少数民族地区吸毒人群艾滋病抗病毒治疗的疗效及影响因素

Efficacy evaluation of HAART among IDUs in minority regions and its impact factors

目的了解少数民族地区吸毒人群艾滋病抗病毒治疗的疗效及其影响因素。方法对纳入调查的初治吸毒者进行问卷调查和实验室检测,每隔3个月随访1次,观察半年。结果 180名初次抗病毒治疗的吸毒者,治疗后6个月余的127人中,123人检测了CD4T淋巴细胞,有12人(占9.8%)免疫学失败;120名已检测病毒载量的病人中,92人病毒载量降至最低检测限以下,病毒学成功率为76.7%。治疗前CD4<50个/μL者[比值比(OR)=0.10,95%可信区间(CI)=0.03～0.37]容易发生免疫学失败;半年的服药依从性在95%以上(OR=4.58,95%CI=1.87～12.57)、半年医学随访次数在≥7次(OR=3.23,95%CI=1.16～8.98)者,容易获得病毒学成功。结论吸毒人群的抗病毒治疗疗效低于其他人群,开始抗病毒治疗时间较晚、服药依从性差和参加医学随访次数较少,是造成吸毒人群疗效差的主要原因。

Objective To investigate the efficacy of highly active antiretroviral therapy （HAART） and its impact factors among injection drug users （IDUs） in minority regions. Methods A total of 180 treatment naive IDUs were selected for questionnaire survey and laboratory tests. In a six month study, they were followed-up every 3 months. Results Of the 180 treatment naive IDUs, 127 completed the six month followed-up; 123 patients received CD4 T lymphocyte test, of whom 12 （9.8%） had immunologic failure; 120 patients received plasma viral load （VL） test, of whom 92 （76.7%） had virological suppression, with viral loads under the lowest limit. In the multivariate logistic regression model, those with the baseline CD4 T lymphocyte count less than 50 celts/μL （OR= 0.10,95% CI= 0. 03-0. 37） were prone to have immunologic failure. Those who had the adherence rate over 95% （OR=4.58, 95%CI=1. 87--12. 57） and were interviewed for over 7 times in the half year period （OR=3.23, 95%CI= 1.16-8.98） were prone to be virological success. Conclusion The efficacy of HAART among IDUs is lower than among the other non-drug using people. Being late to start treatment, poor adherence and less follow up are the major im- pact factors related to its efficacy.