使用含依非韦伦方案艾滋病患者基线HIV RNA水平与免疫功能重建相关性分析

Correlation analysis of baseline HIV RNA and immune function reconstitution in patients who receive antiviral regimen contained efavirenz

目的通过观察使用含依非韦伦(efavirenz,EFV)方案进行治疗的不同基线人免疫缺陷病毒核糖核酸(human immunode?ciency virus ribonucleic acid,HIV RNA)水平的艾滋病(acquired immune deficiency syndrome,AIDS)患者在抗病毒治疗过程中CD4^(+)T淋巴细胞计数的变化,探讨基线病毒载量(viral load,VL)与免疫功能重建的相关性。方法研究对象为2010年1月31日—2020年12月31日在柳州市人民医院关爱门诊随访管理的初治成年AIDS患者,所有患者均接受含EFV的抗病毒治疗方案,观察期为120个月。利用受试者工作特征曲线确定基线VL预测免疫功能重建的最佳界值,根据最佳界值将患者分为低基线VL组和高基线VL组,用广义估计方程(generalized estimating equations,GEE)分析基线VL的高低与免疫功能重建的关系。结果基线VL预测免疫功能重建的最佳界值为5.533×10^(4)copies/mL。低基线VL组免疫重建成功率(87.58%)高于高基线VL组(70.93%)(P<0.05)。广义估计方程模型效应检验显示,CD4^(+)T淋巴细胞计数在低基线VL组和高基线VL组之间相比,差异有统计学意义(Waldχ^(2)=24.789,P=0.000),不同随访时间点差异也有统计学意义(Waldχ^(2)=911.501,P=0.000)。结论当AIDS患者的基线VL<5.533×10^(4)copies/mL时,使用含EFV方案进行抗病毒治疗后,其免疫功能的恢复和重建效果较好。

Objective To investigate the correlation between baseline HIV load(VL)and immune function reconfiguration by observing the changes in CD4^(+)T lymphocyte counts during antiviral therapy contained efavirenz(EFV)regimen in AIDS patients with different baseline VL level.Methods The study enrolled initial treatment adult AIDS patients who were followed up and managed at the Care Clinic of Liuzhou People’s Hospital from 2010 to 2020.All patients received antiviral treatment contained EFV with the observation period of 120 months.According to the receiver operating characteristic curve,the optimal cut-off value of baseline VL was calculated in predicting immune function reconstruction.All patients were divided into low baseline VL group and high baseline VL group based on the optimal cut-off value.The relationship between different baseline VL groups and immune function reconstruction was analyzed by the generalized estimation equation(GEE).Results The optimal cut-off value of baseline VL in predicting immune reconstitution was 5.533×10^(4) copies/mL.The success rate of immune reestablishment in the low baseline VL group(87.58%)was higher than that in the high baseline VL group(70.93%)(P<0.05).The analysis of GEE showed that there was a statistically significant difference in CD4^(+)T lymphocyte counts between the low baseline VL group and the high baseline VL group(Waldχ^(2)=24.789,P=0.000)and there were significant differences among different follow-up times(Waldχ^(2)=911.501,P=0.000).Conclusion The immune function recovery and reconstruction effect of contained EFV regimen is better when the baseline VL of AIDS patient was low than 5.533×10^(4) copies/mL.