初治HIV感染者病毒载量水平及影响因素分析

Relationship between baseline viral load and CD4^+ T count and age in patients infected with HIV

目的分析我国初治艾滋病病毒(HIV)感染者体内病毒载量水平及其与细胞免疫水平和年龄之间的关系。方法收集从2018年1月至2019年6月在上海市公共卫生临床中心开始接受抗病毒治疗的临床数据,用SPSS19.0软件对数据进行分析。结果共纳入在上海初治HIV感染者1056例,病毒载量检测率64.6%。病毒载量的中位数为31221拷贝/mL,21.0%的感染者(222人)病毒载量>10万拷贝/mL,年龄>50岁和CD4^T淋巴细胞(简称CD4细胞)≤200个/μL的HIV感染者中,病毒载量>10万拷贝/m L的占比分别较≤50岁和CD4细胞>200个/μL的高。HIV感染者对非核苷类药耐药率9.28%,病毒载量>10万拷贝/m L的原发非核苷类耐药占比与病毒载量较低人群无差异。结论初治HIV感染者中高病毒载量的HIV感染者比例高,中位病毒载量高,CD4细胞计数≤200个/μL是高病毒载量的预测因素。建议使用整合酶或蛋白酶抑制剂作为第三种药物,减少治疗失败的发生。

Objective To analyze the relationship of baseline viral load with CD4^+T lymphocyte count and age in patients infected with HIV.Methods We collected the demographic and clinical data of out-patients during January 2018-June 2019 in Shanghai Public Health Clinical Center,and a retrospective analysis was made accordingly by using SPSS(version 19.0)statistical software package.Results Totally there were 1056 patients enrolled and the detection rate of baseline viral load was 64.4%.The median of viral load was 31221 copies/mL.There were 222 patients(21.1%)with baseline viral load more than 100000 cps/mL.The ratio of patients with viral load more than 100000 cps/mL was more frequent among those aged more than 50 years and CD4 below 200/μL.The resistance rate of NNRTIs was 9.23%.The rate of resistance for NNRTIs was not significantly different between the patients with viral load>100000 copies/mL and those with the load<100000 copies/mL.Conclusion At present,the rate of drug resistance for NNRTIs among the treatment naive patients is higher.The baseline CD4 below 200/μL is a risk factor for viral load more than 100000 copies/mL.It is suggested to use integrase or protease inhibitor as the third drug to reduce the risk of treatment failure.