文章摘要
刘玄华,朱秋映,苏锦明,孟琴,周信娟,沈智勇,唐振柱,杨文敏,阮玉华,邵一鸣.广西壮族自治区2008-2015年艾滋病病毒感染者基线CD4+T淋巴细胞计数水平对抗病毒治疗脱失的影响[J].中华流行病学杂志,2018,39(9):1216-1221
广西壮族自治区2008-2015年艾滋病病毒感染者基线CD4+T淋巴细胞计数水平对抗病毒治疗脱失的影响
Effect of baseline CD4+T cell count on drop-out of antiretroviral therapy in HIV infected persons in Guangxi Zhuang Autonomous Region, 2008-2015
投稿时间:2018-01-22  
DOI:10.3760/cma.j.issn.0254-6450.2018.09.014
中文关键词: 艾滋病病毒感染者;抗病毒治疗;CD4+T淋巴细胞计数;脱失
英文关键词: HIV infected persons;Antiretroviral therapy;CD4+T cell count;Drop-out
基金项目:广西八桂学者艾滋病防控关键技术岗位专项经费
作者单位E-mail
刘玄华 530028 南宁, 广西壮族自治区疾病预防控制中心  
朱秋映 530028 南宁, 广西壮族自治区疾病预防控制中心  
苏锦明 530028 南宁, 广西壮族自治区疾病预防控制中心  
孟琴 530028 南宁, 广西壮族自治区疾病预防控制中心  
周信娟 530028 南宁, 广西壮族自治区疾病预防控制中心  
沈智勇 530028 南宁, 广西壮族自治区疾病预防控制中心  
唐振柱 530028 南宁, 广西壮族自治区疾病预防控制中心  
杨文敏 530028 南宁, 广西壮族自治区疾病预防控制中心 ywm5839@163.com 
阮玉华 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
邵一鸣 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
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中文摘要:
      目的 探讨HIV感染者开始抗病毒治疗(ART)时基线CD4+T淋巴细胞计数(CD4)不同水平对治疗脱失的影响。方法 采用回顾性队列研究方法,从艾滋病防治基本信息系统ART库选取2008-2015年广西壮族自治区(广西)首次开始ART、年龄≥18岁的HIV感染者,分析其ART脱失情况,随访时间截至2016年5月30日。采用Cox比例风险模型分析ART时基线CD4不同水平对ART脱失的影响。结果 共计58 502例HIV感染者进入队列,平均脱失比例为4.8/100人年。在控制了年龄、性别、婚姻状况、感染途径、ART前WHO临床分期、初始治疗方案、目前治疗方案、治疗方案改变、ART开始年份等因素后,基线CD4为200~、351~、≥500个/μl组HIV感染者的脱失风险分别是<200个/μl组的1.110(95% CI:1.053~1.171,P<0.001)、1.391(95% CI:1.278~1.514,P<0.001)、1.695(95% CI:1.497~1.918,P<0.001)倍。HIV感染者因为依从性差而停药的比例为56.0%(1 601/2 861)。结论 随着HIV感染者接受ART时CD4水平提高,ART脱失风险明显增加。为减少ART脱失,应充分考虑开始ART时CD4水平,加强依从性宣传教育和治疗机构人员培训。
英文摘要:
      Objective To investigate the effect of baseline CD4+T cell count (CD4) on drop-out of antiretroviral therapy (ART) in HIV infected persons. Methods Retrospective cohort was conducted in this study. HIV infected persons aged ≥ 18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System, with follow-up conducted till May 30, 2016. Cause-specific Cox proportional hazard models were used to evaluate effect of different CD4 on the drop-out of ART in the HIV infected persons. Results A total of 58 502 eligible study participants were included in this retrospective cohort study. The average drop-out ratio was 4.8/100 person-years. After controlling the following baseline covariates:age, sex, marital status, route of HIV infection, WHO clinical stage before ART, initial/current ART regiment, ART regiment adjustment, and year of initiating ART for potential confounding, the adjusted HR of drop-out for HIV infected persons with 200-cells/μl, 351-cells/μl and ≥ 500 cells/μl were 1.110 (95% CI:1.053-1.171, P<0.001), 1.391 (95% CI:1.278-1.514, P<0.001) and 1.695 (95% CI:1.497-1.918, P<0.001), respectively, in risk for drop-out compared with those with baseline CD4 <200 cells/μl. Among the HIV infected persons, 56.0% (1 601/2 861) of drug withdrawal was due to poor compliance with medication. Conclusions With the increase of baseline CD4 when initiating ART, the risk for the drop-out in HIV infected persons increased significantly. To further reduce the drop-out of ART, it is important to take CD4 into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.
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