成都市2008—2018年艾滋病抗病毒治疗病毒学失败影响因素

Influencing factors of virologic failure among HIV/AIDS patients receiving antiretroviral therapy in Chengdu city, 2008 – 2018: a retrospective analysis

目的分析成都市2008—2018年抗病毒治疗(ART)的艾滋病病毒感染者/艾滋病病人(HIV/AIDS)病毒学失败率及影响因素。方法采用回顾性队列研究方法,利用国家艾滋病综合防治信息系统选取成都市2008年1月1日—2017年12月31日开始ART的病例信息,随访时间截至2018年12月31日。采用Cox比例风险模型分析病毒学失败的影响因素。结果共纳入19945例HIV/AIDS,病毒学失败率为4.45/100人年。多因素Cox分析结果显示,治疗前基线CD4+T淋巴细胞计数(CD4)为0~、50~、200~349个/μL组HIV/AIDS病毒学失败的风险是CD4≥500个/μL组的11.908(95%CI=9.838~14.412)、2.824(95%CI=2.484~3.212)和1.586(95%CI=1.420~1.771)倍。确证到治疗间隔≤30 d、31~365 d组病毒学失败的风险是≥366 d组的0.829(95%CI=0.734~0.935)和0.840(95%CI=0.755~0.934)倍。男性HIV/AIDS病毒学失败的风险是女性的1.216(95%CI=1.090~1.356)倍,含齐多夫定初始治疗方案组病毒学失败的风险是含替诺福韦治疗方案组的1.272(95%CI=1.153~1.402)倍。结论成都市HIV/AIDS治疗病毒学失败的危险因素包括治疗前基线CD4水平较低,确证后启动ART时间间隔较长、男性、含齐多夫定的初始治疗方案。

Objective To examine the incidence rate and influencing factors of virologic failure(VF)among human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients after antiretroviral therapy(ART)in Chengdu city from 2008 to 2018.Methods The data on all HIV/AIDS patients receiving initial ART from 2008 through2017 were extracted from the National Integrated HIV/AIDS Prevention and Control Information System and the patients were retrospectively followed-up till December 31,2018.Cox proportional hazard model was used to explore factors associated with VF after ART treatment.Results Among 19945 HIV/AIDS patients included in the study,2500 individuals experienced VF,with an incidence rate of 4.45 per 100 person-years.Multivariate Cox proportional hazard analysis demonstrated that the level of pre-ART CD4+T cell count(CD4)were significantly associated with VF.Compared to the patients with the baseline CD4 count of≥500 cells/μL,the adjusted hazard ratio(a HR)of VF was 11.908(95%confidence interval[95%CI]:9.838–14.412),2.824(95%CI:2.484–3.212),and 1.586(95%CI:1.420–1.771)for the patients with the baseline CD4 count of 0–49,50–199,and 200–349 cells/μL,respectively(P<0.01 for all);in contrast to the patients with delayed ART(the time from the diagnosis to the initial treatment:≥366 days),the a HR of VF was 0.829(95%CI:0.734–0.935)and 0.840(95%CI:0.755–0.934)for the patients with immediate ART(the time from the diagnosis to the initial treatment:≤30 days and 31–365 days);the analysis also revealed that in comparison with the female patients,the male patients were more likely to have VF(a HR=1.216,95%CI:1.090–1.356);the patients with initial ART regimen of zidovudine+lamivudine+efavirenz/nevirapine(AZT+3 TC+EFV/NVP)were more likely to have VF(a HR=1.272,95%CI:1.153–1.402)compared to the patients with the initial ART regimen of tenofovir(TDF)+3 TC+EFV/NVP.Conclusion Lower baseline CD4,delayed initial ART after HIV diagnosis,male gender and AZT+3 TC+EFV/NVP regimen are significantly associated with increased risk of VF among HIV/AIDS patients in Chengdu city.