河南三个重点县HIV/AIDS抗病毒治疗者病毒学失败率横断面研究

Cross-sectional study on the rate of virologic failure in HIV/AIDS patients with highly active antiretroviral therapy in three key counties of Henan

目的探讨河南省3个重点县HIV/AIDS抗病毒治疗者病毒学失败率,为HIV/AIDS患者抗病毒治疗效果分析提供依据。方法采用流行病学横断面研究方法,调查2009～2010年河南省上蔡县、新蔡县和尉氏县经病毒载量(VL)检测的在治HIV/AIDS成人患者共5957例,VL检测率为81%(5957/7385)。结果入组的5957例HIV/AIDS成人患者抗病毒治疗1年以上,病毒完全抑制者(VL<400拷贝/ml)占60.2%,治疗1～7年中病毒完全抑制率自64.7%逐渐下降为59.7%;不确定者(VL:400～999拷贝/ml)占4.0%;可疑抑制者(VL:1000～9999拷贝/ml)占16.4%;不完全抑制者(VL>10000拷贝/ml)占19.4%。对于患者病毒载量≥400拷贝/ml比例,男性高于女性,村卫生所治疗者高于乡镇卫生院治疗者,接受去羟肌苷(ddI)治疗方案者高于接受含拉米扶定(3TC)治疗方案者、最近7天漏服药物者高于近7天未漏服药物者,差异均具有统计学意义(P<0.05)。结论各地卫生行政部门应加强农村基层艾滋病临床医护人员的专业培训,加强患者服药依从性教育以及随访管理,优化抗病毒治疗方案,加强病毒载量的疗效监测,以上均为提高患者病毒抑制成功率的有效措施。

Objective To investigate the rate of virologic failure in HIV/AIDS patients who received highly active antiretroviral therapy （HAART） treatment in three key counties of Henan, and provide the reference for analyzing the effect of HAART treatment in HIV/AIDS. Methods Cross-sectional study were carried out on 5957 adult patients who received HAART and had virus load tested more than once were investigated in Shangcai, Xincai and Weishi counties of Henan from 2009 to 2010, with the rate of virus load tested as 81% （5957/7385）. Results All 5957 adult AIDS patients received antiretroviral treatment for more than one year, the most recent viral load （VL） test indicated that the ratio of individuals with virus completely suppressed （ VL 〈 400 copies/ml） was 60.2% , which gradually declined from 64.7% to 59.7% in the treatment of 1 to 7 years;uncertain suppression rate （VL： 400-999 copies/ml） was 4.0% ; suspicious suppression rate （VL： 1000-9999 copies/ml） was 16.4% ; not completely suppressed （VL 〉 10000 copies/ml） rate was 19.4%. The proportions of VL≥ 400 copies/ml in male patients, patients whose treatment program including di-deoxyinosine （ddI） , patients receiving village health clinic treatment and without compliance （missed medication in the last 7 days ） were higher than that in female patients, patients whose treatment program including Lamivudine （3TC）, patients receiving country health clinic treatment and with compliance （ did＇ t missed medication in the last 7 days）. The difference were statistically significant （P 〈 0. 05 ）. Conclusions To improve the success rate of viral suppression, local health administration department should strengthen the professional training of clinical staff working on AIDS ingrass roots, enhance the education of treatment compliance and follow-up the management of patients, optimize the antiretroviral therapy programs and enhance the efficacy monitoring of viral load.