辽宁省阜新市2011—2019年HIV/AIDS抗病毒治疗免疫学失败分析

Immunological failure analysis of HIV/AIDS patients receiving antiviral therapy,Fuxin,Liaoning,2011-2019

目的了解阜新市2011—2019年接受艾滋病高效抗逆转录病毒治疗(HAART)的HIV/AIDS患者状况,分析患者治疗后免疫学失败情况及其影响因素。方法利用“全国艾滋病防治基本信息系统”进行筛选,检测患者CD4+T淋巴细胞、基因型耐药等情况,通过Logistic回归模型分析免疫学失败的影响因素。结果243例HIV/AIDS患者纳入研究,总计随访2680次,66例(占27.16%)患者发生免疫学失败,其中57例(86.36%)患者CD4细胞计数降低至或低于开始治疗前水平,甚至CD4细胞数<200个/μL;9例(占13.64%)患者连续接受治疗≥1年CD4细胞计数<100个/μL。Logistic回归分析显示,从确诊至启动治疗时间≥12个月(OR=1.73,95%CI:1.24~3.55)、离异或丧偶(OR=1.61,95%CI:1.10~3.21)、以CCR5为辅助受体(OR=1.67,95%CI:1.01~3.43)、以NVP为基础的治疗方案(OR=2.73,95%CI:1.84~3.55)、发生基因型耐药(OR=9.90,95%CI:1.35~23.68)与发生免疫学失败呈正相关,而CD4+T淋巴细胞数≥600个/μL(OR=0.03,95%CI:0.01~0.08)和服药依从性≥95%(OR=0.23,95%CI:0.11~0.48)与发生免疫学失败呈负相关。结论HIV/AIDS患者应及早开展HARRT治疗,治疗过程中增加患者CD4+T淋巴细胞数监测次数,及时掌握患者免疫系统恢复动态情况和耐药情况,同时加强服药依从性教育,树立患者治疗信心,巩固治疗效果,改善患者生活质量。

Objective To understand the status of HIV/AIDS patients receiving AIDS highly active antiretroviral therapy(HAART)in Fuxin City from 2011 to 2019.This study analyzes the immunological failure of patients after treatment and its influencing factors.MethodsThis paper used the national"Basic Information System for AIDS Prevention and Treatment"to screen and detect CD4+T lymphocytes and genotype drug resistance in patients.This study used Logistic regression model to analyze the influencing factors of immunological failure.ResultsTotally 243 HIV/AIDS patients were included in the study,and a total of 2680 times of follow-ups were conducted.During the follow-up,66 patients(27.16%)had immunological failures,CD4 cell count in 57 patients(86.36%)was reduced to or lower than the level before treatment,or even<200 cells/μL.Nine patients(13.64%)received continuous treatment for more than 1 year with CD4 cell count<100/μL.Logistic regression analysis showed that the time from diagnosis to initiation of treatment was≥12 months(OR=1.73,95%CI:1.24-3.55),divorced or widowed(OR=1.61,95%CI:1.10-3.21),with CCR5 as auxiliary receptor(OR=1.67,95%CI:1.01-3.43),NVP-based treatment plan(OR=2.73,95%CI:1.84-3.55),genotype resistance(OR=9.90,95%CI:1.35-23.68)were positive correlation with immunological failure.The number of CD4+cells≥600/μL(OR=0.03,95%CI:0.01-0.08)and medication compliance≥95%(OR=0.23,95%CI:0.11-0.48)were negative correlation with immunological failure.Conclusions start HARRT treatment as soon as possible,increase the number of CD4+T lymphocyte count monitoring in patients during the treatment,and the management department timely monitors the patient′s immune system recovery dynamics and drug resistance.The disease control agency also strengthened medication compliance education to build patient confidence in treatment,consolidate treatment effects,and improve the quality of life of patients.