2015-2021年湖南省HIV-1低病毒血症患者基本特征与发生耐药风险分析

Analysis of characteristics and drug resistance risk of HIV-1 patients with low-level viremia in Hunan in 2015-2021

目的分析湖南省艾滋病低病毒血症(low-level viremia,LLV)患者信息数据,探讨其发生耐药风险的影响因素。方法收集艾滋病综合防治数据信息管理系统中湖南省2015年1月1日-2021年12月31日艾滋病患者抗病毒治疗信息资料,对LLV患者基础特征进行描述性分析,采用χ^(2)检验分析持续性低病毒血症(persistent low-level viremia,pLLV)、间歇性低病毒血症(viral blip,Blip)患者分别与病毒学长期抑制(virologic suppression,VS)和病毒学失败(virological failure,VF)患者的特征差异性,使用logistic回归和限制性立方样条(restricted cubic spline,RCS)模型分析不同病毒载量的pLLV、Blip与耐药风险的关联性。结果2015—2021年湖南省发生pLLV、Blip、VS、VF的患者分别为233、3316、18682、7235例。单因素分析结果显示,pLLV、Blip患者分别与VS和VF患者比较,性别(χ_(1)^(2)=61.929,P_(1)<0.01;χ_(2)^(2)=25.872,P_(2)<0.01)、年龄(χ_(1)^(2)=11.312,P_(1)=0.023;χ_(2)^(2)=149.75,P 2<0.01)、感染途径(χ_(1)^(2)=116.207,P_(1)<0.01;χ_(2)^(2)=508.515,P_(2)<0.01)、WHO分期(χ_(1)^(2)=206.357,P_(1)<0.01;χ_(2)^(2)=52.948,P_(2)<0.01)、入组CD4+T淋巴细胞数(χ_(1)^(2)=177.715,P_(1)<0.01;χ_(2)^(2)=50.484,P_(2)<0.01)、治疗时长(χ_(1)^(2)=464.055,P_(1)<0.01;χ_(2)^(2)=685.623,P_(2)<0.01)、初始治疗方案(χ_(1)^(2)=87.935,P_(1)<0.01;χ_(2)^(2)=281.910,P_(2)<0.01)和是否耐药(χ_(1)^(2)=743.141,P_(1)<0.01;χ_(2)^(2)=125.616,P 2<0.01)等因素差异均有统计学意义,但2组患者与VF患者比较体质量指数(BMI)差异无统计学意义(χ_(2)^(2)=13.631,P_(2)=0.092),与VS患者比较婚姻状况差异无统计学意义(χ_(1)^(2)=5.710,P_(1)=0.434)。logistic回归分析结果提示,500~999拷贝/ml的pLLV与耐药发生有关(OR=7.427,95%CI:3.318~16.626),RCS模型显示pLLV和Blip的病毒载量水平变化与耐药发生风险呈线性剂量反应关系(整体关联性检验χ_(p)^(2)=19.22,P p=0.014;χ_( B)^(2)=107.08,P_(B)<0.01;非线性检验χ_(p)^(2)=1.30,P p=0.254;χ_(B)^(2)=1.47,P_(B)=0.225)。结论与VS和VF患者比较,pLLV和Blip患者的基本特征具有特异性,2类艾滋病患者的病毒载量水平越高则与耐药发生风险关联性越强,在抗病毒治疗过程中应该引起重视和关注。

Objective To analyze the clinical data of HIV-1 patients with low-level viremia(LLV)in Hunan province and explore the influential factors of drug resistance risk.Methods The antiretroviral therapy data of patients with HIV/AIDS in Hunan province from January 1,2015 to December 31,2021 were retrieved from the National Comprehensive Information System for HIV/AIDS Control and Prevention,and a descriptive analysis was used to analyze the data of patients with LLV.Chi-square test was used to analyze and compare the differ⁃ences in characteristics of patients with persistent low-level viremia(pLLV),viral blip(Blip)and long-term viro⁃logic suppression(VS)and virological failure(VF).The logistic regression model and restricted cubic spline(RCS)model were used to analyze the association between viral and the risk of drug resistance in patients with pLLV or Blip.Results During 2015 and 2021,the number of patients with pLLV,Blip,VS and VF in Hunan Province were 233,3316,18682 and 7235,respectively.The univariable analysis showed that pLLV and Blip patients did not have statistically significant difference in body mass index(BMI)compared with VF patients(χ_(2)^(2)=13.631,P_(2)=0.092),nor statistically significant difference in marital status compared with VS patients(χ_(1)^(2)=5.710,P_(1)=0.434).The gender(χ_(1)^(2)=61.929,P 1<0.01;χ_(2)^(2)=25.872,P 2<0.01),age(χ_(1)^(2)=11.312,P_(1)=0.023;χ_(2)^(2)=149.75,P_(2)<0.01),infection route(χ_(1)^(2)=116.207,P1<0.01;χ_(2)^(2)=508.515,P 2<0.01),disease stage by WHO(χ_(1)^(2)=206.357,P_(1)<0.001;χ_(2)^(2)=52.948,P 2<0.01),baseline CD4+ T cell counts(χ_(1)^(2)=177.715,P 1<0.01;χ_(2)^(2)=50.484,P 2<0.01),duration of treatment(χ_(1)^(2)=464.055,P 1<0.01;χ_(2)^(2)=685.623,P 2<0.01),initial treatment regimen(χ21=87.935,P 1<0.001;χ_(2)^(2)=281.910,P 2<0.001),drug resistance(χ_(1)^(2)=743.141,P 1<0.001;χ_(2)^(2)=125.616,P 2<0.001)were all statistically significantly different between patients with pLLV and Blip and patients with VS,and between patients with pLLV and Blip and patients with VF.Logistic regression analysis showed that 500–999 copies/ml was associated with the development of drug resistance in pa⁃tients with pLLV(OR=7.427,95%CI:3.318~16.626),and the RCS model showed that there was linear dose-response relationship between the viral load and the risk of drug resistance in patients with pLLV and Blip(overall association test χ_(p)^(2)=19.22,P_(p)=0.014;χ_(B)^(2)=107.08,P B<0.001;nonlinearity test χ_(p)^(2)=1.30,P_(p)=0.254;χ_(B)^(2)=1.47,P B=0.225).Conclusions There are significant differences in basic information of patients with pLLV and Blip,patients with higher viral load are more likely to develop drug resistance,therefore,more attentions should be paid during antiretroviral treatment.