2011年新报告的艾滋病病毒感染者接受抗病毒治疗前CD_4^+T淋巴细胞计数自然变化情况分析

Study on changes in natural CD_4^+ T cell count before antiretroviral treatment and related factors in newly reported HIV infected persons

目的探讨2011年新报告的艾滋病病毒(HIV)感染者接受抗病毒治疗前的CD_4^+T淋巴细胞计数自然变化情况及其影响因素。方法对2011年新报告且至少接受过2次CD_4^+T淋巴细胞计数的HIV感染者进行分析,描述并比较其末次与首次CD_4^+T淋巴细胞计数自然变化情况,运用Cox比例风险模型分析CD_4^+T淋巴细胞计数显著下降的影响因素。结果共有24 222例HIV感染者纳入分析,月均CD_4^+T淋巴细胞计数变化速率中位数为-2.00(IQR:-7.81~3.601)cell/μl,其中60.9%的HIV感染者末次CD_4^+T淋巴细胞计数结果低于首次,且随着首末次检测间隔时间的延长,CD_4^+T淋巴细胞计数下降明显。运用Cox比例风险模型分析发现,年龄较大和同性传播的HIV感染者CD_4^+T淋巴细胞计数下降明显。结论未经过抗病毒治疗的HIV感染者大部分仍处于疾病进展阶段,应加强对未接受抗病毒治疗的HIV感染者尤其是高年龄组以及同性传播感染者的随访,定期进行CD_4^+T淋巴细胞计数检测,及早开展抗病毒治疗。

Objective To explore the changes in natural CD4^＋ T cell count before antiretroviral treatment（ART） and related factors in newly reported HIV infected persons in 2011. Methods The analysis was conducted on the CD4^＋ T cell count before ART in newly reported HIV infected persons who had received at least two CD4^＋ T cell count tests in 2011. Difference between the first and the last CD4^＋ T cell count tests was calculated and described. Cox multivariate proportional hazards model was used to identify the factors associated with the obvious decline of CD4^＋ T cell count among them. Results A total of24 222 HIV infected persons were included in the study. The monthly change of CD4^＋ T cell count between the first and the last CD4^＋ T cell count tests had a median of-2. 00 cell/μl（IQR：-7. 81-3. 01）. In the last CD4^＋ T cell count test,60. 9% of the HIV infected persons had decreased CD4^＋ T cell count compared with the first one,and the decrease was more obviously when the interval between two tests was longer. Result from the Cox multivariate proportional hazards model analysis indicated that older age and HIV homosexual transmission were significantly associated with the significant decrease of CD4^＋ T cell count. Conclusion There was a progressive decline in the CD4^＋ T cell count in most newly HIV infection cases before ART.It is necessary to strengthen the follow up and CD4^＋ T cell count test and conduct early ART among them,especially among the elderly and those infected through homosexual contact.