快速启动抗病毒治疗对人类免疫缺陷病毒感染者抗病毒治疗结果的影响

Impact of Rapid ART on antiretroviral treatment outcomes in HIV-infected patients

目的通过真实世界队列研究,探讨“快速启动抗病毒治疗”策略对人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者抗病毒治疗启动率、病毒抑制率、免疫功能恢复、治疗维持率等的影响。方法以2022年4月至2023年3月间在北京佑安医院开始首次接受抗病毒治疗的HIV感染者为研究对象,根据其是否在诊断14 d内启动抗病毒治疗分为快速治疗组和非快速治疗组,对比2组患者抗病毒治疗启动时间,6、12个月的病毒抑制率、CD4^(+)T淋巴细胞计数、CD4^(+)/CD8^(+)比值及治疗维持率等数据,探讨快速启动抗病毒治疗对HIV感染者临床转归的影响。结果共纳入研究对象472例,其中快速治疗组281例(59.5%),非快速治疗组191例(40.5%);非快速治疗组3个月治疗启动率88%,12个月治疗启动率95%。快速治疗组6个月(90.0%vs.72.8%,P=0.001)、12个月(92.5%vs.77.5%,P=0.001)的病毒学抑制率均高于非快速治疗组。快速治疗组与非快速治疗组在长期治疗维持率、CD4^(+)T淋巴细胞计数及CD4^(+)/CD8^(+)比值增长方面的差异均无统计学意义(P均>0.05)。结论快速启动抗病毒治疗能提高HIV感染者6个月及12个月病毒学抑制率,但在长期治疗维持率和免疫功能恢复方面未见显著影响。

Objective To evaluate the effect of the“Rapid Initiation of Antiretroviral Therapy(RAPID ART)”strategy on the initiation of treatment,virological suppression,immunological recovery,and retention rates of HIV/AIDS patients.Methods In this real-world cohort study,HIV-positive individuals firstly initiating ART at Beijing You an Hospital between April 2022 and March 2023 were divided into rapid start group(confirmed to start ART for≤14 d)and non-rapid start group(confirmed to start ART for>14 d).We compared the time to start ART initiation,the virological inhibition rate at 6 and 12 months,changes in CD4^(+)T cell counts,CD4^(+)/CD8^(+)ratios,and retention in care between 2 groups to ascertain the benefits of Rapid ART initiation on clinic outcomes.Results A total of 472 subjects were enrolled,including 281(59.5%)in the rapid start group and 191(40.5%)in the non-rapid start group.The initiation rate of ART at 3 months was 88%in the nonrapid group and reached 95%by 12 months.The rapid start group exhibited a significantly higher virological inhibition rate than the non-rapid start group at 6 months(90.0%vs.72.8%,P=0.001)and 12 months(92.5%vs.77.5%,P=0.001).However,there were no statistically significant differences between the groups in terms of long-term retention in care,CD4^(+)T cell recovery,and CD4^(+)/CD8^(+)ratio improvement(P>0.05).Conclusions The rapid ART initiation significantly improves virological suppression rates at 6 and 12 months in HIV-infected individuals and does not significantly impact long-term rate of compliance in care or CD4 cell recovery.