经异性性接触与注射吸毒HIV感染者/艾滋病患者一线抗病毒药物疗效分析  

Analysis on the effectiveness of first-line antiretroviral therapy for HIV/AIDS patients infected from heterosexual intercourse or injection drug use

作　　者：阿热祖·肉孜呢亚孜 单濛 胡晓敏[2] 陈浩 倪明健[2] Arezu ROUZINIYAZI;SHAN Meng;HU Xiaomin;CHEN Hao;NI Mingjian(Xinjiang Medical University,School of Public Health,Urumqi,Xinjiang Uygur Autonomous Region 830054,China;不详)

机构地区：[1]新疆医科大学公共卫生学院,新疆维吾尔自治区乌鲁木齐830054 [2]新疆维吾尔自治区疾病预防控制中心 [3]伊宁市第二人民医院(金陵阳光医院)

出　　处：《中国预防医学杂志》2023年第11期1197-1203,共7页Chinese Preventive Medicine

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项目(XJYS1706)。

摘　　要：目的 分析目前使用一线治疗方案的经异性性传播和注射吸毒人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者/艾滋病患者抗病毒治疗(antiretroviral therapy,ART)效果差异及其影响因素。方法 采用前瞻性队列研究方法,选取2019年1月—2020年10月在新疆维吾尔自治区(新疆)伊宁市第二人民医院接受国家免费ART、目前使用一线治疗方案且感染途径为异性性接触与注射吸毒人群HIV感染者/艾滋病患者为研究对象,分析其随访期间CD4^(+)T淋巴细胞(CD4^(+)T细胞)计数变化趋势和病毒抑制情况。以首次出现病毒学失败为结局,采用比例风险Cox回归模型分析经异性性接触和静脉吸毒的HIV感染者/艾滋病患者ART效果的影响因素。结果 共纳入1 107例HIV感染者/艾滋病患者,随访期间死亡7例,总随访1 542.82人年。以男性(610例,55.10%)和30-40岁(598例,54.02%)为主,大多数(884例,79.86%)的HIV/艾滋病患者使用替诺福韦+拉米夫定+依非韦伦(TDF+3TC+EFV)的治疗方案。随访期间经异性性传播和注射吸毒感染的HIV感染者/艾滋病患者CD4^(+)T细胞计数均增加100个/μl以上,注射吸毒患者增长幅度低于异性性传播患者。最后一次随访时,异性性传播患者病毒完全抑制率为82.97%,而注射吸毒患者的为68.81%。经注射吸毒感染的HIV感染者/艾滋病患者病毒学失败率高于异性性传播患者(13.33%vs.5.53%,a HR=2.33,95%CI:1.55-3.55)。基线CD4^(+)T细胞计数350-<500个/μl (a HR=2.41,95%CI:1.12-5.22)、200-<350个/μl (a HR=2.23,95%CI:1.12-5.22)和<200个/μl (a HR=3.60,95%CI:1.67-7.77)的HIV感染者/艾滋病患者较≥500个/μl患者病毒学失败率较高。结论 伊犁州经异性性接触感染的HIV感染者/艾滋病患者的病毒学抑制率高于经注射吸毒感染人群,不同感染途径患者经过免疫功能恢复良好。使用一线治疗方案人群中病毒学失败的高危人群感染途径为注射吸毒和低基线CD4^(+)T细Objective To analyze the difference in treatment effect of first-line antiretroviral therapy(ART)between human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)patients attributed to heterosexual intercourse and those due to injection drug use,and to explore the influencing factors of the treatment effect.Methods A prospective cohort study was conducted to analyze the trends in CD4^(+)T lymphocyte(CD4^(+)T cell)counts and viral suppression during follow-up in the HIV/AIDS patients who 1)received free national ART at the Second People's Hospital of Yining City,Xinjiang,from January 2017 to October 2020,2)were currently using first-line regimens,and 3)were infected due to heterosexual contact or injection drug use.Proportional hazard Cox regression models were used to analyze the factors influencing the effect of ART in the HIV/AIDS patients,taking the first occurrence of virologic failure as the outcome.Results A total of 1107 patients with HIV/AIDS were included,with 7 deaths in 1542.82person-years of follow-up.The included patients were predominantly males(610 cases,55.10%),aged 30-40 years(598 cases,54.02%),mostly receiving TDF+3TC+EFV regimen(884 cases,79.86%).The CD4^(+)T cell count increased by more than 100 cells/μl in both heterosexual intercourse-and injection drug-infected HIV/AIDS patients during the follow-up period,but with a smaller magnitude in patients due to injection drug use.At the last follow-up,the rate of complete viral suppression was 82.97%in heterosexually transmitted patients but 68.81%in injection drug use-infected patients.The incidence of virologic failure was significantly higher in HIV/AIDS patients infected via injection drug use than in heterosexually transmitted patients(13.33%vs.5.53%,a HR=2.33,95%CI:1.55-3.55).HIV/AIDS patients with baseline CD4^(+)T cell counts of 350-<500/μl(a HR=2.41,95%CI:1.12-5.22),200-<350/μl(a HR=2.23,95%CI:1.12-5.22)and<200/μl(a HR=3.60,95%CI:1.67-7.77)had higher virologic failure rate than patients with≥500/μl CD4^(+)T cell co

关 键 词：抗病毒治疗 一线治疗方案 病毒学失败 差异性 

分 类 号：R512.91[医药卫生—内科学]