county,Henan province,and to provide a basis for prolonging the survival of AIDS patients.Methods A prospective cohort survey was conducted semiannually from December 2003 to December 2016,among AIDS patients starting antiretroviral treatment between 2003 and 2008 in Queshan county.Information about patients’demographics,antiretroviral therapy information,CD4 cell count,viral load and genotypic drug resistance test results was collected,and Cox proportional hazards model was used to analyze the factors of mortality in patients on antiretroviral therapy.Results 297 AIDS partners receiving antiretroviral therapy had been followed for 2840.67 person-years,the average follow-up time was 11.08(QR:7.67-12.17)years,88 died(3.10/100 person-years).Cox proportional risk regression model showed that,compared with patients of aged 18-34 years old,the AHR of those aged≥50 years old at initiation of antiviral therapy was 1.94(95%CI:1.02-3.69),compared with patients with baseline CD4≥350 cells/μL,the AHR of patients with baseline CD4<350 cells/μL was 2.65(95%CI:1.45-4.84),compared with patients with initial antiviral therapy containing 3 TC first-line regimen,the AHR of patients with initial antiviral therapy containing DDI was 4.96(95%CI:1.19-20.62),and no change in second-line regimen containing LPV/r was 23.89 times(95%CI:12.25-46.61)of change drug,and the earlier emergence of drug resistance after antiviral therapy was 2.66 times(95%CI:1.61-4.41)of non-drug resistance.Conclusion Older age,lower CD4 value before treatment,failure to switch to a second-line regimen and earlier emergence of drug resistance after treatment are the death risk factors in AIDS patients on longterm antiviral therapy.In addition to improving the timeliness and compliance of antiretroviral therapy and scientific switch to second-line drug regimens,we should strengthen the monitoring of drug resistance in patients

关 键 词：艾滋病 抗病毒治疗 耐药 死亡率 生存分析 

分 类 号：R512.91[医药卫生—内科学]