个案管理模式下人类免疫缺陷病毒感染者和艾滋病患者抗病毒治疗效果分析  

Analysis of the efficacy and influencing factors of HIV/AIDS antiretroviral therapy based on individualized case management model

作　　者：单濛 阿热祖·肉孜呢亚孜 胡晓敏[2] 陈浩 叶富秀 艾克热木·艾尔肯 倪明健[2] SHAN Meng;Arezu ROUZINIYAZI;HU Xiao-min;CHEN Hao;YE Fu-xiu;Aikeremu AIERKEN;NI Ming-jian(The College of Public Health,Xinjiang Medical University,Urumqi,Xinjiang 830011,China;不详)

机构地区：[1]新疆医科大学公共卫生学院,新疆乌鲁木齐830011 [2]新疆维吾尔自治区疾病预防控制中心,新疆乌鲁木齐830002 [3]伊宁市第二人民医院,新疆伊宁835000

出　　处：《中国病毒病杂志》2023年第1期20-26,共7页Chinese Journal of Viral Diseases

基　　金：国家科技重大专项(2018ZX10715-007);新疆艾滋病防控研究重点实验室(XJYS1706)。

摘　　要：目的分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者个案管理抗病毒治疗(antiretroviral therapy,ART)的病毒学及免疫学效果,为建立精准有效的个体化管理模式提供理论依据。方法2019年5月—2020年10月在新疆伊犁州第二人民医院招募符合纳入标准的HIV感染者和艾滋病(ac⁃quired immune deficiency syndrome,AIDS)患者,根据性别和年龄进行1∶1匹配分为个案管理组(977例)与常规干预组(977例),开展为期18个月的治疗随访。常规干预组进行免费的抗逆转录病毒治疗(anti⁃retroviral therapy,ART)、心理支持、健康教育和实验室检测;个案管理组在常规干预的基础上开展个案管理,包括全面评估HIV感染者和AIDS患者的身体状况,制定“一对一”服务计划,提供持续的医疗、社会及心理支持,定期监测病毒载量、CD4^(+)T细胞水平、耐药性及不良反应情况,并及时调整治疗方案。随访结束后,采用logistic回归模型分析HIV感染者个案管理模式的ART效果及影响ART效果的因素。结果随访结束后,个案管理组与常规干预组发生病毒学失败的患者分别为64例(64/977,6.6%)和104例(104/977,10.6%),发生免疫学失败的患者分别为48例(48/971,4.9%)和80例(80/970,8.2%),差异均有统计学意义(waldχ^(2)值分别为10.233和8.426,均P<0.05)。多因素logistic回归分析结果显示,接受个案管理的HIV感染者和AIDS患者发生病毒学失败(OR=0.617,95%CI:0.441~0.862)以及免疫学失败(OR=0.642,95%CI:0.417~0.989)的风险较低,其他影响ART效果的保护因素包括文化程度高中及以上以及ART一线方案,危险因素包括注射吸毒、临床晚期、确证-治疗间隔时间较长。结论个案管理可以有效提高ART的病毒学及免疫学效果,作为一种以个体为中心的综合管理方法,该方法有助于提高HIV感染者随访管理的服务质量。针对注射吸毒、临床晚期以及确证-治疗间隔时间较长的HIV感染者和AIDSObjective To investigate the virological and immunological effects of antiretroviral therapy(ART)in patients with HIV/AIDS,and to provide the theoretical basis for the formation of accurate and effective indi⁃vidualized management model.Methods From May 2019 to October 2020,a total of 1945 patients with HIV/AIDS who met the inclusion criteria were recruited in the Second People's Hospital of Yili,Xinjiang,and were divided into individual case management group(n=977)and routine intervention group(n=977)in matched pairs by age and gender.Patients in routine intervention group received free ART,psychological sup⁃port,health education and laboratory testing for 18 months,while those in case management group also received individualized case management,including comprehensive physical assessment and formulation of“one-to-one”service plan of medical,social and psychological support,regular monitoring of viral load,CD4^(+)T cell level,drug resistance and adverse reactions,as well as timely adjustment of treatment plan.After 18 month follow-up,logistic regression model was used to analyze the ART effect of patients under individualized management and the factors affecting the ART efficiency.Results After follow-up,64 cases(64/977,6.6%)and 48 cases(48/971,4.9%)in the case management group and 104 cases(104/977,10.6%)and 80 cases(80/970,8.2%)in the routine intervention group had virological failure and immunological failure,respectively,the differences were statistically significant(waldχ^(2) value was 10.233 and 8.426,respectively,both P<0.05).Multivariate logistic regression analysis showed that patients in case management group had lower risk of virological failure(OR=0.617,95%CI:0.441-0.862)and immunological failure(OR=0.642,95%CI:0.417-0.989).Other risk factors were injecting drug use,late stage,and longer interval between disease confirmation and treatment.How⁃ever,the protective factors included high school or above education and first-line ART regimen.Conclusion In⁃dividualized case management can effe

关 键 词：个案管理 艾滋病 抗病毒治疗 病毒学效果 免疫学效果 

分 类 号：R512.91[医药卫生—内科学]