海南省HIV感染者/AIDS患者抗病毒治疗免疫学效果及其影响因素

Immunological effects of antiviral therapy and its influencing factors in HIV/AIDS patients in Hainan

目的了解海南省艾滋病病毒感染者/艾滋病患者(human immunodeficiency virus/acquired immunodeficiency syndrome,HIV/AIDS)参加高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)的状况,分析其治疗后免疫学效果及其影响因素。方法本研究选取中国疾病预防控制信息系统抗病毒治疗子模块中海南省截至2022年治疗的HIV/AIDS患者,根据纳入和排除标准共纳入3150例研究对象,采用logistic回归分析影响免疫学效果的因素。结果3150例研究对象中,发生免疫学成功2906例(占92.2%);治疗后最近一次CD4^(+)T淋巴细胞计数M(P25,P75)为491(351,656)个/μL,不同水平的CD4^(+)T淋巴细胞计数组间治疗后与基线增加值的差异有统计学意义(P<0.001)。Logistic多因素分析结果显示:离异或丧偶(OR=0.50,95%CI:0.31~0.79),开始治疗时年龄≥60岁(OR=0.51,95%CI:0.29~0.90),确诊到治疗的时间间隔1~<12个月(OR=0.55,95%CI:0.40~0.77),确诊到治疗的时间间隔12~<60个月(OR=0.53,95%CI:0.34~0.80),确诊到治疗的时间间隔≥60月(OR=0.41,95%CI:0.23~0.75),CD4^(+)T淋巴细胞计数300~<400个/μL组(OR=0.36,95%CI:0.22~0.58),CD4^(+)T淋巴细胞计数400~<500个/μL组(OR=0.30,95%CI:0.18~0.49)与发生免疫学成功呈负相关(P<0.05)。而同性传播(OR=3.46,95%CI:2.03~5.90),异性传播(OR=1.91,95%CI:1.14~3.19),其他传播途径(OR=3.13,95%CI:1.50~6.53),治疗时长2~<4年(OR=1.71,95%CI:1.13~2.58),治疗时长4~<6年(OR=2.86,95%CI:1.81~4.51),治疗时长≥6年(OR=2.21,95%CI:1.47~3.32)与发生免疫学成功呈正相关(P<0.05)。结论海南省HIV/AIDS患者抗病毒治疗后取得较好的免疫学效果,应扩大HIV监测检测,早发现早治疗,持续加强服药依从性教育,进一步提升治疗免疫学效果。

Objective To investigate the status of participation in highly active antiretroviral therapy(HAART)among individuals infected with human immunodeficiency virus(HIV)/patients with acquired immunodeficiency syndrome(AIDS)(hereinafter referred to as HIV/AIDS)in Hainan province,and to analyze the immunological outcomes and their influencing factors following treatment.Methods In this study,HIV/AIDS patients treated in Hainan Province until 2022 from the antiretroviral treatment were selected from the antiviral treatment submodule of the China Disease Prevention and Control Information System.According to the inclusion and exclusion criteria,a total of 3150 HIV/AIDS patients were enrolled.Logistic regression analysis was used to analyze factors affecting the immunological effect of antiretroviral therapy.Results Of the 3150 subjects,2906 achieved immunological success,accounting for 92.2%.The M(P25,P75)CD4^(+)T lymphocyte count after treatment was 491(351,656)cells/μL.There were significant differences in the increase in CD4^(+)T lymphocyte counts after treatment compared to baseline across different CD4^(+)T levels(P<0.001).Multifactorial logistic regression analysis showed that being divorced or widowed(OR=0.50,95%CI:0.31-0.79),age≥60 years at the onset of treatment(OR=0.51,95%CI:0.29-0.90),the interval from diagnosis to treatment of 1 to<12 months(OR=0.55,95%CI:0.40-0.77),12 to<60 months(OR=0.53,95%CI:0.34-0.80),and≥60 months(OR=0.41,95%CI:0.23-0.75),as well as a CD4^(+)T cell count of 300 to<400 cells/μL(OR=0.36,95%CI:0.22-0.58)and 400 to<500 cells/μL(OR=0.30,95%CI:0.18-0.49)were negative correlation with immunological success(P<0.05).On the other hand,homosexual transmission(OR=3.46,95%CI:2.03-5.90),heterosexual 2 to<4 years(OR=1.71,95%CI:1.13-2.58),4 to<6 years(OR=2.86,95%CI:1.81-4.51),and≥6 years(OR=2.21,95%CI:1.47-3.32)were positive correlation with immunological success(P<0.05).Conclusions The highly active antiretroviral therapy has achieved good immunological effects among patients with HIV/AIDS in Hainan Province.It is essential to expand HIV monitoring and detection,to diagnose and treat at an early stage,and to continue strengthening medication compliance education to further improve the immunological effects of treatment.