浙江省2009-2014年艾滋病抗病毒治疗效果分析

Analysis on antiretroviral therapy efficacy for HIV/AIDS in Zhejiang province, 2009-2014

目的分析浙江省2009-2014年艾滋病抗病毒治疗效果及其相关影响因素。方法采用回顾性研究，对浙江省2009-2014年接受国家免费抗病毒治疗，且年满15周岁的艾滋病病毒感染者／艾滋病患者进行分析。采用描述流行病学的方法，描述艾滋病抗病毒治疗基本情况、治疗效果。绘制不同基线信息免疫学恢复的Kaplan—Meier曲线。采用logistic回归分析影响病毒抑制的影响因素。结果浙江省2009-2014年累计治疗9594例艾滋病患者，平均年龄（38．7±13．0）岁。男女性别比为4．11：1，传播途径以异性性传播（55．9％）和同性性传播（40．0％）为主，参加抗病毒治疗时CD4＋T淋巴细胞计数（CD4）以200～349个／ul为主（45．4％），基线CD。的中位数为221（IQR：123—298）个／μl。基线CD4〈200个／μl组的CD4恢复成功的中位时间分别为CD4 200—349个／μl组和CD4≥350个／μl组的3．48倍和11．58倍。logistic回归多因素分析显示：婚姻状况、抗病毒治疗方案、最近一周漏服药和CD4恢复情况，是抗病毒治疗患者病毒抑制成功的影响因素。结论浙江省艾滋病抗病毒治疗取得了较好的治疗效果，影响抗病毒治疗效果的因素较多。建议采取扩大HIV筛查检测、扩大抗病毒治疗覆盖面、抗病毒治疗依从性教育、对抗病毒治疗的高危人群进行特别随访关怀等措施，进一步提高浙江省抗病毒治疗效果。

Objective To analyze the efficacy of highly active antiretroviral therapy （HAART） for HIV/AIDS in Zhejiang province from 2009 to 2014. Methods A retrospective cohort study was conducted among patients with access to HAART aged 〈15 years from 2009 to 2014 through descriptive epidemiological analysis on the patients＇ demographic characteristics, HAART efficacy. The immune recovery Kaplan-Meier curves were drawn by using baseline CD4 T lymphocytes cell （CD4） data. The influencing factors for virus suppression were analyzed by using logistic regression model. Results There were 9 594 patients with access to HAART in Zhejiang from 2009 to 2014. The average age of the patients was 38.7 years old, the male to female ratio was 4.11 ： 1. Heterosexual （55.9%） and homosexual （40.0%） contacts were the main transmission routes. Baseline CD4 count 200-349 cells/μl was found in 45.4% of the patients, the median of the CD4 count was 221 （IQR： 123-298）. The median of time for CD4 recovery in patients with baseline CD4 count 〈 200 cells/μl was 3.48 and 11.58 times higher than the patients with baseline CD4 count 200-349 cells/μl and baseline CD4 count ≥350 cells/μl. Univariate and multivariate logistic regression analyses showed that marital status, HAART regimen, treatment miss in last week and CO4 recovery were major influencing factors for HAART efficacy. Conclusions HAART had good treatment effecacy in HIV/AIDS patients in Zhejiang. The baseline CD4 count and adherence to HAART were the most important influencing factors. It is recommended to take measures to expand HIV screening and HAART coverage, conduct HAART adherence education, and strengthen the special care for high-risk groups to improve the HAART efficacy in Zhejiang province.