重庆市初治HIV感染者基线病毒载量、CD4^(+)T细胞水平在新型冠状病毒感染疫情下的变化

Changing patterns of baseline viral load and CD4^(+)T level of treatment-naïve HIV-infected patients in the context of COVID-19 pandemic in Chongqing

目的分析近3年重庆市初治HIV感染者人口学特征,明确基线病毒载量、CD4^(+)T细胞免疫水平及相关影响因素,了解新型冠状病毒感染疫情下上述指标是否发生变化。方法收集2019年1月—2021年12月确诊HIV感染且在重庆市公共卫生医疗救治中心初始启动抗病毒治疗患者的人口学信息及临床数据,以年份分组,用SPSS 25.0软件对比分析。结果共纳入HIV初治患者3573例,男性2814例(78.8%),年龄中位数45.9岁,同性性传播总占比28.4%(1016例),呈逐年降低趋势,从2019年30.9%下降到2021年25.2%(P<0.05)。基线HIV RNA中位数5.1 log_(10)拷贝/mL,1887例(52.8%)≥5.0 log_(10)拷贝/mL,呈逐年增高趋势,从2019年5.0 log_(10)拷贝/mL上升到2021年5.2 log_(10)拷贝/mL,且HIV RNA≥5.0 log_(10)拷贝/mL占比也逐年递增(P均<0.05)。CD4^(+)T细胞中位数158个/μL,2205例(61.7%)≤200个/μL,年度间未见显著差异。HIV RNA≥5.0 log_(10)拷贝/mL组较<5.0 log_(10)拷贝/mL组男性占比更高,年龄更大(P均<0.05),异性性传播占比更高,且CD4^(+)T细胞中位数95.0个/μL,显著低于非高病毒载组210.5个/μL(P<0.05)。结论重庆市HIV初治患者普遍存在基线高病毒载量与极低CD4^(+)T细胞免疫水平,尤其易发生在老年、男性、异性性传播感染者,且新型冠状病毒感染疫情下基线病毒载量有增高趋势,需加大对该群体的宣教力度,早筛查、早诊断、早治疗。

Objective To examine the changing patterns of baseline viral load and CD4^(+)T level and the corresponding demographic characteristics of treatment-naïve HIV-infected patients in the context of COVID-19 pandemic in Chongqing in 3-year period.Methods The demographic and clinical data were collected for the treatment-naïve HIV-infected patients treated in Chongqing Public Health Medical Center from January 2019 to December 2021.The data were compared by year using SPSS 25.0 software.Results A total of 3573 treatment-naïve HIV patients were identified,including 2814(78.8%)males.The median age of the patients was 45.9 years.Overall,same-sex transmission accounted for 28.4%of the cases,showing a downward trend from 30.9%in 2019 to 25.2%in 2021(P<0.05).The median baseline HIV RNA was 5.1 log_(10) copies/mL.The baseline HIV RNA level was≥5.0 log_(10) copies/mL in 1887 cases(52.8%),showing an increasing trend from 5.0 log_(10) copies/mL in 2019 to 5.2 log_(10) copies/mL in 2021.The prevalence of patients with HIV RNA≥5.0 log_(10) copies/mL also increased significantly during the 3-year period(P<0.05).The median CD4^(+)T were 158 cells/μL.The CD4^(+)T level was≤200 cells/μL in 2205 cases(61.7%).CD4^(+)T level did not change significantly during the 3-year period.HIV RNA≥5.0 log_(10) copies/mL was associated with significantly higher percentage of men and heterosexual transmission,older age,and significantly lower median CD4^(+)T level(95.0 vs 210.5 cells/μL)compared with HIV RNA<5.0 log_(10) copies/mL(all P<0.05).Conclusions High baseline viral load and very low CD4^(+)T level are prevalent in the treatment-naïve HIV-infected patients during the 3-year period of COVID-19 pandemic in Chongqing,especially in the elderly,male and the sexually transmitted cases among heterosexual population.Early awareness,screening,diagnosis and treatment are required for the people living with HIV due to the increasing baseline viral load in the context of COVID-19 pandemic.