四川省HIV耐药患者后续治疗效果和影响因素分析

Efficacy of Extended Treatment and Influencing Factors of HIV Drug Resistance Patients in Sichuan

目的分析四川省接受一线艾滋病抗病毒治疗方案失败并产生耐药的患者后续治疗效果和影响因素。方法以四川省2012-2014年间接受艾滋病抗病毒治疗并检测为HIV-1基因型耐药的HIV/AIDS患者为研究对象,以发现耐药时间点为观察起点,连续随访2年,采用秩和检验分析研究对象后续CD4中位数差异,采用卡方检验分析研究对象后续CD4上升≥50个/μl和病毒载量(VL)<400拷贝/ml的比例,采用Logistic回归分析耐药患者后续治疗效果影响因素。结果357例符合研究标准,325例完成两年随访,观察起点、随访12个月、24个月的CD4中位数分别为206、233、242个/μl,其中观察起点和随访12个月差异秩和检验有统计学意义(P=0.02),病毒载量(VL)<400拷贝/ml患者数分别为0例(0%)、121例(37.23%)和179例(55.08%),相邻观察时间点差异卡方检验均有统计学意义(P=0.005);随访12个月和24个月的CD4细胞计数上升≥50个/μl患者数分别为118例(36.31%)和130例(40.00%),差异经卡方检验无统计学意义(P=0.333);多因素Logistic回归分析发现年龄≤40岁、观察终点使用含洛匹那韦+利托那韦(LPV/r)的二线方案是CD4细胞计数上升≥50个/μl的保护因素(P<0.05),无性病、观察终点使用含LPV/r的二线方案是VL<400拷贝/ml的保护因素(P<0.05)。结论四川省艾滋病一线药物耐药患者后续治疗取得一定成效,但还需加强免疫学恢复机制的研究;含LPV/r的二线方案可有效改善使用一线治疗方案失败并产生耐药的患者的治疗效果。

Objective To analyze the efficacy of extended treatment and its influencing factors in patients who failed the-front-line anti-HIV treatment and produced drug resistance in Sichuan Province. Methods HIV/AIDS patients in Sichuan province who received anti-HIV treatment and were detected with HIV-1 drug resistance were followed up,starting from the date of identification of drug resistance,and followed for 2 years continuously. Rank-sum test was used to analyze the differences in subsequent median CD4 counts among the subjects; chi-square test was used to analyze the proportions of subjects with ≥50/μl increase in subsequent CD4 count and with subsequent viral load（ VL）〈 400 copies/ml; logistic regression analysis was performed to address the influencing factors for efficacy of subsequent treatment following drug resistance. Results A total of 325 of the 357 patients meeting the inclusion criteria completed 2-year follow-up. The median CD4 counts at point 0,12 and 24 months of follow-up were 206,233 and 242/μl,respectively,with statistically significant difference between point 0 and 12 months of follow-up（ P = 0. 02）. The numbers of patients with VL〈 400 copies/ml were 0（ 0%）,121（ 37. 23%） and 179（ 55. 08%）,respectively,with statistically significant differences between any two consecutive points（ P =0. 005）. The numbers of patients with ≥50/μl increase in CD4 count at 12 months and 24 months of followup were 118（ 36. 31%） and 130（ 40. 00%）,respectively,without statistically significant difference（ P =0. 333）. Multivariate logistic regression analysis identified age ≤ 40 years and use of Lopinavir ＋ Ritonavir（ LPV/r）-based following project at the endpoint of observation as the protective factors for ≥50/μl increase in CD4 count（ P〈 0. 05）,and without STDs and used LPV/r-based following project at the endpoint of observation,the protective factors was for VL〈400 copies/ml（ P〈0. 05）. Conclusion For HIV/AIDS patients in Sichuan province who developed resistance to previous treatment,subsequent treatment produced certain effects,which however requires further enhancement of the immunological recovery mechanism. LPV/r-based following project could effectively improve the therapeutic effects in patients who failed the front-line treatment and produced drug resistance.