台州市2006-2019年HIV/AIDS抗病毒治疗策略与免疫学效果的关联及影响因素分析

Influencing factors of antiretroviral therapy and its association with immunological effect among HIV/AIDS patients in Taizhou city,2006-2019

目的分析2006-2019年台州市HIV/AIDS立即抗病毒治疗(ART)的影响因素,探讨不同ART策略与免疫学效果随时间变化的关联。方法采用回顾性队列研究和logistic回归模型分析立即ART影响因素,采用t检验和χ2检验比较不同ART策略的免疫学效果差异,采用Kaplan-Meier(K-M)法绘制生存曲线。结果2006-2019年台州市2971例HIV/AIDS中,立即ART组1786例(占60.1%),其中2016-2019年立即ART的比例为77.8%(1170/1504)。2006-2019年立即ART组的成功率(87.4%,1561/1786)高于延迟ART组(84.4%,1000/1185)。多因素logistic回归分析结果显示,HIV/AIDS立即ART的影响因素中,男性(aOR=1.28,95%CI:1.03~1.59)、已婚(aOR=1.71,95%CI:1.33~2.19)、基线CD4^+T淋巴细胞(CD4)计数≤200个/μl(aOR=1.60,95%CI:1.27~2.02)与立即ART呈正相关;31~40岁(aOR=0.63,95%CI:0.48~0.84)、感染途径为异性性传播(aOR=0.60,95%CI:0.49~0.74)、确证时间为2015年及以前(aOR=0.20,95%CI:0.17~0.23)与立即ART呈负相关。立即ART组各年份CD4/CD8比值的增幅和ART累积成功率均大于延迟ART组(P<0.05)。结论2006-2019年台州市HIV/AIDS立即ART策略落实较好,立即ART比例超过60.0%,立即ART组的ART免疫学效果较好。针对HIV/AIDS中31~40岁、女性、未婚和异性性传播者,需加强立即ART的健康教育工作,进一步提高ART效果。

Objective To analyze influencing factors of instant antiretroviral therapy(ART)and explore associution between strategies of ART and immunological effects among HIV/AIDS patients in Taizhou city during 2006-2019.Methods A retrospective cohort study was conducted on HIV/AIDS patients under ART,and a logistic regression model was used to analyze factors of instant ART.The student t-test and chi-square test were used to compare immunological effect of different ART strategies while the Kaplan-Meier method was used to generate a survival curve.Results A total of 2971 HIV/AIDS patients were enrolled with 1786 cases(60.1%)having instant ART strategy.The proportion of instant ART were 77.8%(1170/1504)during 2016 to 2019.The treatment success rate of the instant ART group(87.4%,1561/1786)were higher than the delayed ART group(84.4%,1000/1185).The results of multivariate logistic regression model indicated that male(aOR=1.28,95%CI:1.03-1.59),married(aOR=1.71,95%CI:1.33-2.19)and baseline CD4^+T lymphocyte cells(CD4)counts≤200 cells/μl(aOR=1.60,95%CI:1.27-2.02)were factors positively related to instant ART while 31-40 years old(aOR=0.63,95%CI:0.48-0.84),infected through heterosexual transmission(aOR=0.60,95%CI:0.49-0.74)and diagnosed before 2015(aOR=0.20,95%CI:0.17-0.23)were inversely related to instant ART.The increase of the CD4/CD8 ratio was greater,and the cumulative ART success rate was higher each year in the instant ART group than in the delayed ART group(P<0.05).Conclusions The instant ART strategy has been well implemented in Taizhou city during 2006-2019,and the immunological effect was better in instant ART group.The proportion of instant ART were more than 60.0%among HIV/AIDS patients.Instant ART strategy needs to be strengthened for those who are 31-40 years old,women,unmarried,and infected through heterosexual transmission in an attempt to further increase treatment level and improve treatment effect.