湖北省艾滋病抗病毒治疗终止原因分析

Analysis of factors leading to the termination of AIDS antiretroviral therapy in Hubei Province

目的探讨免费艾滋病抗病毒治疗病人终止治疗的原因。方法利用国家统一使用的DataFax抗病毒治疗信息收集系统所收集的全省抗病毒治疗数据资料，采用断面调查方法，对湖北省接受艾滋病抗病毒治疗患者终止治疗的原因进行分类统计；用1：2配比分析研究方法，对治疗中死亡病例与未死亡病例的数据资料进行Logistic回归分析。结果（1）在终止与未终止治疗病例的比较中，性别比有显著性差异；（2）终止治疗的首要原因是药物副反应引起停药（56．74％），其次是死亡（36．17％）；（3）治疗中发生副反应的首要表现是肝功能异常（52．50％）；（4）治疗中发生死亡的危险因素是：不按医嘱服药，漏服次数愈多危险性愈大（P=0．0086，OR95％CI是1．165～2．852）；防止治疗中死亡的保护因素是：患者在治疗中未出现药物副反应（P=0．0027，OR95％CI是0．320～0．787），当出现严重副反应时，能及时更换药物（P〈0．01，OR95％CI是0．262～0．636）。结论应着重提高就诊者特别是男性患者的服药依从性教育，建立抗病毒治疗药物不良毒副反应监测体系，雌测中一旦发现出现严重副反应，要及时更换药物，这些措施可有效降低终止抗病毒治疗的发生。

Objective To explore factors leading to the termination of antiretroviral therapy among AIDS patients who were receiving free treatment. Methods The data of antiretroviral therapy over the province were collected by the DataFax antiretro-viral therapy information searching system commonly used in China, and the cross-section survey method was adopted to classify systematically the factors leading to the termination of antiretroviral therapy among AIDS patients in Hubei province. Logistical regression analysis was also employed for the data of both deceased and surviving cases by using 1 ： 2-match case-control study. Results （ 1 ）There was an evident gender difference in the rate of antiretroviral therapy termination; （2）The primary factor leading to therapy termination was adverse reaction of the drug （56.74 % ）; and the next was death （36.17 % ）;（3）The main symptom of adverse reaction was abnormal liver function （52.50 % ）;（4 ）The risk factor to death in the course of therapy was poor compliance, and failure to take bills regularly represented greater risk to the patients（ P = 0. 0086, OR 95 % CI is 1.165 = 2. 852）. The factors preventing death in the course of treatment in eluded absence of side effeet（ P = 0. 0027, OR95 % CI is 0. 320- 0. 787）, and immediate adoption of alternative drugs（ P 〈0.01 ,OR 95% CI is 0.262-0.636）. Conclusion Education should be strengthened among AIDS patients to improve their compliance with treatment regime and a system to monitor the adverse reaction of antiretroviral drugs should be established so that alternative drugs could be used timely whenever side effect of one drug is identified. Only by adopting all these measures in a proper way,can the antiretroviral therapy be sustained.