HIV/AIDS病例抗病毒治疗后免疫重建的影响因素研究  

Factors affecting immune reconstitution in HIV/AIDS patients after antiretroviral therapy

作　　者：吴虹[1] 许珂[1] 张兴亮[1] 李西婷[1] 程伟[2] WU Hong;XU Ke;ZHANG Xingliang;LI Xiting;CHENG Wei(Department of AIDS/STD Control and Prevention,Hangzhou Center for Disease Control and Prevention,Hangzhou,Zhejiang 310021,China;Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou,Zhejiang 310051,China)

机构地区：[1]杭州市疾病预防控制中心艾滋病性病防制所,浙江杭州310021 [2]浙江省疾病预防控制中心,浙江杭州310051

出　　处：《预防医学》2024年第4期277-282,共6页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：杭州市卫生科技计划一般(A类)项目(A20210346);浙江省科技计划项目(2024C35088);浙江省医药卫生科技计划项目(2020KY777)。

摘　　要：目的了解杭州市艾滋病病毒感染者和艾滋病患者(HIV/AIDS)抗病毒治疗后的免疫重建情况及其影响因素,为提高HIV/AIDS病例抗病毒治疗效果,改善其生存质量提供依据。方法纳入杭州市2016年1月1日—2021年8月31日开始抗病毒治疗、基线CD4~+T淋巴细胞(CD4)计数<500个/μL或基线CD4/CD8~+T淋巴细胞(CD8)比值<0.8的HIV/AIDS病例为研究对象,通过中国疾病预防控制信息系统收集抗病毒治疗开始至2023年8月31日随访终止期间的资料,包括基本信息、治疗情况、CD4计数和CD4/CD8比值等,分析HIV/AIDS病例的免疫重建情况,治疗后CD4计数≥500个/μL且CD4/CD8比值≥0.8定义为免疫重建良好。采用多因素Cox比例风险回归模型分析免疫重建的影响因素。结果纳入HIV/AIDS病例3349例,其中男性3075例,占91.82%;开始治疗年龄M(Q_(R))为31(20)岁;大专及以上学历1600例,占47.78%;世界卫生组织(WHO)临床分期Ⅰ~Ⅱ期2455例,占73.31%。免疫重建良好1368例,占40.85%;2016年开始抗病毒治疗的HIV/AIDS病例免疫重建良好比例最高,为51.90%。多因素Cox比例风险回归分析结果显示,WHO临床分期(Ⅰ~Ⅱ期,HR=2.529,95%CI:2.023~3.162)、治疗及时(HR=1.196,95%CI:1.027~1.394)、初始治疗方案(替诺福韦+拉米夫定+奈韦拉平/依非韦伦,HR=2.185,95%CI:1.891~2.524;整合酶抑制剂,HR=8.509,95%CI:6.706~10.795)、基线CD4/CD8比值(≥0.1,HR:1.600~4.515,95%CI:1.061~6.661)、基线血红蛋白(<90 mg/dL,HR=0.327,95%CI:0.121~0.880)、合并乙肝感染(HR=0.619,95%CI:0.457~0.840)和合并丙肝感染(HR=0.308,95%CI:0.099~0.956)是HIV/AIDS病例抗病毒治疗后免疫重建的影响因素。结论HIV/AIDS病例抗病毒治疗后免疫重建情况受WHO临床分期、治疗是否及时、初始治疗方案、基线CD4/CD8比值、基线血红蛋白和乙肝/丙肝感染的影响。Objective To investigate the immune reconstitution of HIV/AIDS patients and its influencing factors after re-ceiving antiviral therapy(ART)in Hangzhou City,so as to provide insights into improving the treatment effects and quality of life in HIV/AIDS patients.Methods A retrospective cohort of HIV/AIDS patients who began antiviral treat-ment between January 1,2016 and August 31,2021 and had a baseline CD4+T lymphocyte(CD4)counts of less than 500 cells/μL or a baseline CD4/CD8+T lymphocyte(CD8)ratio of less than 0.8 in Hangzhou City was followed up until August 31,2023.Demographic information,antiviral therapy in formation,CD4 counts,and CD4/CD8 were collected from the Chinese Disease Prevention and Control Information System.A good immune reconstitution was defined as hav-ing CD4≥500 cells/μL and CD4/CD8≥0.8.The immune reconstitution status of HIV/AIDS patients were analyzed,and factors affecting immune reconstitution were identified using a multivariable Cox proportional risk regression model.Re-sults A total of 3349 HIV/AIDS patients were enrolled,with a median age at ART of 31(interquartile range,20)years.There were 3075 males(91.82%),1600 cases with college education and above(47.78%)and 2455 cases at WHO clinical stageⅠ-Ⅱ(73.31%).There were 1368 cases with good immune reconstitution,accounting for 40.85%,and the proportion of HIV/AIDS patients with good immune reconstitution that began ART in 2016 was the highest,reaching 51.90%.Multivariable Cox proportional risk regression model identified WHO clinical stage(Ⅰ-Ⅱ,HR=2.529,95%CI:2.023-3.162),timely ART(HR=1.196,95%CI:1.027-1.394),initial treatment regimen(TDF+3TC+NVP/EFV,HR=2.185,95%CI:1.891-2.524;integrase inhibitors,HR=8.509,95%CI:6.706-10.795),baseline CD4/CD8(≥0.1,HR:1.600-4.515,95%CI:1.061-6.661),baseline hemoglobin(<90 mg/dL,HR=0.327,95%CI:0.121-0.880),hepatitis B infection(HR=0.619,95%CI:0.457-0.840)and hepatitis C infection(HR=0.308,95%CI:0.099-0.956)as factors affecting immune reconstitution in HIV/AIDS patients.Conclusion The immune

关 键 词：艾滋病 抗病毒治疗 免疫重建 影响因素 

分 类 号：R512.91[医药卫生—内科学]