2008-2013年河南省艾滋病患者抗病毒治疗对HIV的抑制效果及其影响因素分析

Analysis on HIV suppression effect after initiating antiretroviral treatment and related factors among AIDS patients in Henan province during 2008 and 2013

目的了解不同基线免疫学水平的艾滋病患者接受抗病毒治疗后的HIV完全抑制效果及其影响因素。方法利用国家艾滋病抗病毒治疗信息系统，收集河南省2008--2013年加入抗病毒治疗的艾滋病患者基本信息和随访信息，按照基线免疫学水平将艾滋病患者分为常规治疗组（基线CD4＋T淋巴细胞计数≤350个／μl）和早期治疗组（基线CIM’T淋巴细胞计数为351—500个／μ1），计算其治疗6个月、1年、2年、3年、4年、5年后的HIV完全抑制率，采用非条件logistic回归方法分析开始治疗6个月后HIV未被抑制的影响因素。结果共有16103例艾滋病患者纳入本研究，其中常规治疗组14522例，早期治疗组1581例。男性9428例，女性6675例，性别比为1．41：1，年龄为（47．2±11．7）岁，已婚或同居者占71．6％（11522／16103），感染途径多为血液传播，占57．2％（9214／16103）。所在治疗机构多为乡级或村级，占81．3％（13086／16103），初始治疗方案以司坦夫定（D4T）或齐多夫定（AZT）＋拉米夫定（3TC）＋奈韦拉平（NVP）或依非韦伦（EFV）为主，占77．1％（12426／16103）。开始抗病毒治疗6个月、1年、2年、3年、4年、5年后，常规治疗组的HIV抑制率分别为72．6％（3008／4144）、73．9％（4758／6443）、74．1％（3641／4915）、74．9％（2819／3766）、76．1％（1729／2272）和78．2％（492／629），早期治疗组HIV抑制率分别为65．5％（315／481）、65．4％（448／685）、68．8％（223／324）、66．0％（155／235）、71．4％（110／154）和61％（30／49），除治疗4年时，其余时间点两组HIV抑制率的差异均有统计学意义（P〈0．05）。非条件logistic回归分析发现，在常规治疗组，研究对象男性（OR=1．23，95％C／：1．07—1．42）、确认阳性到开始治疗的时间越长（OR=1．26，95％C／：1．16～1．36）、初始治疗方案为INT／AZT＋去羟肌苷（DDI）＋NVP／EFV（OR=3．00，95％C／：2．26～3．98）和治疗6个月时近7d漏服药物（OR=1．97，95％C／：1．22—3．18）HIV抑制率低，研究对象同性性传播感染途径（OR=0．57，95％C／：0．35～0．90）、在县级及以上治疗机构治疗（OR=0．61，95％C／：0．50—0．75）HIV抑制率高；在早期治疗组，研究对象在县级及以上治疗机构治疗（OR=0．43，95％C／：0．23—0．80）HIV抑制率高，确认阳性到开始治疗的时间越长（OR=1．43，95％C／：1．09～1．88）HIV抑制率低。结论河南省不同基线免疫学水平的艾滋病患者接受抗病毒治疗后病毒抑制效果均较好，在县级及以上治疗机构治疗的艾滋病患者病毒抑制效果较好，而确认阳性到开始治疗时间越长的艾滋病患者病毒抑制效果较差。

Objective To compare the HIV suppression rate after initiating antiretroviral treatment （ART） among AIDS patients at different immunological levels and to analyze the related factors. Methods Data on AIDS patients initially starting antiretroviral therapy during 2008 and 2013 were collected from Chinese HIV/AIDS integrated control system. All the participants were divided into early treatment group （baseline CIM＋T cell counts between 351/1.d and 500/μl） and conventional treatment group （baseline CIM ＋T cell counts ≤350/μl）. The rates of comprehensive virologic suppression at different time nodes after the initiation of ART were analyzed accordingly. Unconditional logistic regression model was adopted to examine the factors associated with the failure of viral suppression after 6 months after initiation of ART. Results A total of 16 103 cases were selected, among which, 1 581 cases were early treatment group, and 14 522 cases were conventional treatment group. A total of 9 428 cases were males, 6 675 cases were females, and the sex ratio was 1.41： 1. The age was 47.2 ± 1 1.7, and 71.55% （ 11 522/16 103 ） of cases were married or cohabiting, 57. 22% （9 214/16 103 ） were transmitted by blood. 81.26% （13 086/16 103） were cures in the township or village treatment institution, and 77.17% （12 426/16 103）received the ART regimen as Stavudine（D4T） or Zidovudine （AZT） ＋ Lamivudine （ 3TC ） ＋ Nevirapine （NVP） or Efevirenz （EFV）. After O. 5, 1,2, 3, 4, 5 and 6 years after the initiation of ART, the rates of virologic suppression in the conventional treatment cohort were 72. 6% （3 008/4 144） ,73.9% （4 758/6 443）, 74. 1% （3 641/ 4 915） ,74. 9% （2 819/3 766）, 76. 1% （ 1 729/2 272） and 78.2% （492/629）, respectively. While the rates of viral suppression in the early treatment cohort at the same time nodes were 65.5% （315/481）, 65.4% （448/685）, 68. 8% （ 223/324 ）, 66. 0% （ 155/235 ）, 71.4% （ 110/154 ） and 61% （ 30/49 ）, respectively, and the differences between the two groups were significant （P 〈 O. 05 ）except at the fourth year. Non-conditional logistic regression analysis showed that in the conventional treatment group, factors associated with low HIV suppression rate were male（ OR = 1.23,95% CI： 1.07 - 1.42）, longer time interval from confirmed HIV infection to received ART （OR = 1.26,95% CI：I. 16- 1.36）, using IMT/AZT ＋ DDI ＋ NVP/EFV as initial treatment regimen （OR =3. 00,95% CI：2. 26 -3. 98） and nearly missing doses for 7 days at treatment of six months （OR = 1.97,95% CI： 1.22 -3. 18）and factors associated with high HIV suppression rate were infected through homosexual transmission mute（ OR = 0. 57,95% CI：0. 35 -0. 90）and treated in the county level medical institution or above （ OR = 0. 61,95% CI： 0. 50 - 0. 75 ）. Among early treatment group, cases who received treatment at county level medical institution or above had high HIV suppression rate（ OR =0. 43,95% CI： 0. 23-0. 80）and objects with longer time interval from confirmed HIV infection to receive ART had low HIV suppression rate （OR = 1.43,95% CI： 1.09 - 1.88）. Conclusion The viral suppression efficacy among AIDS patients with different baseline immunologic levels after treatment was similarly satisfactory. AIDS cases who received ART at county level medical institution or above had better viral suppression effect and patients with longer time interval from confirmation to treatment had poor HIV suppression effect.