郑州市HIV/AIDS病人一线抗病毒治疗失败发生规律及影响因素分析

Occurrence and related factors of first-line antiviral therapy failure in HIV/AIDS patients in Zhengzhou

目的研究艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)一线抗病毒治疗失败的发生规律,分析其影响因素。方法运用回顾性队列研究方法,分析郑州市城区接受艾滋病抗病毒治疗病人的基本信息、基线特征以及随访信息。使用寿命表法分析一线抗病毒治疗失败的发生率,Log-Rank法检验各组差异,并通过单因素和多因素COX比例风险模型分析一线失败的影响因素。结果本研究共纳入1 173例HIV/AIDS病人,47例发生一线抗病毒治疗失败,失败率为4%(47/1 173),其中24例一线失败发生在抗病毒治疗1年内,第1、3、5、7年抗病毒治疗一线成功率分别为98%、96%、93%、91%。多因素COX比例风险模型分析结果显示,基线CD4^+T淋巴细胞(简称CD4细胞)计数中"201～350个/μL"组、">351个/μL"组相对于"0～200个/μL"组的风险比(HR)[95%可信区间(CI)]分别为0.248(0.109～0.565)、0.203(0.071～0.584),合并乙型肝炎(HR=2.893,95%CI:1.131～7.403)一线失败风险高,确证到治疗的时间间隔(月)"12～23"组、"≥24"组相对于"<12"组的HR(95%CI)分别为2.588(1.060～6.317)、2.579(1.289～5.159)。结论艾滋病抗病毒治疗一线失败多发生在治疗早期,且与病人的基线CD4细胞计数、合并乙型肝炎、确证到抗病毒治疗的时间间隔有关。

Objective To analyze the incidence among HIV/AIDS patients who failed in first-line antiviral treatment(ART), and the influencing factors. Methods A retrospective cohort study was conducted to analyze the basic information, baseline characteristics and follow-up information of patients receiving ART in the urban areas of Zhengzhou. The life table method was used to analyze the incidence of first-line ART failures, and the log-rank method used to test the differences between groups, and the influencing factors of first-line ART failure were analyzed by the Cox proportional hazard model. Results A total of 1 173 HIV/AIDS patients were included in the study, and 47 patients failed in first-line ART, with the rate of 4%(47/1 173). Among them, 24(51%) patients failed within 1 year, and the success rates of first-line ART in the 1, 3, 5, and 7 years were 98%, 96%, 93%, and 91%. The multivariate Cox proportional hazard model analysis showed that the HR(95% CI) of the "201-350" group and the "351-" group relative to the "0-200" group in the baseline CD4^+T lymphocyte count were 0.248(0.109-0.565), and 0.203(0.071-0.584). Combined with hepatitis B(HR=2.893, 95% CI: 1.131-7.403), the risk of failure in the first-line ART was high. And the HR(95% CI) of the "12-23" group and the "≥24" group relative to the "<12" group in the time interval between HIV confirmation and treatment was 2.588(1.060-6.317) and 2.579(1.289-5.159). Conclusion The failure of first-line ART for AIDS patients occurred mostly in the early stage of treatment, and related to the patient’s baseline CD4^+ T lymphocyte count, combined with hepatitis B, and the time interval between HIV confirmation and treatment.