快速启动艾滋病抗病毒治疗成效观察及影响因素分析  

Effect Observation and Influencing Factors Analysis of Rapid Initiation of Antiretroviral Therapy

作　　者：田波 刘俊 李重熙 张伟 房梅芹 陈海云 柏静萍 周鑫 程雷 金永梅 TIAN Bo;LIU Jun;LI Chongxi;ZHANG Wei;FANG Meiqin;CHEN Haiyun;BAI Jingping;ZHOU Xin;CHENG Lei;JIN Yongmei(Dept.of Infection One,The 3rd People’s Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院/云南省传染性疾病临床医学中心感染一科,云南昆明650041

出　　处：《昆明医科大学学报》2024年第9期163-167,共5页Journal of Kunming Medical University

基　　金：云南省科技厅-大理大学地方高校联合专项基金资助项目(202001BA070001-194);昆明市卫生科技项目(2022-03-08-013,2022-03-08-007)。

摘　　要：目的了解昆明市快速启动艾滋病抗病毒治疗48周患者的成效,同时分析非快速启动的影响因素。方法回顾性收集2018年1月至2022年12月昆明市第三人民医院初始接受艾滋病抗病毒治疗患者的资料,确诊到开始治疗时间间隔≤7 d为快速启动组,>7 d为非快速启动组。卡方检验及t检验对比分析2组患者基线人口学及临床特征差异,Logistic回归分析影响因素。卡方检验比较2组患者治疗48周的CD4计数、病毒抑制率、队列保持率及病死率差异。结果快速启动率为32.70%,非快速启动组48周失访率更高(χ^(2)=11.169,P=0.001),病死率更高(χ^(2)=3.924,P=0.048)。无配偶患者非快速启动的风险是有配偶患者的1.212倍(P=0.040)。静脉注射吸毒传播的患者非快速启动的风险是异性性接触传播的2.987倍(P<0.001)。基线CD4/CD8<0.5的患者非快速启动的风险是CD4/CD8≥0.5患者的1.423倍(P=0.001),CD4计数≤350个/μL的患者非快速启动的风险更高(P=0.047)。治疗48周快速启动组病毒抑制率高于非快速启动组(P=0.031),CD4/CD8≥0.5的患者比例快速启动组更高(P<0.001)。结论快速启动抗病毒治疗,有利于提高病毒抑制率及队列保持率,降低病死率。对于无配偶,静脉注射传播以及CD4/CD8<0.5的患者应给予更多的干预措施,帮助患者尽快接受抗病毒治疗。Objective To investigate the efficacy of 48 weeks of rapid initiation of HIV antiviral therapy in Kunming,and analyze the influencing factors of Non-rapid initiation.Methods Data of patients initially receiving HIV antiviral treatment in The Third People's Hospital of Kunming from January 2018 to December 2022 were retrospectively collected.The time interval between diagnosis and treatment initiation was≤7 days in the rapid ART group,and>7 days in the non-rapid ART group.Chi-square test and T-test were used to compare the baseline demographic and clinical characteristics between the two groups and logistic regression analysis was used to analyze the influence factors.The chi-square test was used to compare the difference of CD4 count,viral inhibition rate,cohort retention rate and mortality between the two groups after 48 weeks of treatment.Results The Rapid ART rate was 32.70%,the Non-rapid ART group has higher loss rate in 48 week(χ^(2)=11.169,P=0.001),higher mortality(χ^(2)=3.924,P=0.048).The risk of Non-rapid initiation was 1.212 times higher in patients without a spouse(P=0.040).The risk of Non-rapid initiation in patients transmitted by intravenous drug use was 2.987 times that of heterosexual transmission(P<0.001).Patients with baseline CD4/CD8<0.5 had a 1.423 times greater risk of Non-rapid initiation than patients with CD4/CD8≥0.5(P=0.001),patients with CD4 counts≤350/μL were at higher risk for Non-rapid initiation(P=0.047).After 48 weeks of treatment,the virus inhibition rate in the Rapid ART group was higher than that in theNon-rapid ART group(P=0.031),the proportion of patients with CD4/CD8≥0.5 was higher in theRapid ART group(P<0.001).Conclusion Rapid initiation of antiviral therapy is beneficial to improve viral inhibition rate and cohort retention rate,and reduce mortality.For patients without spouses,with intravenous transmission and CD4/CD8<0.5,more interventions should be given to help patients receive antiviral therapy as soon as possible.

关 键 词：艾滋病 人类免疫缺陷病毒 抗逆转录病毒治疗 快速启动 早期 疗效 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]