HIV感染者抗病毒治疗前基线病毒载量特征及相关因素研究

Characteristics of baseline viral load and related factors in HIV-infected people before antiretroviral therapy

目的了解我国部分医疗机构中新启动治疗的HIV感染者治疗前病毒载量(viral load,VL)的分布特征及相关因素。方法采用横断面研究方法,选取2016—2021年间首次启动抗病毒治疗的HIV感染者规模超过1000人,且基线VL检测率≥90%的医疗机构共9个,并将治疗前有VL检测的HIV感染者作为研究对象,描述研究对象治疗前VL不同水平的分布情况,分析基线精英控制者(VL<50拷贝/mL)及基线高VL者(VL≥105拷贝/mL)的相关因素。结果纳入HIV感染者共36452人,精英控制者占1.31%(476/36452),基线高VL的感染者占41.51%(15131/36452)。多因素Poisson回归模型分析显示,与基线CD4细胞计数<200个/mm3的HIV感染者相比,351~500个/mm3(aOR=1.64,95%CI:1.24~2.17)和>500个/mm3(aOR=4.19,95%CI:3.25~5.40)的感染者是基线精英控制者的可能性显著增加。多因素Logistic回归模型分析显示,与基线CD4细胞计数>500个/mm3相比,<200个/mm3(aOR=6.20,95%CI:5.68~6.77)、200~350个/mm3(aOR=2.46,95%CI:2.25~2.68)和351~500个/mm3(aOR=1.74,95%CI:1.58~1.91)的感染者更可能有高VL。结论我国初治HIV感染者治疗前基线高VL者较多,基线CD4细胞计数水平越低,感染者越有可能是基线高VL者。治疗前CD4细胞计数较高者中更易出现精英控制者。

Objective To understand the distribution characteristics of baseline viral load(VL)and related factors in HIV-infected patients newly initiating antiretroviral therapy in some medical institutions in China.Methods By cross-sectional study method,a total of 9 institutions with>1000 HIV-infected patients and baseline VL test rate≥90%were included from 2016 to 2021.All HIV-infected patients undergoing baseline VL test were enrolled in this study.Distribution of baseline VL as well as the related factors of elite controllers(VL<50 copies/mL)and patients with high baseline VL(VL≥105 copies/mL)were described.Results A total of 36452 patients were enrolled.The proportions of elite controllers and patients with high baseline VL were 1.31%(476/36452)and 41.51%(15131/36452).Multivariate Poisson regression model showed that patients with baseline CD4 cell count 351-500 cells/mm3(aOR=1.64,95%CI:1.24-2.17)and>500 cells/mm3(aOR=4.19,95%CI:3.25-5.40)were significantly more likely to be baseline elite controllers,comparing with those with baseline CD4 cell count<200 cells/mm3.Multivariate Logistic regression model indicated that patients with baseline CD4 cell count<200 cells/mm3(aOR=6.20,95%CI:5.68-6.77),200-350 cells/mm3(aOR=2.46,95%CI:2.25-2.68)and 351-500 cells/mm3(aOR=1.74,95%CI:1.58-1.91)were significantly more likely to had high baseline VL,compar with those with baseline CD4 cell count>500 cells/mm3.Conclusions Among initial HIV-infected patients in China,a majority have high VL at baseline.The lower the baseline CD4 cell counts are,the more likely the patients are to have high VL at baseline.Elite controllers are commonly seen in patients with high CD4 cell count before treatment.