凉山州彝族人群艾滋病抗逆转录病毒治疗失败的影响因素分析  

Analysis of influential factors of antiretroviral therapy failure for AIDS among Yi people in Liangshan Prefecture

作　　者：邓晚秋 蒙春莉 冯萍[1] 陈立宇 王颖[1] 刘凯[1] DENG Wanqiu;MENG Chunli;FENG Ping;CHEN Liyu;WANG Ying;LIU Kai(Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041

出　　处：《传染病信息》2024年第4期299-304,共6页Infectious Disease Information

基　　金：四川大学超前部署学科《华西医院艾滋病防控综合研究平台》基金(0040204151013)。

摘　　要：目的探究四川省凉山彝族自治州(凉山州)昭觉县感染人类免疫缺陷病毒(human immunodeficiency virus,HIV)或者确诊艾滋病(acquired immune deficiency syndrome,AIDS)的患者接受国家一线免费抗逆转录病毒治疗(antiretroviral therapy,ART)的效果以及可能的影响因素,以便为凉山州在AIDS防治方面的科学和高效工作提供科学依据。方法本研究采用了回顾性分析方法,对凉山州在2020年12月31日之前接受了至少48周一线ART的1651例HIV/AIDS患者的病毒载量进行检测,并使用SPSS 26.0软件进行了单因素和多因素Logistic回归分析,以识别影响ART失败(HIV RNA≥50copies/m L)的各种因素。结果纳入的1651例HIV/AIDS患者中男性占比53.1%(877/1651),中位年龄为35.00(31.00,40.00)岁,病毒学失败率为24.3%(402/1651)。多因素Logistic分析结果显示,文化程度(OR=0.11,95%CI:0.01~1.00,P=0.047)、启动治疗时长(OR=1.002,95%CI:1.001~1.003,P=0.003)以及服药依从性都是导致HIV/AIDS患者在ART中失败的关键因素,其中依从性是影响ART效果最主要的因素,依从性越差,ART效果越差,依从性等级2级为1级ART失败的85.95倍(95%CI:4.27~1723.88,P=0.004)。结论依从性是凉山州AIDS患者ART失败的主要因素,应通过提高患者服药依从性和尽早开始ART来降低病毒抑制失败率。Objective The aim of this study was to investigate the efficacy and possible factors influencing the efficacy of national first-line free antiretroviral therapy(ART)for HIV/AIDS patients in Zhaojue County,Liangshan Prefecture,Sichuan Province,in order to provide a scientific basis for scientific and efficient work in the prevention and treatment of HIV/AIDS in Liangshan Prefecture.Methods In this study,a retrospective analysis was used to test the viral load of 1651 people living with HIV/AIDS(PLWH)who received at least 48 weeks of first-line ART by December 31,2020 in Liangshan Prefecture,and univariate and multivariate logistic regression analyses were performed using SPSS 26.0 software to identify the various factors affecting antiretroviral treatment failure(HIV RNA≥50 copies/mL).Results A total of 1651 PLWH were enrolled,53.1%were male,median age was 35.00(31.00,40.00)years,and virologic failure rate was 24.3%.Multifactorial logistic analysis showed that literacy(OR=0.11,95%CI:0.01-1.00,P=0.047),and duration of treatment initiation(OR=1.002,95%CI:1.001-1.003,P=0.003),were significant factors influencing antiviral outcomes.Adherence was identified as the most critical factor,with poorer adherence being associated with poorer antiviral treatment outcomes,with adherence grade 2 being 85.95 times more likely to fail antiviral treatment than grade 1(95%CI:4.27-1723.88,P=0.004).Conclusion Adherence is a major factor in antiretroviral treatment failure among PLWH in Liangshan State,and viral suppression failure should be reduced by improving patients’adherence to medication and starting antiretroviral therapy as early as possible.

关 键 词：人类免疫缺陷病毒 艾滋病 抗病毒治疗 病毒学失败 影响因素 

分 类 号：R512.91[医药卫生—内科学]