宁波市2010-2020年抗病毒治疗HIV/AIDS免疫重建情况及影响因素分析

Immune reconstitution and influencing factors in HIV/AIDS patients receiving antiretroviral therapy in Ningbo,2010-2020

目的分析宁波市抗病毒治疗HIV/AIDS的免疫重建情况及影响因素。方法研究对象来源于艾滋病综合防治信息系统2010-2020年宁波市HIV/AIDS数据库,纳入标准为开始抗病毒治疗时年龄≥18岁、随访时间≥1年和基线CD4+T淋巴细胞(CD4)计数资料完整。采用回顾性队列研究方法,对研究对象流行病学特征进行描述性分析,采用单因素和多因素Cox比例风险回归模型分析抗病毒治疗HIV/AIDS免疫重建情况及影响因素。结果共纳入3851例HIV/AIDS,开始抗病毒治疗的年龄为(39.47±13.47)岁,男性3185例(82.71%)、汉族3769例(97.87%)、初中文化程度1333例(34.62%),随访时间M(Q_(1),Q_(3))为47(25,77)个月。抗病毒治疗后发生免疫重建的HIV/AIDS占66.22%(2550/3851)。多因素Cox比例风险回归模型分析结果显示,相比于开始抗病毒治疗年龄≥45岁、基线BMI<23.0 kg/m^(2)、基线CD4计数<200个/μl和初始治疗方案为齐多夫定+拉米夫定+奈韦拉平(AZT+3TC+NVP)的HIV/AIDS,开始抗病毒治疗年龄<30岁、基线BMI≥23.0 kg/m^(2)、基线CD4计数≥200个/μl和初始治疗方案为AZT+3TC+依非韦伦(EFV)的HIV/AIDS更容易发生免疫重建。结论开始抗病毒治疗年龄、基线BMI、基线CD4计数、初始治疗方案是HIV/AIDS免疫重建的影响因素。因此,建议尽早开始抗病毒治疗,定期随访和监测CD4计数水平,重点关注年龄较大、基线BMI较低的HIV/AIDS。

Objective To investigate the immune reconstitution and its influencing factors in HIV/AIDS patients with antiretroviral therapy in Ningbo.Methods The data were collected from HIV/AIDS patients of HIV/AIDS Comprehensive Response Information System in Ningbo during 2010-2020.The inclusion criteria of study subjects were HIV/AIDS patients aged 15 or above at initiation of antiretroviral therapy with duration of more than one year follow-up and baseline CD4+T lymphocyte(CD4)counts completed.A retrospective cohort study was conducted to describe the epidemiological characteristics of the subjects,and univariate and multivariate Cox proportional risk regression models were used to analyze the influencing factors of immune reconstitution in HIV/AIDS patients.Results A total of 3851 HIV/AIDS patients were enrolled,in whom 3185 were males(82.71%,3185/3851),3769 were in Han ethnic group(97.87%,3769/3851),and 1333 had education level of junior high school(34.62%).Of the subjects,the age at initiation of antiretroviral therapy was(39.47±13.47)years.The median(Q_(1),Q_(3))of follow-up time was 47(25,77)months.The immune reconstitution after antiretroviral therapy accounted for 66.22%(2550/3851)in HIV/AIDS patients.Multivariate Cox proportional risk regression model results showed that,compared with HIV/AIDS patients receiving initial antiretroviral therapy at age≥45 years,having baseline BMI<23.0 kg/m^(2) and baseline CD4 counts<200 cells/μl,receiving initial antiretroviral therapy regimen of zidovudine+lamivudine+nevirapine(AZT+3TC+NVP),the immune reconstitution was more likely to occur in HIV/AIDS cases receiving initial antiretroviral therapy at age<30 years,having baseline BMI≥23.0 kg/m^(2) and baseline CD4 counts≥200 cells/μl,receiving initial antiretroviral therapy regimen of AZT+3TC+efavirenz(EFV).Conclusions Age at initial antiretroviral therapy,baseline BMI,baseline CD4 counts and initial regimens were the main factors affecting immune reconstitution.Therefore,it is necessary to start antiretroviral therapy as early as possible,conduct regular follow up and monitor CD4 levels,and pay attention to HIV/AIDS patients with older age and lower baseline BMI.