玉溪市不同年龄HIV/AIDS病人抗病毒治疗效果对比分析

Comparative analysis of antiretroviral treatment effect among HIV/AIDS patients of different ages in Yuxi prefecture

目的了解不同年龄艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗(ART)效果。方法收集玉溪市2005-2016年的ART信息库中随访记录,历史卡片和治疗数据库的相关信息进行回顾性分析,了解不同年龄病人病毒学治疗效果、CD4^+T淋巴细胞(简称CD4细胞)变化及一年内死亡情况。结果1 930例接受了ART的病人中,218例(11.3%)病毒学治疗失败,不同年龄段在不同治疗基线CD4细胞层次失败率差异无统计学意义;随着年龄增长,CD4细胞上升速率中位数由13.9个/μL/月下降至6.2个/μL/月,差异有统计学意义(H=46.080,P<0.001);不同治疗时基线CD4细胞分层分析发现,治疗时基线<200个/μL组和200~350个/μL组不同年龄段CD4细胞上升速率中位数为12.7~18.8个/μL/月之间和1.5~16.8个/μL/月之间,组间差异分别有统计学意义(H=13.575和9.133,P均<0.05),治疗时基线CD4细胞351~500个/μL和>500个/μL组不同年龄段CD4细胞变化速率差异无统计学意义(H=7.171和3.110,P=0.067和0.157);ART后一年内死于艾滋病相关疾病者占2.8%(54/1 930),其治疗时基线CD4细胞均<200个/μL,其中18~29岁者治疗后一年内死亡率1.7%(7/412),30~39岁者死亡率1.5%(10/650),40~49岁者死亡率3.4%(16/476),≥50岁者死亡率5.4%(21/392),差异有统计学意义(χ~2=15.616,P<0.001)。结论年龄不影响ART后病毒学疗效,但是年龄越大CD4细胞恢复越差,一年内死亡率越高,针对≥50岁感染者应该早发现、早治疗。

Objective To analyze comparatively the effects of antiretroviral treatment(ART)among HIV/AIDS patients in Yuxi city of Yunnan province,and to explore the effect of ages on ART.Methods Data were collected including HIV/AIDS case reporting cards,follow-up cards and ART database between 2005 and 2016,and analysis was made on the difference of virologic efficacy,CD4 dynamic variation and cases who died within one year after ART initiation.Results Among 1 930 HIV/AIDS patients,218 cases(11.3%)failed in virologic treatment after ART initiation and age was not an influencing factor.CD4 counts seemed less increased in the group aged 50 years and above(6.24 cells/μL/month)than in the group aged between 18-29 years(13.9 cells/μL/month)with the difference significant(H=46.080,P<0.001).Among the groups with the baseline CD4 counts less than 200 and 200-350 cells/μL,CD4 counts seemed less increased with age(12.7-18.8 and 1.5-16.8 cells/μL/month),with significant differences on CD4 counts in different ages(H=13.575 and 9.133,P<0.05).However,in the groups with the baseline CD4 counts of 351-500 and more than 500 cells/μL,there were no differences on CD4 counts increase in different age groups(H=7.171 and 3.110,P=0.067 and 0.157).Among 1 930 HIV/AIDS patients,54(2.8%)cases died in one year after ART initiation and all of their baseline CD4 counts less than 200,among whom 7 cases(7/412,1.7%)aged between 18-29 years,10 cases(10/650,1.5%)aged between 30-39 years,16 cases(16/476,3.4%)aged between 40-49 years,and 21 cases(21/4392,5.4%)aged 50 years and above,with the difference statistically significant(χ~2=15.616,P<0.001).Conclusion Age might be an influencing factor on CD4 counts increase and death in one year after ART initiation.However,age does not affect virologic efficacy,suggesting that earlier diagnosis and ART initiation can help recover immune function and avoid death rapidly in the elderly group.