艾滋病HAART治疗中免疫重建炎性综合征临床特征与潜在影响因素探讨

Study on clinical features of HAART associated immune reconstitution inflammatory syndrome and its potential risk factors

目的观察艾滋病患者高效抗逆转录病毒治疗（HAART）启动后发生免疫重建炎性综合（IRIS）的临床特征,并探讨IRIS发生影响因素。方法以2003年6月—2013年6月接受HAART治疗的艾滋病患者102例为研究对象,设立6个月随访期。分别与HAART启动时,启动后90 d和180 d检测患者HIV RNA病毒载量和CD4＋细胞计数,根据观察期内是否出现IRIS将患者分为IRIS组（19例）和非IRIS组（83例）。收集2组一般资料,实验室和影像检查资料。结果 IRIS发病率18.6%（19/102）,HAART启动后IRIS发生平均为33 d,感染类型以结核分枝杆菌感染为主（57.9%,11/19）。IRIS组和非IRIS组CD4＋细胞计数基线比较差异有统计学意义（P〈0.01）;HAART启动后2组HIV RNA病毒载量呈下降趋势,CD4＋细胞计数呈上升趋势。经分析,HAART启动时CD4＋细胞计数（OR=6.45,95%CI∶4.59~15.6）和HAART启动后HIV RNA病毒载量变化（〉2 log10拷贝/m L）（OR=3.12,95%CI∶1.45~6.24）与IRIS发生相关。结论 IRIS多发生于HAART启动后3个月内,HAART启动前基线CD4＋细胞水平越低,HAART启动后HIV RNA病毒载量变化越大,则患者IRIS发生风险越大,应积极开展对症抗感染治疗。

Objective To observe clinical features of highly active anti- retroviral therapy（ HAART） associated immune reconstitution inflammatory syndrome（ IRIS） and explore its potential risk factors. Methods A total of 102 HIV / AIDS patients treated with HAART from June 2003 to June 2013 were selected and followed up for 6 months. Blood sample were collected before HAART,90 days and 180 days after HAART in order to detect level of HIV RNA viral load and CD4＋cell count. Patients were assigned to IRIS group（ n = 19） and non- IRIS group（ n = 83） according to the occurrence of IRIS. Results The incidence of IRIS was 18. 6%（ 19 /102）,and the average length from initiation to IRIS occurrence was 33 days,and mycobacterium tuberculosis infection was the main infection type（ 57. 9%,11 /19）. There was significant difference in CD4＋cell count at baseline between the IRIS group and the non- IRIS group（ P〈0. 01）. After HAART initiation,the HIV RNA viral load declined and CD4＋cell count increased in both groups. A correlation was found between IRIS occurrence, the CD4＋cell count at baseline（ OR = 6. 45, 95% CI ∶4. 59 ~ 15. 6） and changes（ 〉2 log10 copies / m L） of HIV RNA viral load（ OR = 3. 12,95 % CI ∶ 1. 45~ 6. 24）. Conclusion IRIS usually occur within 3 months after HAART initiation. The lower level of CD4＋cell count at baseline,the greater change of HIV RNA viral load after HARRT initiation,and this correlation may indicate the higher risk of IRIS.