新疆儿童HIV/AIDS病人抗病毒治疗的免疫学因素分析

Analysis of immunological factors of antiviral therapy in HIV/AIDS children in Xinjiang

目的探讨儿童艾滋病病毒(HIV)感染者/艾滋病(AIDS)患儿(简称HIV/AIDS患儿)抗反转录病毒治疗(ART)后,免疫学疗效随治疗时间变化的特点,了解影响免疫学疗效的相关因素,为提高HIV/AIDS患儿治疗效果提供理论依据。方法收集了新疆确诊年龄<15岁,治疗时间<3年的271例HIV/AIDS患儿的随访数据,按照年龄分为<5岁和≥5岁两组,进行免疫学疗效因素分析,利用广义线性混合效应模型进行统计学分析。结果271例HIV/AIDS患儿,按年龄<5岁和≥5岁分为两组,分别是71例和200例。患儿基线中位CD4^+T淋巴细胞计数分别是654个/μL和400个/μL。年龄<5岁的HIV/AIDS患儿治疗≤1年、1~2年、2~3年的免疫学失败率分别是12.68%、8.33%、8.70%;年龄≥5岁的HIV/AIDS患儿治疗≤1年、1~2年、2~3年的免疫学失败率分别是14.00%、15.33%、22.37%。在多因素分析中,免疫学治疗失败的危险因素为基线免疫学抑制程度、基线世界卫生组织(WHO)临床分期、最近7天漏服情况[比值比(OR)均>1],均会增加免疫学失败的发生,而持续治疗时间则会降低免疫学失败的发生[OR=0.971 5,95%可信区间(CI):0.971 4~0.971 5]。不同确诊到开始ART的间隔时间与治疗时间存在交互作用,即确诊到开始ART的间隔时间长的HIV/AIDS患儿免疫学失败的风险会增加(OR=1.045 0,95%CI:1.044 7~1.045 3)。结论在治疗三年中,漏服次数多,免疫学程度高,WHO临床分期重,确诊到开始ART的间隔时间长的HIV/AIDS患儿治疗效果较差,应加大对HIV/AIDS患儿早诊断、早治疗的宣传力度,加强随访管理。

Objective To explore the characteristics of immunological efficacy of HIV/AIDS children treated with antiviral therapy,and understand the factors influencing immunological failure,so as to provide a basis to improve the therapeutic efficacy.Methods The data of 271 pediatric HIV/AIDS patients aged<15 years old and treated with ART treatment<3 years in Xinjiang were collected,and all the cases were divided into two groups<5 and>5 years old.Generalized linear mixed model was used for statistical analysis.Results In the 271 cases,the group<5 y had 71 cases and another>5 y had 200 cases,with 654 cells/μL and 400 cells/μL baseline median T lymphocytes,respectively.CD4^+T lymphocytes in different age groups were higher than the baseline with the increase of treatment time.The immunological success rates of children<5 y old were 14.29%,8.33%and 8.70%after one,two and three years of treatment.The immunological success rates of children>5 y were 14.00%,15.33% and22.37% after one,two and three years of treatment.The multivariate analysis showed the risk factors for immunological treatment failure were baseline CD4^+T lymphocyte level,WHO clinical stage,and the last 7 days of missed medication(OR>1).Treatment time reduced the occurrence of immunological failure(OR=0.971 5 CI:0.971 4-0.971 5).There was an interaction between the intervals between the diagnosis and the start of ART and the duration of treatment,i.e.children with HIV/AIDS who had a longer interval between diagnosis and ART initiation increased immunological failure(OR=1.045 0,CI:1.044 7-1.045 3).Conclusion During the three years of treatment,many times of missing medication,high degree of immunology,being late at clinical stage,and a long interval between diagnosis and ART start will result in less effective treatment.More efforts should be made to promote early diagnosis and early treatment of children with HIV/AIDS,strengthen follow-up management,and improve compliance and quality of life of children with HIV/AIDS.