台州市2006-2019年艾滋病抗病毒治疗免疫学失败风险分析

Risk analysis of immunological failure of antiretroviral therapy in HIV/AIDS patients in Taizhou prefecture,2006-2019

目的分析台州市2006-2019年HIV/AIDS抗病毒治疗免疫学失败情况、基线贫血与免疫学失败关联及其影响因素。方法采用回顾性队列研究设计和Cox回归分析免疫学失败的影响因素,采用logistic回归分析HIV/AIDS基线贫血的影响因素。结果共纳入2904例HIV/AIDS,抗病毒治疗随访时间中位数为28(P25~P75:12~53)个月。抗病毒治疗免疫学失败177例(占6.1%),失败率为2.17人/100人年,第1、3、5和10年免疫学失败累积发生率分别为5.49%、6.94%、7.30%和8.82%。多因素logistic回归分析结果显示,HIV/AIDS基线贫血的影响因素中,≥66岁组是18~25岁组的4.17倍(95%CI:1.68~10.33)、男性是女性的0.67倍(95%CI:0.50~0.89)、CD4<200个/μl是CD4≥350个/μl的4.35倍(95%CI:2.81~6.72)、基线白细胞计数<4.0×109/L是4.0×109/L^9.9×109/L的1.73倍(95%CI:1.31~2.29)、基线血小板计数<100×109/L和>300×109/L分别是100×109/L^299×109/L的2.02倍(95%CI:1.36~3.01)和4.45倍(95%CI:3.05~6.50)、WHO临床Ⅲ/Ⅳ期是Ⅰ/Ⅱ期的2.15倍(95%CI:1.61~2.87)、异性性传播是同性性传播的2.03倍(95%CI:1.42~2.92)。多因素Cox比例风险回归分析结果显示,HIV/AIDS抗病毒治疗免疫学失败的影响因素中,基线贫血是无贫血的1.77倍(95%CI:1.20~2.60)、WHO临床Ⅲ/Ⅳ期是Ⅰ/Ⅱ期的1.66倍(95%CI:1.10~2.48)、随访状态为退出和死亡分别是在治的3.18倍(95%CI:1.96~5.19)和4.61倍(95%CI:2.98~7.13)。结论台州市HIV/AIDS抗病毒治疗免疫学效果受贫血、临床分期、随访状态等因素影响。应加强HIV/AIDS基线贫血监测,及时纠正老年贫血等危险因素,以进一步提高抗病毒治疗效果。

Objective To analyze the immunological failure of antiretroviral therapy(ART),its association with baseline anemia and related factors in HIV/AIDS patients in Taizhou prefecture,during 2006-2019.Methods A retrospective cohort study was conducted among HIV/AIDS patients under ART.Cox regression model was used to analyze predictors of immunological failure and logistic regression model was used to analyze factors of baseline anemia.Results A total of 2904 HIV/AIDS patients were enrolled with a median time of 28(P25-P75:12-53)months follow-up of ART,in which 177 cases(6.1%)were identified as immunological failure with a failure rate of 2.17 per 100 person-years.The cumulative incidence rates of immunological failure in the first,third,fifth,and tenth years were 5.49%,6.94%,7.30%and 8.82%,respectively.Results of multivariate logistic regression analysis showed that for the risk of baseline anemia,≥66 years old group had 4.17 times higher risk than 18-25 years old group(95%CI:1.68-10.33),males had 0.67 times higher risk than females(95%CI:0.50-0.89),and CD4+T cell counts(CD4)<200 cells/μl group had 4.35 times higher risk than CD4≥350 cells/μl group(95%CI:2.81-6.72),baseline white blood cells<4.0×109 cells/L group had 1.73 times higher risk than 4.0×109 cells/L-9.9×109 cells/L group(95%CI:1.31-2.29),baseline platelet counts<100×109 cells/L and>300×109 cells/L groups had 2.02 times and 4.45 times higher risk than 100×109 cells/L-299×109 cells/L group(95%CI:1.36-3.01,95%CI:3.05-6.50),respectively.WHO classified stageⅢ/Ⅳgroup had 2.15 times higher risk than WHO classified stageⅠ/Ⅱgroup(95%CI:1.61-2.87),while heterosexual transmission group had 2.03 times higher risk than homosexual transmission group(95%CI:1.42-2.92).Results of multivariate cox proportional risk regression showed that for the risk of immunological failure,baseline anemia group had 1.77 times higher risk than no anemia group(95%CI:1.20-2.60),WHO classified stageⅢ/Ⅳgroup had 1.66 times higher risk than WHO classified stageⅠ/Ⅱgroup(95%CI:1.10-2.48),and withdrawal of follow up and death groups had 3.18 times and 4.61 times higher risks than treatment group(95%CI:1.96-5.19,95%CI:2.98-7.13),respectively.Conclusions The immunological effect of ART among HIV/AIDS patients in Taizhou prefecture was affected by multiple factors,including anemia,clinical stage and follow-up status.Enhancing surveillance of baseline anemia and timely correction of anemia in elder group can help improve treatment outcome of HIV/AIDS patients.