老年人类免疫缺陷病毒感染者抗病毒治疗疗效与预后分析

The clinical outcomes and prognosis of older human immunodeficiency virus-infected patients under antiretroviral therapy

目的 评估老年HIV感染者接受抗反转录病毒治疗后的临床结局和预后.方法 回顾性分析2004年1月至2012年12月在中国医科大学附属第一医院接受抗病毒治疗的H IV感染者数据,分析比较年龄≥50岁和〈50岁的H IV感染者治疗后免疫恢复、病毒应答和生存情况.采用t检验、卡方检验、两因素方差和对数秩完成统计分析.结果 291例H IV感染者中,97例为老年H IV感染者,194例为中青年H IV感染者.老年组和中青年组均以男性为主,分别占91.8％ 和87.6％.老年组治疗前基线CD4＋T淋巴细胞计数为（151.9±96.2）个/μL,显著低于和中青年组的（183.4±93.5）个/μL（t=2.657,P=0.009）.治疗12个月时老年组CD4＋T淋巴细胞计数显著低于中青年组（t=2.120,P=0.035）,在24个月时两组差异无统计学意义（t=1.025,P=0.299）.随访期间老年组和青年组CD4＋T淋巴细胞增加至500个/μL的比例分别为11.3％ 和16.0％（χ2=1.127,P=0.376）.Log-rank检验显示,两组人群达到病毒抑制时间的差异无统计学意义[中青年组：7.6个月（95％CI：6.8～8.5）,老年组：7.9个月（95％C I：6.5～9.3）;χ2=0.002,P=0.961].两组人群分别有4.1％（4/97）和5.7％（11/194）的感染者发生病毒学失败,差异无统计学意义（χ2=0.15,P=0.78）;随访期间老年组和中青年组分别有19.6％（19/97）和3.6％（7/194）H IV感染发生死亡,差异有统计学意义（χ2=21.113,P〈0.01）.结论 与中青年相比,老年H IV感染者接受抗病毒治疗后免疫功能恢复差,可以获得较好的病毒学应答,但死亡风险高.针对老年H IV感染者这一特殊人群应该制定相应的诊断和治疗策略,早期诊断和及时抗病毒治疗,以提高其疗效和降低死亡风险.

Objective To evaluate the clinical outcomes and prognosis of older human immunodeficiency virus （HIV ）-infected patients under antiretroviral therapy （ART ） in China .Methods This study was carried out in a retrospective cohort of HIV-infected patients initiated ART between January 2004 and December 2012 at The First Affiliated Hospital ,China Medical University .The patients were enrolled and divided into two groups ,including 〈50 years group （young and middle-aged group） and≥50 years group （older group） .Immunological and virological responses and mortality were analyzed . Data were analyzed by t test ,chi-square test ,two-way analysis of variance and log-rank test .Results Totally 291 subjects were included ,among whom 97 subjects were older patients and 194 subjects were young and middle-aged patients .Male was predominate in both groups ,which accounted for 91 .8% and 87 .6% ,respectively .The CD4＋ T lymphocyte count in the older group before treatment was （151 .9 ±96 .2） cells /μL ,which was significantly lower than that in the young and middle-aged group （183 .4 ± 93 . 5） cells/μL （t= 2 .657 , P=0 .009） .At month 12 of treatment ,the CD4＋ T lymphocyte count in the older group was significantly lower than that in the young and middle-aged groups （t= 2 .120 , P=0 .035） ,while there was no statistically significant difference between the two groups at month 24 （t=1 .025 ,P=0 .299） .The percentage of CD4＋ T lymphocyte count increasing to 500 cells/μL in the older and youth groups during follow-up were 11 .3% and 16 .0% ,respectively （χ2=1 .127 ,P =0 .376） .Log-rank analysis showed that the mean times of virus inhibition in older group and young and middle-aged group were 7 .9 （95% CI：6 .8-8 .5） and 7 .6 （95% CI：6 .5 -9 .3） ,respectively ,with no statistically significant difference （χ2 =0 .002 , P=0 .961） .Virological failure was reported in 4 patients （4 .1% ） in older group and 11 patients （5 .7% ） in young and middle-aged group . Chi-square test showed no statistically significant difference between the two groups （χ2 = 0 .15 , P= 0 .78） .During follow-up , 19 .6% （19/97） in older group and 3 .6% （7/194） in young and middle-aged group died .The former was significantly higher than the latter （χ2 = 21 .113 , P〈 0 .01 ） .Conclusions Older patients show a poor immunologic response ,similar viral suppression and higher risk of mortality compared with young and middle-aged patients . Future research should be aimed at the feasible and specific strategy for early diagnosis and timely treatment for older patients to improve treatment efficacy and reduce mortality .