| 何佳谕,林海江,汪剡灵,李桂霞,沈伟伟,陈潇潇,何纳.台州市2006-2019年艾滋病抗病毒治疗免疫学失败风险分析[J].中华流行病学杂志,2020,41(11):1888-1893 |
| 台州市2006-2019年艾滋病抗病毒治疗免疫学失败风险分析 |
| Risk analysis of immunological failure of antiretroviral therapy in HIV/AIDS patients in Taizhou prefecture，2006-2019 |
| 收稿日期:2020-03-30 出版日期:2020-11-25 |
| DOI：10.3760/cma.j.cn112338-20200330-00465 |
| 中文关键词: 艾滋病 抗病毒治疗 免疫学失败 贫血 |
| 英文关键词: HIV/AIDS Antiretroviral therapy Immunological failure Anemia |
| 基金项目:国家科技重大专项（2018ZX10721102-004） |
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| 中文摘要: |
| 目的 分析台州市2006-2019年HIV/AIDS抗病毒治疗免疫学失败情况、基线贫血与免疫学失败关联及其影响因素。方法 采用回顾性队列研究设计和Cox回归分析免疫学失败的影响因素，采用logistic回归分析HIV/AIDS基线贫血的影响因素。结果 共纳入2 904例HIV/AIDS，抗病毒治疗随访时间中位数为28（P25～P75：12～53）个月。抗病毒治疗免疫学失败177例（占6.1%），失败率为2.17人/100人年，第1、3、5和10年免疫学失败累积发生率分别为5.49%、6.94%、7.30%和8.82%。多因素logistic回归分析结果显示，HIV/AIDS基线贫血的影响因素中，≥66岁组是18～25岁组的4.17倍（95% CI：1.68～10.33）、男性是女性的0.67倍（95% CI：0.50～0.89）、CD4<200个/μl是CD4≥350个/μl的4.35倍（95% CI：2.81～6.72）、基线白细胞计数<4.0×109/L是4.0×109/L～9.9×109/L的1.73倍（95% CI：1.31～2.29）、基线血小板计数<100×109/L和>300×109/L分别是100×109/L～299×109/L的2.02倍（95% CI：1.36～3.01）和4.45倍（95% CI：3.05～6.50）、WHO临床Ⅲ/Ⅳ期是Ⅰ/Ⅱ期的2.15倍（95% CI：1.61～2.87）、异性性传播是同性性传播的2.03倍（95% CI：1.42～2.92）。多因素Cox比例风险回归分析结果显示，HIV/AIDS抗病毒治疗免疫学失败的影响因素中，基线贫血是无贫血的1.77倍（95% CI：1.20～2.60）、WHO临床Ⅲ/Ⅳ期是Ⅰ/Ⅱ期的1.66倍（95% CI：1.10～2.48）、随访状态为退出和死亡分别是在治的3.18倍（95% CI：1.96～5.19）和4.61倍（95% CI：2.98～7.13）。结论 台州市HIV/AIDS抗病毒治疗免疫学效果受贫血、临床分期、随访状态等因素影响。应加强HIV/AIDS基线贫血监测，及时纠正老年贫血等危险因素，以进一步提高抗病毒治疗效果。 |
| 英文摘要: |
| Objective To analyze the immunological failure of antiretroviral therapy (ART), its association with baseline anemia and related factors in HIV/AIDS patients in Taizhou prefecture, during 2006-2019. Methods A retrospective cohort study was conducted among HIV/AIDS patients under ART. Cox regression model was used to analyze predictors of immunological failure and logistic regression model was used to analyze factors of baseline anemia. Results A total of 2 904 HIV/AIDS patients were enrolled with a median time of 28 (P25-P75:12-53) months follow-up of ART, in which 177 cases (6.1%) were identified as immunological failure with a failure rate of 2.17 per 100 person-years. The cumulative incidence rates of immunological failure in the first, third, fifth, and tenth years were 5.49%, 6.94%, 7.30% and 8.82%, respectively. Results of multivariate logistic regression analysis showed that for the risk of baseline anemia, ≥66 years old group had 4.17 times higher risk than 18-25 years old group (95%CI: 1.68-10.33), males had 0.67 times higher risk than females (95%CI: 0.50-0.89), and CD4+T cell counts (CD4)<200 cells/μl group had 4.35 times higher risk than CD4≥350 cells/μl group (95%CI: 2.81-6.72), baseline white blood cells<4.0×109 cells/L group had 1.73 times higher risk than 4.0×109 cells/L-9.9×109 cells/L group (95%CI: 1.31-2.29), baseline platelet counts <100×109 cells /L and >300×109 cells/L groups had 2.02 times and 4.45 times higher risk than 100×109 cells/L-299×109 cells/L group (95%CI: 1.36-3.01, 95%CI: 3.05-6.50), respectively. WHO classified stage Ⅲ/Ⅳ group had 2.15 times higher risk than WHO classified stageⅠ/Ⅱ group (95%CI: 1.61-2.87), while heterosexual transmission group had 2.03 times higher risk than homosexual transmission group (95%CI: 1.42-2.92). Results of multivariate cox proportional risk regression showed that for the risk of immunological failure, baseline anemia group had 1.77 times higher risk than no anemia group (95%CI: 1.20-2.60), WHO classified stage Ⅲ/Ⅳ group had 1.66 times higher risk than WHO classified stageⅠ/Ⅱgroup (95%CI: 1.10-2.48), and withdrawal of follow up and death groups had 3.18 times and 4.61 times higher risks than treatment group (95%CI: 1.96-5.19, 95%CI: 2.98-7.13), respectively. Conclusions The immunological effect of ART among HIV/AIDS patients in Taizhou prefecture was affected by multiple factors, including anemia, clinical stage and follow-up status. Enhancing surveillance of baseline anemia and timely correction of anemia in elder group can help improve treatment outcome of HIV/AIDS patients. |
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