湖北省HIV感染者低病毒血症和病毒抑制失败的关联及影响因素

Relationship between low-level viraemia and virus inhibition failure and its influencing factors in HIV-infected patients in Hubei Province

目的目前艾滋病病毒(HIV)感染者低病毒血症(LLV)和病毒抑制失败(VF)的关联尚存在争议,该研究旨在研究湖北省一线抗病毒治疗(ART)的HIV感染者LLV对VF的影响,并就影响LLV的因素进行探讨。方法以湖北省2015—2016年新诊断,一线ART满半年且达到病毒持续抑制(连续两次血浆病毒载量[VL]<50cp/mL)的HIV感染者为研究对象,收集HIV感染者历年的随访时间、VL检测时间和结果及人口学特征、感染途径、基线CD4^(+)T淋巴细胞计数、WHO临床分期、治疗方案等数据。统计LLV和VF发生情况,比较不同水平LLV对VF的影响,利用logistic回归分析探讨HIV感染者发生LLV的影响因素。结果研究纳入881例HIV感染者,总共随访3428人年,平均随访时间为(3.40±1.20)人年,ART后出现过至少一次LLV的有304例,占34.51%。K-M生存曲线分析显示,LLV水平越高,患者发生VF风险越高(P<0.01)。logistic回归分析显示,一线ART的HIV感染者LLV的影响因素有年龄≥51岁(OR=1.755)、异性传播(OR=0.812)、基线CD4^(+)T淋巴细胞计数50~200个/mm^(3)(OR=1.425)。结论对于湖北省一线ART的HIV感染者来说,LLV的发生会增加后续VF出现的风险,且随着LLV水平的增高而增高。增加HIV治疗患者VL的监测频率并及时干预十分必要。

Objective To study the effect of low-level viraemia(LLV)on virus inhibition failure(VF)in HIV infected patients treated with first-line antiretroviral therapy(ART)in Hubei Province,and to explore the factors affecting LLV.Methods People infected with HIV who were newly diagnosed in Hubei Province from 2015-2016,had first-line ART for≥6 months,and achieved continuous virological suppression(two consecutive plasma viral load[VL]<50 copies/mL)were included in this study.Data including follow-up time,VL testing time and results,demographic characteristics,route of infection,baseline CD4^(+)T lymphocyte count,WHO clinical stage,and treatment plan were collected.The incidence of LLV and VF was statistically analyzed,and the effect of different levels of LLV on VF was compared.Logistic regression analysis was used to explore the influencing factors of the occurrence of LLV in HIV infected patients.Results A total of 881 HIV-infected patients were included in this study,and a total of 3428 person-years were followed up,with an average follow-up time of(3.40±1.20)person-years.304 patients(34.51%)had at least one LLV after ART.K-M survival curve analysis showed that the higher the LLV level,the higher the risk of VF(P<0.01).Logistics regression analysis showed that the influencing factors for LLV in HIV-infected patients with first-line ART were age≥51 years old(OR=1.755),heterosexual transmission(OR=0.812),and baseline CD4^(+)T lymphocyte count of 50-200/mm^(3)(OR=1.425).Conclusion For HIV-infected patients with first-line ART in Hubei Province,the occurrence of LLV will increase the risk of subsequent VF and increase with the increase of LLV level.It is necessary to increase the monitoring frequency of VL in treated HIV patients and to intervene in time.