重庆市艾滋病抗病毒治疗效果及其影响因素分析

Therapeutic effect and associated factors of HIV/AIDS patients receiving highly active antiretroviral therapy in Chongqing

目的了解重庆市艾滋病抗病毒治疗者的病毒载量(VL)抑制情况,分析其影响因素,为细化抗病毒治疗措施提供建议。方法采用回顾性研究方法,评估抗病毒治疗的病毒学效果。在国家艾滋病综合防治信息系统中下载抗病毒治疗病例的历史卡片,对数据库进行信息筛选和关联。数据核查后运用SPSS 18.0软件进行统计分析。结果 9 302例治疗患者平均年龄(44.6±14.7)岁,男性占75.3%,女性占24.7%。患者基线CD4^+T淋巴细胞(简称CD4细胞)平均值(中位数)为231个/μL,治疗后CD4细胞值平均为362个/μL。患者病毒载量检测结果<400拷贝/mL的占89.5%,≥400拷贝/mL的占10.5%。多因素Logistic回归分析显示,同性性接触[比值比(OR)=1.60]、长期坚持治疗≥25个月(OR=1.46)、较高基线CD4细胞值、实施中默项目措施(OR=1.32),是患者治疗后VL有效抑制的保护性因素;静脉吸毒传播(OR=0.41)、治疗时间≤3月(OR=0.19)、最近7天漏服药物≥4次(OR=0.16)、最近出现过药品不良反应(OR=0.40),是患者治疗VL有效抑制的危险性因素。结论继续推行扩大治疗策略,针对影响治疗效果的影响因素细化工作措施,进一步提高治疗质量。

Objective To know the inhibition rate of viral load of HIV/AIDS patients with highly active antiret- roviral therapy （HAART）, and assess the associated factors of the inhibition, to provide suggestions for effective HAART in Chongqing. Methods Basic data of HIV/AIDS cases were collected from the national AIDS comprehensive data information system, and observation and analysis were made to see the effect by the retrospective study. Software SPSS17. 0 was used for the statistical analysis. Results Among the total of 9302 cases recruited, 75.3% were male and 24.7% female, and the median CD4＋ T counts increased from 231/μL to 362 /μL after HAART. The inhibition rate of viral load （≤400copies/ml） was 89.5%, and the rate of viral load over 400copies/ml was 10.5 %. The multi-variable regression analysis indicated that the protective factors of the inhibition rate of viral load included the route of infection （homosexuality： OR： 1.60）, time of therapy（≥25monthes.- OR： 1.46）, higher basic CD4＋T counts and measures of China-MSD HIV/AIDS project （OR = 1.32）, and the risk factors were the route of infection （IDU： OR：0. 41）, time of therapy（≤3monthes： OR=0. 19）, doses missed（≥4times： OR= 0. 16） and drug toxicity （OR=0. 40）. Conclusion HAART needs to be strengthened by further expanding the coverage, improving the measures according to the associated factors of the inhibition, and upgrading the quality.