| 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 |
| 收稿日期:2018-01-22 出版日期:2018-09-20 |
| 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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