云南省HIV-1感染儿童一线抗病毒治疗病毒学反弹影响因素研究

Risk factors of viral load rebound on first-line antiretroviral therapy in HIV-infected children in Yunnan

目的观察云南省艾滋病病毒(HIV-1)感染儿童抗病毒治疗(ART)的疗效,探讨ART过程中出现病毒学反弹的影响因素。方法通过"国家艾滋病抗病毒治疗信息系统"收集资料,并进行描述性分析,采用COX比例风险回归模型分析发生病毒学反弹的影响因素。结果2005年1月1日至2015年12月31日,云南省随访治疗1年以上且在治疗过程中第一年病毒学得到抑制的548例儿童感染者,其中有85例在随后的治疗中出现病毒学反弹。不同疗程组中疗程在13~24个月组病毒学反弹比例(40.71%)高于25~36个月组(11.76%)和≥37个月组(4.84%)。最近7天有漏服药物病毒学反弹的风险高于未漏服者[风险比(HR)=4.111,95%可信区间(CI):2.679~6.310],发生药物不良反应者病毒学反弹的风险高于未发生者(HR=1.767,95%CI:0.994~3.141)。结论云南省HIV-1感染儿童病毒学反弹发生的时间段主要在治疗的13~24个月。最近7天漏服药物和发生药物不良反应是影响儿童抗病毒治疗发生病毒学反弹的主要因素,通过提高儿童的服药依从性可以降低抗病毒治疗中病毒学反弹的发生。

Objective To understand the situation of anti-retroviral therapy(ART)and evaluate the therapeutic effect and the factors influencing viral load rebound among children in Yunnan province Methods Data were collected from the National ART information system,and analyzed with Cox proportional hazard regression model for the risk factors.Results The incidence rate of viral load rebound within 13-24 months(40.71%)were higher than 25-36 months(11.76%)and 37 months(4.84%).Hazard ratio of children who had doses missed and had toxic side-effect events were 4.111 times(HR=4.111,95%CL=2.679-6.310)and 1.767 times(HR=1.767,95%CL=0.994-3.141)of children who did not have those events.Conclusion The incidence rate of viral load rebound in children occurs mainly in the period of 13-24 months after treatment.Drug adherence and toxic side-effect events are the main factors causing viral load rebound.The occurrence of viral load rebound in ART can be reduced by improving children’s adherence.