老年HIV感染者/AIDS患者临床特点及治疗效果分析

Clinical Features and Response to ART in the Elderly Patients with HIV/AIDS: a Comparative Study

目的分析抗逆转录病毒治疗(ART)的老年艾滋病病毒感染者/艾滋病患者(HIV/AIDS)的临床特点及早期效果。方法选择2011年11月-2014年6月在广西横县人民医院就诊的老年HIV/AIDS患者为研究对象,同期就诊的非老年患者为对照组,对比分析老年患者临床特征和抗病毒治疗后预后不良、失访、停药、维持治疗及免疫学恢复情况。结果两组患者性别、年龄、传播途径、血红蛋白的差异有统计学意义(P均<0.05)。两组CD4+T细胞≤200(个/μL)的比率占半数以上,CD4+T细胞分层构成比无统计学意义(P>0.05),但是老年组WHO分期Ⅲ期或Ⅳ期比率、慢性病患病率比非老年组高(P均<0.05),而非老年组乙型肝炎、丙型肝炎及肝功能异常率较老年组高(P均<0.05),维持治疗率低于非老年组(P<0.05)。两组预后不良率差异有统计学意义(P均<0.05)。两组CD4+T细胞较抗病毒前增加明显,但增殖、失访及停药率差异无统计学意义(P均>0.05)。结论该县老年HIV/AIDS患者以男性少数民族患者多见。性传播为主要感染途径,基线CD4+T细胞及血红蛋白低,WHO临床分期高,多合并有慢性疾病,免疫应答良好,维持治疗率低,ART后易发生预后不良。

Objective To evaluate the clinical feature and early response of antiretroviral therapy （ART） in the elderly patients with HIV/AIDS. Methods From November 2013 to Jun 2014, there were 770 HIV/AIDS patients enrolled and divided into elderly group and non-elderly group. The clinical feature, prognosis, drop-off, treatment withdrawal, maintenance treatment, immune recovery in the elderly group after ART were compared with those of non-elderly group. Results There were differences found in gender, age, route of transmission, hemoglobin concentration between two groups （ P 〈 0. 05 ）. The percentage of ≤ 200 CD4^＋ T counts in two groups was over 50% , however, there was no statistical significance between two group. The WHO stage Ⅲ or Ⅳ HIV/AIDS and chronic diseases were more common in elderly patients than those in non-elderly group（P 〈0. 05）. In addition, hepatitis B, hepatitis C, liver dysfunction in non-elderly group were more common than those in elderly group （ P 〈 0. 05 ）. Elderly patients received less maintenance therapy that non-elderly patients（P 〈 0. 05 ）. The significant difference of poor prognosis was seen between the two groups （P 〈 0. 05 ）. After ART, CD4^＋ T counts in two groups were increased. There were no differences in drop-off, treatment withdrawal between two groups （ P 〉 0. 05 ）. Conclusion Most of elderly patients with HIV/AIDS were males from ethnic minority, who were infected by sexual transmission. Base line CD4 ＋ T cell count and hemoglobin were low. Significantly, WHO clinical stages were advanced in these elderly patients who were complicated by various chronic diseases. The elderly patients also showed augmented immune response, less maintenance treatment and poor prognosis.