凉山州艾滋病高流行县抗病毒治疗效果及其相关因素分析

Analysis of antiviral treatment effect and its influencing factors in HIV high prevalence counties of Liangshan Prefecture

目的分析凉山州艾滋病高流行县(布拖县、昭觉县、越西县和美姑县,以下简称“四县”)艾滋病抗病毒治疗效果及其影响因素。方法以四县2005—2019年入组治疗的艾滋病病毒感染者/病人(HIV/AIDS)为研究对象,从国家艾滋病综合防治信息系统收集病例报告、治疗及随访相关信息;以抗病毒治疗满12个月病毒载量小于400拷贝/ml为研究结局,采用SAS9.4统计软件进行χ^(2)检验和多因素Logistic回归分析。结果凉山州四县HIV/AIDS接受抗病毒治疗12个月后,治疗有效率为49.09%(9622/19600),随开始治疗年份变化治疗有效率呈上升趋势(χ^(2)=345.579,P<0.001)。多因素Logistic回归分析显示:女性(OR=1.18,95%CI:1.11~1.25)、初中及以上教育程度(OR=1.12,95%CI:0.98~1.27)、身体质量指数(BMI)≥24 kg/m^(2)(OR=1.15,95%CI:1.03~1.29)、HCV抗体阴性(OR=1.12,95%CI:1.04~1.21)、基线CD4^(+)T淋巴细胞计数(CD4^(+))>500个/μl(OR=1.25,95%CI:1.14~1.38)、开始治疗时间在2016年及之后(OR=1.43,95%CI:1.31~1.57)是病毒有效抑制的的保护性因素;彝族(OR=0.66,95%CI:0.53~0.82)、基线CD4^(+)细胞计数≤350个/μl(OR=0.89,95%CI:0.83~0.96)、抗病毒治疗开始时间在2016年之前(OR=0.48,95%CI:0.43~0.52)、治疗过程中发生脱失(OR=0.84,95%CI:0.79~0.88)是病毒有效抑制的危险因素。结论凉山州四县艾滋病抗病毒治疗有效率呈逐年上升趋势。HIV/AIDS启动抗病毒治疗时较低的CD4^(+)细胞值,治疗脱失等因素影响了治疗效果,需采取相应的措施。

Objective To analyze the effect of AIDS antiviral therapy and its influencing factors in high prevalence counties(Butuo county,Zhaojue county,Yuexi county and Meigu county,hereinafter referred to as“four counties”)of Liangshan.Methods A total of HIV/AIDS patients enrolled for treatment in four counties from 2005 to 2019 were selected as the study subjects.Information related to case report,treatment and follow-up was collected from the National Comprehensive AIDS Prevention and Control Information System.With viral load less than 400copies/mL after 12 months of antiviral therapy as the outcome,SAS9.4 statistical software was used for Chi-square tests and multivariate Logistic regression analysis.Results After 12 months of antiviral treatment,the effective rate of HIV/AIDS in four counties of Liangshan prefecture was 49.09%(9622/19600),and the effective rate showed an increasing trend with the change of the starting year of treatment(χ^(2)=345.579,P<0.001).Multivariate Logistic regression analysis showed that female(OR=1.18,95%CI:1.11-1.25),junior high school education or above(OR=1.12,95%CI:0.98-1.27),body mass index(BMI)≥24 kg/m^(2)(OR=1.15,95%CI:1.03-1.29),HCV antibody negative(OR=1.12,95%CI:1.04-1.21),baseline CD4^(+)T lymphocyte count(CD4^(+))>500/μl(OR=1.25,95%CI:1.14-1.38)and the start time of treatment in 2016 and later(OR=1.43,95%CI:1.31-1.57)were protective factors for effective suppression of the virus.Yi nationality(OR=0.66,95%CI:0.53-0.82),baseline CD4^(+)cell count≤350 cells/μl(OR=0.89,95%CI:0.83-0.96),start time of antiviral therapy before 2016(OR=0.48,95%CI:0.43-0.52)and loss during treatment(OR=0.84,95%CI:0.79-0.88)were risk factors for effective virus suppression.Conclusions The effective rates of antiviral treatment for AIDS in four counties of Liangshan prefecture increase year by year.When HIV/AIDS starts antiviral therapy,low CD4^(+)cell count,loss to ART follow-up and other factors affect the therapeutic effect,and corresponding measures should be taken.