2011-2020年菏泽市HIV/AIDS患者抗病毒治疗一年后病毒学效果及影响因素分析

Virological effect and influencing factors for HIV/AIDS patients after one-year antiretroviral treatment in Heze City from 2011 to 2020

目的了解菏泽市HIV/AIDS患者ART一年后病毒学效果,分析相关影响因素,为开展精准随访管理、进一步提高艾滋病ART效果提供依据。方法采用回顾性队列研究,描述2011-2020年菏泽市HIV/AIDS患者ART一年后病毒学效果,运用Logistic回归模型分析相关影响因素。结果645例HIV/AIDS患者纳入分析,其中485例(75.2%)在ART一年后达到病毒抑制。多因素分析结果显示,接受ART一年后,文化程度为高中或中专(OR=1.80,95%CI:1.16~2.79)、大专及以上(OR=2.29,95%CI:1.05~5.01)的HIV/AIDS患者达到病毒抑制的可能性相对高,治疗基线CD4细胞计数≥500个/μL(OR=2.37,95%CI:1.09~5.15),免疫恢复情况较好(OR=2.21,95%CI:1.45~3.38),治疗基线无临床症状(OR=4.08,95%CI:2.43~6.86)的HIV/AIDS患者达到病毒抑制的可能性相对高;确诊后超过180天启动ART(OR=0.28,95%CI:0.14~0.57),ART期间曾漏服药物(OR=0.29,95%CI:0.12~0.67)的HIV/AIDS患者达到病毒抑制的可能性相对低。结论HIV/AIDS患者的病毒学效果与文化程度、治疗基线CD4细胞计数、免疫恢复状况、治疗基线临床症状、确诊后启动ART的时间、服药依从性有关联,建议尽早启动ART,加强随访和治疗监测,提高依从性,促进病毒抑制率提高。

Objective To investigate the virological effect of people living with HIV/AIDS(PLWH)after one-year antiretroviral treatment(ART)in Heze City,and to analyze related influencing factors,so as to provide evidence for carrying out accurate follow-up management and further improving the efficacy of antiretroviral treatment.Methods A retrospective cohort study was conducted to describe the virological effect of PLWH after one year of antiretroviral treatment in Heze City from 2011 to 2020,and logistic regression model was used to analyze the influencing factors.Results A total of 645 PLWH were included,of which 485(75.2%)cases achieved VL suppression after one-year ART.Multivariate analysis showed that one-year after receiving ART,PLWH with education level of high school or junior college(OR=1.80,95%CI:1.16-2.79),college and above(OR=2.29,95%CI:1.05-5.01)were more likely to achieve viral inhibition.PLWH with CD4 count≥500 cells/μL at treatment baseline(OR=2.37,95%CI:1.09-5.15),better immune recovery(OR=2.21,95%CI:1.45-3.38),and without clinical symptoms at treatment baseline(OR=4.08,95%CI:2.43-6.86)were more likely to achieve viral inhibition.PLWH who initiated ART more than 180 days after diagnosis(OR=0.28,95%CI:0.14-0.57),and had once missed medication during ART(OR=0.29,95%CI:0.12-0.67)were less likely to achieve viral inhibition.Conclusions The virological effect of PLWH is associated with literacy,treatment baseline CD4 cell count,immune recovery status,treatment baseline clinical symptoms,time to ART initiation after diagnosis,and medication compliance.It is recommended that ART should be initiated as early as possible,and that follow-up and treatment monitoring should be strengthened to improve compliance and promote the rate of VL suppression.