天津市未接受抗病毒治疗HIV/AIDS病例CD_4^+T淋巴细胞计数变化情况及影响因素

Study on the changes of CD_4^+T counts and associated factors among antiretroviral treatment-naive HIV/AIDS patients in Tianjin

目的探讨天津市新发现并报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人),在未开展抗病毒治疗的情况下,CD+4T淋巴细胞(简称CD4细胞)计数的变化情况及其影响因素。方法计算2005-2013年间天津市新报告的HIV/AIDS病人的首次CD4细胞计数,与在2013年12月31日之前无抗病毒治疗史或抗病毒治疗前最后一次CD4细胞计数的差值及其月均变化情况,运用Logistic回归分析快速下降的影响因素。结果纳入符合条件的研究对象942例,CD4细胞计数月均变化中位数为-4.94。68.68%的研究对象末次CD4细胞计数低于首次,31.32%的研究对象末次CD4细胞计数高于首次或持平。多因素分析表明,传播途径[比值比(OR)=1.785,95%可信区间(CI):1.025~3.107]、年龄组(OR=1.164,95%CI:1.013~1.338)、首末次CD4细胞检测时间间隔(OR=0.585,95%CI:0.521~0.657)、首次CD4细胞计数(OR=2.388,95%CI:2.016~2.828),与CD4细胞计数快速下降有统计学意义。结论天津市未接受抗病毒治疗的HIV/AIDS病例中,CD4细胞计数快速下降与多种因素有关,有必要有针对性地加强随访、检测了解病情进展,以便及时开展抗病毒治疗。

Objective To explore the changes of CD4＋ T lymphocytes counts and associated factors among an- tiretroviral treatment-naive HIV/AIDS patients in Tianjin. Methods Calculate the differences between the first and the last CD4＋ T lymphocyte counts among the HIV/AIDS new-found during the period of 2005~2013. The first CD4＋ T lymphocyte count was tested as the new-diagnosis of HIV/AIDS and the last one was tested before the start of the antiretroviral treatment. Logistic regression analysis was conducted to examine the associated factors of the descents of CD＋ T lymphocyte counts among them. Results There were 942 HIV/AIDS patients included in the stud- y. The change between the first CD＋ T lymphocyte counts and the last CD＋ T lymphocyte counts had a median of -4.94 cells/μL in month. 68. 68% of HIV/AIDS patients had descents of CD4＋ T lymphocyte counts, and 31.32% of HIV/AIDS patients had raise or equals of CD4＋ T lymphocyte counts. Binary logistic regression analysis showed that the factors associated with the rapid descents among antiretroviral treatment-naive HIV/AIDS patients included routes of trans-mission （OR=1. 785,95%CI： 1. 025-3. 107）, ages （OR =1. 164, 95% CI： 1. 013 - 1. 338）, the interval between the first and the last CD＋ T lymphocyte counting tests（OR =0. 585,95%CI：0. 521~0. 657）, the first CD＋ T counts （OR=2. 388,95%CI：2. 016-2. 828）. Conclusion The rapid descents of CD＋ T counts among antiretroviral treat- ment-naive HIV/AIDS patients in Tianjin was associated with a variety of factors, so it is necessary to strengthen the timely monitoring of CD＋ T counts to understand pro- gression of disease.