上海市某区HIV感染者治疗结局及危险因素分析

Study on Treatment Outcome and Risk Factors of HIV Infected Patients in a District of Shanghai

目的 了解上海市原静安区HIV感染者抗病毒治疗成功率及所需时间,探索影响治疗结局和治疗时间的危险因素。方法 收集原静安区管理并开展抗病毒治疗的HIV感染者和艾滋病病人的人口学和临床特征及抗病毒治疗信息,计算治疗成功率,并采用Cox比例风险回归模型分析影响治疗的危险因素。结果 239例HIV感染者纳入研究,其中有50.21%治疗成功,成功率为19.45/100人年。基线CD4结果为〈200个、200~350个和〉350个/μL的患者5年治疗成功率分别为39%、79%和90%。多因素分析结果显示,传播模式为同性传播（HR=0.556,95%CI：0.371~0.835）、基线CD4〈200个/μL（HR=0.029,95%CI：0.015~0.056）和基线CD4为200~350个/μL（HR=0.162,95%CI：0.099~0.265）的患者治疗失败的风险更高。结论基线CD4结果和感染途径对治疗效果和所需时间影响较大,推广“医务人员主动提供HIV检测咨询服务（Provider-InitiatedHIV Test and Counseling,PITC）”和“确诊后立即治疗”两项策略有助于提高HIV感染者抗病毒治疗的及时性和有效性。

OBJECTIVE To detect successful rates and elapsed time of antiretroviral treatment on HIV infected patients in Jing＇an Dis-trict, Shanghai, and to explore risk factors that infect treatment outcome and time. METHODS It collected demographic, clinicaland treatment information of HIV infected patients managed and treated in Jing＇an District to calculate successful rates of antiretrovi-ral treatment, and analyzed risk factors associated with treatment by Cox proportional hazard regression model. RESULTS 239HIV-infected patients were included and 50.21% were treated successfully with the rate of 19.45/100 person years. The 5-year suc-cessful rates of HIV-infected patients with baseline CD4＋T cell counts200,200~350 and 350/μL were 39%,79% and 90%,separately. Multivariate analysis showed that hazard of treatment failure was higher in patients who infected by homosexual transmis-sion（HR=0.556, 95% CI： 0.371~0.835）, and who had baseline CD4200/μL（HR=0.029, 95% CI： 0.015~0.056） and be-tween 200 and 350/μL（HR=0.162, 95% CI： 0.099~0.265）. CONCLUSION Baseline CD4 ＋ T cell counts and infection routesshowed significant influence on treatment outcome and time. Strategies of＂Provider-Initiated HIV Test and Counseling,PITC＂and＂immediate antiretroviral therapy after diagnosis＂would be helpful to improve timeliness and effectiveness of antiretroviral treatmenton HIV infected patients.