金华市AIDS病人抗病毒治疗病毒学失败情况分析

Analysis of virological failure in HIV/AIDS patients with highly active anti-retroviral therapy in Jinhua city

目的了解金华市艾滋病(AIDS)病人接受抗病毒治疗后病毒学抑制效果,分析病毒学失败的发生状况及其影响因素。方法通过国家艾滋病综合防治信息系统收集资料,并进行描述性和分析性流行病学分析。结果 1 009例治疗病例有70例病毒学失败,病毒学失败率6.94%;多因素Logistic回归分析结果显示,低年龄、近期CD4+T淋巴细胞(简称CD4细胞)水平低、最近7天有漏服药物、最近治疗方案为拉米夫定(3TC)+齐多夫定(AZT)+奈韦拉平(NVP)是出现病毒学失败的影响因素。年龄20岁以下组病毒学失败可能性高于年龄20至39岁组[比值比(OR)=0.088,95%可信区间(CI):0.018~0.421];近期CD4细胞水平200个/μL以下病毒学失败可能性高于200至399个/μL(OR=0.051,95%CI:0.019~0.135)和400个/μL及以上(OR=0.189,95%CI:0.072~0.497);最近7天有漏服药物病毒学失败可能性高于未漏服(OR=0.061,95%CI:0.009~0.389);最近治疗方案为3TC+AZT+NVP出现病毒学失败的可能性高于3TC+AZT+依非韦仑(EFV)(OR=4.276,95%CI:1.558~11.733)。结论金华市AIDS病人抗病毒治疗失败率处于较低水平,针对重点人群进行强化抗病毒治疗依从性指导,加强CD4细胞水平监测,优化治疗方案等措施有助于减低病毒学失败率。

Objective To understand the virological inhibition in HIV/AIDS patients with antiviral therapy,and to analyze the status and the influence factors of virological failure.Methods Data were collected from the National AIDS control information system,and analyzed with the methods of descriptive epidemiology and analytical epidemiology.Results The rate of virological failure was 6.94%among 1009 HIV/AIDS patients.Multi-factor logistic regression analysis showed that the influence factors of virological failure included low age,recent low level of CD4＋T lymphocyte,missing anti-HIV drugs in the latest 7 days,and 3 TC＋AZT＋NVP as current therapeutic regimen.The possibility of virological failure in age group under 20 years was higher than that in age group between 20-39 years.The group with CD4 under 200/μL was more likely to have virological failure than those with CD4=200-399/μL group and ≥400/μL group of CD4＋T lymphocyte.The group missing anti-HIV drugs in latest 7 days was more likely to fail compared to those with high compliance.Therapeutic regimen of 3 TC＋AZT＋NVP seemed to have more virological failure than that of 3 TC＋AZT＋EFV.Conclusion The rate of virological failure in HIV/AIDS patients with antiviral therapy is low in Jinhua.Measures must be taken to improve compliance of HIV/AIDS patients,to strengthen monitoring of CD4＋T lymphocyte,and optimize the treatment regimen,so as to decrease the rate of virological failure.