HIV/AIDS患者病毒学疗效早期预测指标的探讨

Discussion on the Early Predictors for Virological Efficacy in HIV/AIDS Patients

目的:探讨替诺福韦(TDF)+拉米夫定(3TC)+依非韦伦(EFV)方案的HIV感染/艾滋病(HIV/AIDS)患者病毒学疗效的早期(2周)预测指标及预测价值,为临床高效抗反转录病毒治疗(HAART)提供参考。方法:选取2018年1月~2021年1月于某院采用TDF+3TC+EFV方案进行HAART的HIV/AIDS患者121例作为研究对象。采用回顾性研究方法,收集相关资料进行统计学分析。结果:HAART 6个月时HIV RNA被抑制者116例(95.9%);HAART 2周HIV RNA降低幅度(lg值)与病毒学疗效相关;HAART 2周HIV RNA降低幅度预测病毒学疗效的ROC曲线下面积为0.910,具有统计学差异(P<0.05),HAART 2周HIV RNA降低幅度对病毒学疗效有较高的预测价值,lg值1.8016为最佳预测分界点。采用该分界点预测病毒学疗效时,诊断正确率达87.6%,敏感性87.9%,特异性80.0%,阳性预计值99.0%。结论:HAART 2周HIV RNA降低幅度是HIV/AIDS患者病毒学疗效的早期预测指标,预测价值高,值得临床推广应用。

Objective:To explore the early predictors of virological efficacy in human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients with tenofovir(TDF)+lamivudine(3TC)+efavirenz(EFV)regimen(2 weeks)and their corresponding predictive value,and to provide reference for clinically reasonable highly active antiretroviral therapy(HAART).Methods:A total of 121 HIV/AIDS patients who underwent HAART with TDF+3TC+EFV in Infectious Disease Hospital from January 2018 to January 2021 were selected as the study subjects.Use retrospective research methods to collect relevant data and perform statistical analysis.Result:By 6 months of HAART,116 cases(95.9%)had HIV RNA suppressed;by 2 weeks of HAART,the HIV RNA reduction degree was related to virological efficacy;reduction degree of HAART 2-week can be employed to predicte virological efficacy,and its the area under the ROC curve was 0.910,the difference is statistically significant(P<0.05).The reduction degree by HAART in 2 weeks has a higher predictive value for virological efficacy,and 1.8016 is the best predictive cut-off point.When this cut-off point is used to predict the efficacy of virology,the diagnosis accuracy rate is 87.6%,the sensitivity is 87.9%,the specificity is 80.0%,and the positive predictive value is 99.0%.Conclusion:The 2-week HIV RNA reduction degree of HAART can be an early predictor of the virological efficacy of HIV/AIDS patients.It has high predictive value and worthy of clinical application.