山东省HIV/AIDS抗病毒治疗后首次病毒载量抑制情况及影响因素分析

The first viral load suppression and its influencing factors for HIV/AIDS on ART in Shandong province

目的分析2014—2016年山东省新诊断HIV/AIDS接受抗病毒治疗后病毒载量(VL)抑制情况及其影响因素,为促进艾滋病治疗效果提供理论依据。方法采用回顾性队列研究,描述HIV/AIDS接受治疗后VL抑制情况,运用logistic回归模型分析影响VL抑制的影响因素。结果2014—2016年山东省新诊断HIV/AIDS中共4833例接受治疗,其中首次VL抑制的有3449例,抑制率71.36%。文化水平为初高中或中专、大专及以上的HIV/AIDS治疗后首次VL取得抑制的可能性高于小学及以下者,OR值分别为1.75和2.00;在临床机构治疗的HIV/AIDS首次VL取得抑制的可能性高于在疾控机构治疗者,OR值为1.29;治疗基线CD4细胞水平为201~350、351~500及≥501个/μl的HIV/AIDS首次VL取得抑制的可能性高于≤200个/μl者,OR值分别为2.36,2.11和2.66;漏服药物HIV/AIDS首次VL取得抑制的可能性低于按时定量服药者,OR值为0.55。以上P值均<0.05。结论HIV/AIDS的抗病毒治疗效果与其文化水平、治疗基线CD4细胞水平、治疗机构和服药依从性有关联。尽早治疗、医疗机构开展治疗服务以及提高服药依从性可进一步促进抗病毒治疗效果。

Objective To analyze the status of first viral load(VL)suppression for newly diagnosed HIV/AIDS on antiretroviral therapy(ART)from 2014 to 2016 in Shandong province,to provide theoretical evidence for improvement of ART effectiveness.Methods Based on a retrospective cohort study,logistic regression model was used to identify influencing factors about VL suppression.Results There were 4833 newly diagnosed HIV/AIDS cases who received ART from 2014 to 2016 in Shandong province,and 3449 cases achieved VL suppression at the first VL testing.The rate of first VL suppression was 71.36%.The possibilities of first VL suppression among patients on ART with education at junior high school,junior college and above were higher than those with education at primary school and below,with OR values at 1.75 and 2.00,separately.The possibilities of first VL suppression for patients treated at medical institutions was higher than those by CDC,with OR value 1.29.The possibilities of first VL suppression among patients whose CD4 count level at 201-350,351-500 and≥501 cells/μl were higher than that of the patients whose CD4 count level at≤200 cells/μl,with OR values at 2.36,2.11 and 2.66,respectively.The possibilities of first VL suppression among patients who missed doses was lower than those who did not miss doses,with OR value at 0.55.All the Pvalues for the above comparisons was<0.05.Conclusions The suppression of viral load for HIV/AIDS on ART was influenced by culture level,CD4 count level at the entry of ART,treatment institutions and adherence to the therapy.Earlier diagnosis,treatment services provided by medical institutions and improvement of drug adherence can enhance ART effectiveness.