2019—2021年秦皇岛地区HIV/AIDS患者抗病毒治疗效果及影响因素分析

Effect of antiviral therapy and its influencing factors among patients with HIV/AIDS in Qinghuangdao,2019-2021

目的了解2019—2021年秦皇岛地区HIV/AIDS患者首次接受抗病毒治疗的效果,为进一步完善秦皇岛地区AIDS抗病毒治疗工作提供参考依据。方法收集2019—2021年底在秦皇岛地区内接受AIDS抗病毒治疗的18岁及以上HIV/AIDS感染者和AIDS患者基线和抗病毒治疗6个月后的相关资料,分析抗病毒治疗效果。结果450例患者在抗病毒治疗6个月后,病毒抑制失败24例,病毒抑制失败率为5.33%;多因素分析结果显示,相较于青年人群,中年(OR=1.269,95%CI:1.025~1.571)和老年人群(OR=1.645,95%CI:1.165~2.323),在抗病毒治疗6个月后,病毒抑制失败的风险较高(P=0.029);相较于确诊与治疗时间间隔<6个月,间隔时间≥6个月(OR=1.650,95%CI:1.142~2.386)病毒抑制失败的风险较高(P=0.008);相较于基线CD_(4)^(+)T淋巴细胞计数<200个/μl的患者,基线CD_(4)^(+)T淋巴细胞计数为350~499个/μl(OR=0.752,95%CI:0.632~0.895)和500个/μl以上(OR=0.672,95%CI:0.534~0.845)的人群,病毒抑制失败的风险较低;临床分期为Ⅲ~Ⅳ(OR=1.594,95%CI:1.267~2.004)、采用其他治疗方案(OR=1.422,95%CI:1.058~1.912)、漏服药物(OR=1.487,95%CI:1.194~1.852)、具有药物不良反应(OR=1.507,95%CI:1.186~1.914)的患者病毒抑制失败的风险较高。结论秦皇岛地区AIDS免费抗病毒治疗仍有部分患者抗病毒治疗效果失败。应重点关注中老年HIV/AIDS人群的治疗效果。此外,早发现、早诊断、早治疗以及提高患者的依从性对提升抗病毒治疗效果至关重要;抗病毒治疗受到近2年新冠疫情的影响,导致有的患者不能按时来取药用药。

Objective To investigate the efficacy of initial antiviral treatment in patients with human immunodeficiency virus(HIV)infection/acquired immunodeficiency syndrome(AIDS)in Qinhuangdao from 2019 to 2021,and to provide a reference basis for further improving HIV/AIDS antiviral treatment in Qinhuangdao.Methods We recruited the baseline data about HIV-infected persons/AIDS patients aged 18 years and above who received antiviral treatment for HIV/AIDS and the related data after 6 months of antiviral treatment in Qinhuangdao during 2019-2021,and then analyzed the effect of antiviral therapy.Results After 6 months of antiviral treatment,24 out of 450 HIV/AIDS patients had virological suppression failure,with the virological suppression failure rate being 5.33%.The results of multi-factor analysis revealed that the middle-aged population(OR=1.269,95%CI:1.025-1.571)and the elderly population(OR=1.645,95%CI:1.165-2.323)had a higher risk of virological suppression failure(P=0.029)after 6 months of antiviral treatment than the young population.Compared with the time interval between diagnosis and treatment of<6 months,the risk of virological suppression failure in the time interval between diagnosis and treatment of≥6 months(OR=1.650,95%CI:1.142-2.386)was higher(P=0.008).Patients with baseline CD_(4)^(+)T lymphocyte counts 350-499 cells/μl(OR=0.752,95%CI:0.632-0.895)and>500 cells/μl(OR=0.672,95%CI:0.534-0.845)had a lower risk of virological suppression failure than those with baseline CD_(4)^(+)T lymphocyte count<200 cells/μl.Patients with clinical stages Ⅲ~Ⅳ(OR=1.594,95%CI:1.267-2.004),other treatment regimens(OR=1.422,95%CI:1.058-1.912),missed medication(OR=1.487,95%CI:1.194-1.852)and adverse drug reactions(OR=1.507,95%CI:1.186-1.914)had a higher risk of virological suppression failure.Conclusion There are still some HIV/AIDS patients who fail to achieve virus suppression in antiviral therapy for HIV/AIDS offered free in Qinhuangdao.Special attention should be paid to the therapeutic effect among the middle-aged and elderly populations with HIV/AIDS.In addition,early detection,early diagnosis,early treatment and promoting patients’compliance are crucial for improving the effect of antiviral therapy.Antiviral treatment has been affected by the SARS-CoV-2 pandemic in the last two years,thus leading to some patients being unable to get and take the medicine on time.