山西省艾滋病免费ART病例治疗效果分析

Effect analysis of free antiretroviral therapy(ART)for HIV infection in Shanxi Province

目的评估山西省艾滋病免费抗病毒治疗(ART)的效果。方法选择2004年6月底至2013年12月底纳入国家免费抗病毒治疗的病例,采用回顾性队列研究方法,通过治疗前后死亡率、CD+4T淋巴细胞(简称CD4细胞)、病毒载量的变化进行评估。结果共调查2377例艾滋病病例,平均年龄38.8岁、男性占66.0%、农民占59.3%、传播途径以异性性传播为主(43.1%)。共有17种抗病毒治疗用药方案,使用其中6种初始治疗用药方案的病例占97.7%。治疗前CD4细胞数平均为158个/μL,治疗后平均为345.1个/μL,治疗前后平均增加187.1个/μL(P=0.000)。病毒载量治疗前<最低检测限(LDL)占18.3%、几何均数4.0×104拷贝/mL,治疗后<LDL占85.0%、几何均数2.2×103拷贝/mL。治疗前后CD4细胞和病毒载量数值差异和构成比有统计学意义。死亡病例和存活病例的CD4细胞计数在治疗前、治疗后、治疗前后增长值均有明显差异。治疗后第6、12、24、36、48、60、72、84、96、108个月死亡率(CDR;1/100人年)分别为13.8、9.0、2.6、1.8、1.9、2.9、2.9、1.5、3.9、4.6。结论治疗后死亡率下降、CD4细胞增加和病毒载量下降明显,抗病毒治疗取得了较好的效果。

Objective To evaluate the effect of free antiretroviral therapy（ART）for HIV infection in Shanxi Province.Method A retrospective cohort study was conducted in Shanxi Province.The subjects were enrolled from the national free ART program from Jun 2004 to Dec 2013.Analysis was performed in mortality,CD＋4T cell counts,viral load before and after ART.Results A total of 2377 HIV infected patients were enrolled,with the average age of 38.8years,66.0% males,59.3%farmers and 43.1%transmitted by heterosexual behavior.There were 17 regimens prescribed,among which 6were initially used in 97.7% patients.The median of CD＋4T cell counts was 158cells/μL prior to treatment and 345cells/μL post treatment,with a increase of 187.1cells/μL（P=0.000）.Percentage of patients with viral load less than the lowest detection limit（LDL）was 18.3% with a geometric mean of 4.0×104 cp/ml prior to treatment,and 85.0% with 2.2×103cp/ml post treatment.There were significant differences in changes and percentages of CD4 cell counts and viral loads before and after treatment.There were significant differences in CD4 cell counts before and after treatment between death and survival patients.The mortality rates at 6,12,24,36,48,60,72,84,96 and 108months after treatment were 13.8,9.0,2.6,1.8,1.9,2.9,2.9,1.5,3.9and 4.6per 100person-years,respectively.Conclusion According to the obvious changes in mortality,CD＋4T cell counts and viral loads before and after treatment,effect of ART are good.