文章摘要
何佳谕,汪剡灵,许圆圆,沈伟伟,丁盈盈,林海江,何纳,陈潇潇.台州市2006-2019年HIV/AIDS抗病毒治疗策略与免疫学效果的关联及影响因素分析[J].中华流行病学杂志,2020,41(12):2093-2097
台州市2006-2019年HIV/AIDS抗病毒治疗策略与免疫学效果的关联及影响因素分析
Influencing factors of antiretroviral therapy and its association with immunological effect among HIV/AIDS patients in Taizhou city, 2006-2019
收稿日期:2020-06-11  出版日期:2020-12-25
DOI:10.3760/cma.j.cn112338-20200611-00833
中文关键词: 艾滋病病毒/艾滋病;抗病毒治疗;策略;免疫学效果;影响因素
英文关键词: HIV/AIDS;Antiretroviral therapy;Strategy;Immunological effect;Influencing factors
基金项目:国家科技重大专项(2018ZX10721102-004)
作者单位E-mail
何佳谕 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室, 上海 200032  
汪剡灵 台州市疾病预防控制中心 318000  
许圆圆 台州市疾病预防控制中心 318000  
沈伟伟 台州市疾病预防控制中心 318000  
丁盈盈 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室, 上海 200032  
林海江 台州市疾病预防控制中心 318000  
何纳 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室, 上海 200032 nhe@fudan.edu.cn 
陈潇潇 台州市疾病预防控制中心 318000 tzcdccxx@126.com 
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中文摘要:
      目的 分析2006-2019年台州市HIV/AIDS立即抗病毒治疗(ART)的影响因素,探讨不同ART策略与免疫学效果随时间变化的关联。方法 采用回顾性队列研究和logistic回归模型分析立即ART影响因素,采用t检验和χ2检验比较不同ART策略的免疫学效果差异,采用Kaplan-Meier(K-M)法绘制生存曲线。结果 2006-2019年台州市2 971例HIV/AIDS中,立即ART组1 786例(占60.1%),其中2016-2019年立即ART的比例为77.8%(1 170/1 504)。2006-2019年立即ART组的成功率(87.4%,1 561/1 786)高于延迟ART组(84.4%,1 000/1 185)。多因素logistic回归分析结果显示,HIV/AIDS立即ART的影响因素中,男性(aOR=1.28,95% CI:1.03~1.59)、已婚(aOR=1.71,95% CI:1.33~2.19)、基线CD4+T淋巴细胞(CD4)计数≤200个/μl(aOR=1.60,95% CI:1.27~2.02)与立即ART呈正相关;31~40岁(aOR=0.63,95% CI:0.48~0.84)、感染途径为异性性传播(aOR=0.60,95% CI:0.49~0.74)、确证时间为2015年及以前(aOR=0.20,95% CI:0.17~0.23)与立即ART呈负相关。立即ART组各年份CD4/CD8比值的增幅和ART累积成功率均大于延迟ART组(P<0.05)。结论 2006-2019年台州市HIV/AIDS立即ART策略落实较好,立即ART比例超过60.0%,立即ART组的ART免疫学效果较好。针对HIV/AIDS中31~40岁、女性、未婚和异性性传播者,需加强立即ART的健康教育工作,进一步提高ART效果。
英文摘要:
      Objective To analyze influencing factors of instant antiretroviral therapy (ART) and explore associution between strategies of ART and immunological effects among HIV/AIDS patients in Taizhou city during 2006-2019. Methods A retrospective cohort study was conducted on HIV/AIDS patients under ART, and a logistic regression model was used to analyze factors of instant ART. The student t-test and chi-square test were used to compare immunological effect of different ART strategies while the Kaplan-Meier method was used to generate a survival curve. Results A total of 2 971 HIV/AIDS patients were enrolled with 1 786 cases (60.1%) having instant ART strategy. The proportion of instant ART were 77.8% (1 170/1 504) during 2016 to 2019. The treatment success rate of the instant ART group (87.4%, 1 561/1 786) were higher than the delayed ART group (84.4%, 1 000/1 185). The results of multivariate logistic regression model indicated that male (aOR=1.28, 95% CI:1.03-1.59), married (aOR=1.71, 95% CI:1.33-2.19) and baseline CD4+T lymphocyte cells (CD4) counts ≤ 200 cells/μl (aOR=1.60, 95% CI:1.27-2.02) were factors positively related to instant ART while 31-40 years old (aOR=0.63, 95% CI:0.48-0.84), infected through heterosexual transmission (aOR=0.60, 95% CI:0.49-0.74) and diagnosed before 2015 (aOR=0.20, 95% CI:0.17-0.23) were inversely related to instant ART. The increase of the CD4/CD8 ratio was greater, and the cumulative ART success rate was higher each year in the instant ART group than in the delayed ART group (P<0.05). Conclusions The instant ART strategy has been well implemented in Taizhou city during 2006-2019, and the immunological effect was better in instant ART group. The proportion of instant ART were more than 60.0% among HIV/AIDS patients. Instant ART strategy needs to be strengthened for those who are 31-40 years old, women, unmarried, and infected through heterosexual transmission in an attempt to further increase treatment level and improve treatment effect.
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