获得性免疫缺陷综合症抗病毒治疗失败情况及相关因素分析

Influencing factors of treatment failure in AIDS patients receiving first-line highly active antiretroviral therapy

目的了解获得性免疫缺陷综合症(AIDS)患者抗病毒治疗失败情况,分析影响抗病毒治疗失败的相关因素。方法对河南省中部地区接受抗病毒治疗方案>6个月的AIDS患者进行横断面调查访谈和血样采集,全自动实时荧光定量病毒载量检测系统检测病毒载量,扩增/测序方法分析基因型耐药性,流式细胞术检测CD4^+T淋巴细胞;多因素Logistic回归分析法分析影响抗病毒治疗出现病毒学失败、基因型耐药和免疫学失败的相关因素。结果 740例抗病毒治疗患者中,出现病毒学失败(病毒载量>1 000拷贝/m L)304例(41.1%)、基因型耐药243例(34.4%)、免疫学失败(CD4^+T淋巴细胞<200个/μL)177例(23.9%),依从性差、治疗时间>36个月、含去羟肌苷(dd I)的治疗方案是影响抗病毒治疗发生病毒学失败、基因型耐药的相关因素,男性、依从性差、含dd I的治疗方案是影响抗病毒治疗发生免疫学失败的相关因素。结论 AIDS患者抗病毒治疗失败的主要原因是出现病毒学失败、基因型耐药和免疫学失败,依从性差、含dd I的治疗方案是其相关因素。

Objective To understand the treatment failure of AIDS patients treated with first-line highly active antiret-roviral therapy （ HAART） and to analyze the associated factors. Methods AIDS patients treated with first-line HAART after 6 months in the central Henan region were investigated by cross-sectional survey, and their blood samples were collect-ed. Human immunodeficiency virus （ HIV）-1 viral loads were measured by uiral load of full-automatlc real-time fluorescent quantitation, the genotypic drug resistance was determined by amplification/sequencing method, and T lymphocyte count was detected by flow cytometry. Multivariate Logistic regression was used to analyze the factors associated with the develop-ment of virological failure, HIV-1 drug resistance and immunologic failure. Results Among the 740 participants, virologi-cal failure （defined as 〉1 000 copies/mL） was observed in 304 patients （41. 1%）, HIV-1 genotypic drug resistance was found in 243 patents （34. 4%）, and 177 patients （23. 9%） were the current CD4 ＋ lymphocyte〈200 cell/μL. Multivari-ate Logistic regression analysis showed that the risk factors associated with the development of drug resistance and virologi-cal failure contained poor compliance, 〉36 months of treatment and initial regimen with ddI;and the risk factors associat-ed with immunologic failure contained male, poor compliance and initial regimen with ddI. Conclusions The main rea-sons for treatment failure of AIDS patients were virological failure, development of drug resistance and immunologic failure. Patients with poor compliance and initial first-line HAART regimen with ddI were the risk factors associated with treatment failure.