广西柳州市HIV感染者早期及时治疗和初始用药方案对抗病毒治疗死亡及脱失的影响  

Impact of early and timely treatment and initial antiviral treatment regimen on antiviral treatment mortality and attrition among HIV-infected patients in Liuzhou,Guangxi

作　　者：覃丽泰 黄精华[2] 陈欢欢[2] 蓝光华[2] 冯毅[3] 邢辉[3] 朱金辉[2] 蔡文龙 阮玉华[3] 朱秋映[2] 谢艺红[1] QIN Litai;HUANG Jinghua;CHEN Huanhuan;LAN Guanghua;FENG Yi;XING Hui;ZHU Jinhui;CAI Wenlong;RUAN Yuhua;ZHU Qiuying;XIE Yihong(School of Public Health,Guangxi Medical University,Nanning,Guangxi 530021,China;Key Laboratory of Prevention and Control of Major Infectious Diseases and Biosafety Emergency Response,Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention,Nanning,Guangxi 530028,China;National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]广西医科大学公共卫生学院,广西南宁530021 [2]广西壮族自治区疾病预防控制中心,广西重大传染病防控与生物安全应急响应重点实验室,广西南宁530028 [3]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206

出　　处：《中国热带医学》2024年第2期126-131,共6页China Tropical Medicine

基　　金：国家科技部十四五重大专项(No.2022YFC2305205,No.2022YFC2305201);国家自然科学基金项目(No.82260670,No.82160636);广西艾滋病防控与成果转化研究重点实验室(No.ZZH2020010);广西八桂学者艾滋病防控关键技术岗位专项(No.厅发〔2019〕79号);广西医疗卫生重点学科建设项目(No.桂卫科教发〔2022〕4号)。

摘　　要：目的了解HIV感染者早期及时治疗和初始用药方案对抗病毒治疗死亡及脱失的影响,为有效治疗提供依据。方法采用回顾性队列研究方法,从艾滋病防治基本信息系统数据库下载2010—2020年广西柳州市HIV感染者抗病毒治疗数据。采用Cox比例风险回归模型分析死亡和脱失的影响因素。结果共纳入HIV感染者15713例,18~<50岁占53.4%,男性占69.4%,农民占61.0%,治疗前CD4计数<350个/μL占75.1%,总体死亡率4.30/100人年,总体脱失率2.42/100人年。Cox比例风险回归模型分析结果显示,治疗前CD4计数350~<500个/μL(AHR=0.72,95%CI:0.63~0.81)和≥500个/μL(AHR=0.64,95%CI:0.55~0.76),从HIV确证阳性至抗病毒治疗间隔90~<180 d(AHR=1.25,95%CI:1.08~1.45)、180~<365 d(AHR=1.26,95%CI:1.08~1.47)和≥365 d(AHR=1.26,95%CI:1.11~1.44),初始用药方案为D4T+3TC+EFV/NVP(AHR=1.47,95%CI:1.32~1.63)、AZT/D4T/TDF+3TC+LPV/r(AHR=1.73,95%CI:1.50~1.99)与HIV感染者抗病毒治疗死亡有统计学关联(P<0.05);治疗前CD4计数350~<500个/μL(AHR=1.32,95%CI:1.16~1.50)和≥500个/μL(AHR=1.28,95%CI:1.10~1.50),从HIV确证阳性至初始用药间隔≥365 d(AHR=1.21,95%CI:1.04~1.40),初始用药方案为TDF+3TC+NVP(AHR=1.32,95%CI:1.13~1.55)、AZT+3TC+EFV/NVP(AHR=1.43,95%CI:1.26~1.62)、AZT/D4T/TDF+3TC+LPV/r(AHR=1.33,95CI%:1.06~1.67)与HIV感染者抗病毒治疗脱失有统计学关联(P<0.05)。结论HIV感染者早期治疗和及时治疗以及初始用药方案为TDF+3TC+EFV的抗病毒治疗效果好,但需关注治疗前CD4计数高的HIV感染者在抗病毒治疗中面临较高的脱失风险问题。Objective To understand the impact of early and timely treatment and initial antiviral treatment regimen on mortality and attrition of antiretroviral therapy.Methods A retrospective cohort study was conducted using download data on antiretroviral therapy for HIV-infected patients in Liuzhou City,Guangxi Province,from the database of the Basic Information System for AIDS Control and Prevention(BISAC)from 2010 to 2020.The Cox proportional risk regression model was used to analyze the influencing factors of mortality and attrition.Results A total of 15713 infected patients were included,including 53.4%aged 18-<50 years,69.4%male,61.0%farmer,75.1%CD4 count<350 cells/μL before initial antiviral treatment,the overall mortality rate was 4.30/100 person-years,and the overall attrition was 2.42/100 person-years.The results of Cox regression analysis showed that the influencing factors of mortality were pretreatment CD4 counts of 350-<500 cells/μL(AHR=0.72,95%CI:0.63-0.81)and≥500 cells/μL(AHR=0.64,95%CI:0.55-0.76);duration from diagnosis to initial antiviral treatment 91-180 days(AHR=1.25,95%CI:1.08-1.45),181-365 days(AHR=1.26,95%CI:1.08-1.47),and≥365 days(AHR=1.26,95%CI:1.11-1.44);initial antiviral treatment regimens of D4T+3TC+EFV/NVP(AHR=1.47,95%CI:1.32-1.63)and AZT/D4T/TDF+3TC+LPV/r(AHR=1.73,95%CI:1.50-1.99).Factors affecting attrition were pretreatment CD4 counts of 350-499 cells/μL(AHR=1.32,95%CI:1.16-1.50)and≥500 cells/μL(AHR=1.28,95%CI:1.10-1.50);interval from HIV positivity confirmation to initial dosing≥365 days(AHR=1.21,95%CI:1.04-1.40),initial antiviral treatment regimens of TDF+3TC+NVP(AHR=1.32,95%CI:1.13-1.55),AZT+3TC+EFV/NVP(AHR=1.43,95%CI:1.26-1.62)and AZT/D4T/TDF+3TC+LPV/r(AHR=1.33,95CI%:1.06-1.67).Conclusions Early and timely treatment and the initial antiviral treatment regimen of TDF+3TC+EFV have good efficacy,but attention should be paid to the high risk of attrition of HIV-infected people with high CD4 count before treatment.

关 键 词：HIV感染者 抗病毒治疗 早期治疗 及时治疗 初始用药方案 死亡 脱失 

分 类 号：R512.99[医药卫生—内科学]