广西HIV/AIDS患者合并巨细胞病毒感染特征与影响因素分析

Characteristic and risk factors analysis of HIV/AIDS patients combined with cytomegalovirus infection in Guangxi

目的调查HIV/AIDS患者巨细胞病毒(CMV)感染情况,比较不同标本(血液、尿液)在HIV合并CMV感染早期筛查的应用价值,分析HIV合并CMV感染的影响因素。方法收集2018年1月—2020年12月南宁市第四人民医院诊治的848例HIV/AIDS患者的性别、年龄、CD4^(^(+))T细胞计数、抗逆转录病毒治疗(ART)等资料信息,采用荧光PCR(FQ-PCR)检测血液/尿液CMV-DNA载量。采用卡方检验、Fisher确切概率法分析感染的差异,以二项Logistic回归分析HIV合并CMV感染的危险因素。结果848例HIV/AIDS患者中,有205例(24.17%)CMV-DNA阳性。尿液CMV-DNA检出率20.03%(142/709)高于血液CMV-DNA检出率12.04%(102/847)。多因素二项Logistic回归分析显示男性合并CMV感染的危险是女性2.30倍(95%CI:1.43~3.71),年龄30~<50岁和≥50岁合并CMV感染危险是年龄<30岁的2.43和2.32倍(95%CI分别为:1.20~4.91,1.15~4.65)、CD4^(+)T<50个/μL合并CMV感染的危险是CD4^(+)T≥100个/μL的3.88倍(95%CI:2.50~6.03),ART治疗患者合并CMV感染的危险比非ART治疗下降89%(OR=0.11,95%CI:0.05~0.24)。结论尿液在CMV感染的早期筛查比血液准确度更高,应重视CD4^(+)T计数较低、中年以上男性,加强其CMV感染的早期筛查和抗病毒治疗。

Objective According to the investigation the infection of cytomegalovirus(CMV)in HIV/AIDS patients,to analyze the application value of different samples(blood and urine)in early screening of AIDS patients with CMV infection,and we analyze the factors of AIDS patients with CMV infection.Methods Cross sectional data of 848 HIV/AIDS patients were collected,including gender,age,CD4^(+)T cell count and antiretroviral therapy(ART)in The Fourth People's Hospital of Nanning City,January 2018-December 2020.Fluorescent PCR(FQ-PCR)was used to test CMV-DNA load in blood/urine,chi-square test,Fisher′s exact test and Logistic regression were used to analyze the risk factors of HIV combined with CMV infection.Results Totally 848 HIV/AIDS patients were collected to this study,205 of them were positive in CMV-DNA,with a positive rate 24.17%(205/848).The positive rate of CMV-DNA in urine was 20.03%(142/709),which was higher than that in blood 12.04%(102/847).Multivariate binomial Logistic regression analysis showed that,among the HIV/AIDS patients,risk of CMV infection in male were 2.30 folds higher than female(95%CI:1.43-3.71),age among 30-<50 years and over 50 years were 2.43 and 2.32 folds risk of infected CMV than age less than 30 years(with the 95%CI were 1.20-4.91 and 1.15-4.65),CD4^(+)T less 50 cells/μL were 3.88 folds risk infected CMV than CD4^(+)T over 100 cells/μL(95%CI:2.50-6.03),while ART could decrease 89%risk to infect the CMV than no ART treatment(OR=0.11,95%CI:0.05-0.24).Conclusion Urine sample was more accurate than blood in the early screening of CMV infection.HIV/AIDS combined with CMV infection was more common in male,low CD4^(+)T count and middle aged above patients.More attention should be paid to the early screening of CMV infection in the above patients.ART can effectively reduce the risk of CMV infection.