2011—2015年经性传播HIV感染青少年抗病毒治疗的效果及生存分析

Efficacy and survival analysis after antiretroviral therapy among HIV-infected adolescents through sexual transmission, 2011-2015

目的了解经性传播HIV感染青少年抗病毒治疗的效果和生存状况,并探讨其影响因素。方法回顾性分析2011-2015年全国2765例经性传播的HIV感染青少年接受抗病毒治疗的基线和随访资料,分析其两年内病毒抑制效果和生存状况及其影响因素。结果2765例青少年感染者中有检测结果的2451例病毒抑制率达到90.06%;死亡47例,死亡者中位治疗生存时间6.8个月(3.4~14.5个月)。多因素Logistic回归分析表明,病毒抑制失败与初治年龄偏低(15岁,OR=2.218, 95%CI:1.229~4.004)、异性性传播女性(OR=1.557, 95%CI: 1.093~2.219)、基线 CD4^+T细胞<200个/μL(OR=2.413, 95%CI:1.569~3.709)、非替诺福韦的初始治疗方案(OR=1.460,95%CI/:1.066~1.998)有关。Cox回归分析显示,异性性传播女性(调整HR=2.259, 95%CI:1.181~4.319)、基线 WHO 临床IV期(调整HR=2.933, 95%CI:1.446~5.950)、基线 CD4^+T 细胞<200 个/μL(调整HR=9.865, 95%CI:3.694~26.348)是经性传播HIV感染青少年死亡的风险因素。结论尽早检测发现并治疗青少年HIV感染者,并通过关注低龄、异性性传播女性,优化治疗方案等措施,以达到降低死亡风险及传播风险的目的。

Objective To understand the effect and survival status after antiretroviral therapy (ART) among HIV-infected adolescents through sexual transmission, and analyze their related risk factors. Methods From 2011 to 2015, a total of 2765 HIV-infected adolescentst hrough sexual transmission across China received ART, whose baseline and follow-up data were collected and used for the retrospective analysis of their viral suppression and survival status, as well as the risk factors related to the two outcomes. Results Among 2451 patients who had viral load tests of 2765 cases, viral suppression rate reached 90.06%.Forty-seven patients died, of which the median survival time from ART initiation was 6.8 months (Qr:3.4~14.5 months). Multivariate logistic regression analysis revealed that the viral failure was associated with lower age (15 years old,OR=2.218,95%CI:1.229~4.004) at ART initiation, heterosexually-transmitted female (OR=1.557,95%CI:1.093~2.219), baseline CD4^+T cell count<200/μL(OR=2A13,95%CI:1.569~3.709) and non-tenofovir-based initial regimens (OR=1.460, 95%CI:1.066~1.998). The cox model showed that heterosexually-transmitted female (adjusted HR=2.259, 95%CI:1.181~4.319), baseline WHO clinical stage IV (adjusted HR=2.933, 95%CI:1.446~5.950), baseline CD4^+T cell count<200/μL (adjusted HR=9.865,95% CI:3.694~26.348) were the risk factors for death in adolescents with sexually-transmitted HIV. Conclusions Early detection and treatment of adolescents with HIV infection, more focus on younger, heterosexually-transmitted female, and optimized treatment regimen are recommended for the reduction of the risk of both death and HIV transmission.