| 俞海亮,杨跃诚,赵燕,曹东冬,金聪,叶润华,曹艳芬,刘雪娇,姚仕堂,陈晨,段松,吴尊友.德宏傣族景颇族自治州成年人HIV/AIDS抗病毒治疗后CD4+T淋巴细胞免疫重建及影响因素分析[J].中华流行病学杂志,2021,42(6):1050-1055 |
| 德宏傣族景颇族自治州成年人HIV/AIDS抗病毒治疗后CD4+T淋巴细胞免疫重建及影响因素分析 |
| Prevalence and related factors of CD4+T lymphocytes immune recovery among adult HIV/AIDS on antiretroviral therapy in Dehong Dai and Jingpo Autonomous Prefecture |
| 收稿日期:2021-03-26 出版日期:2021-06-29 |
| DOI：10.3760/cma.j.cn112338-20210326-00250 |
| 中文关键词: 艾滋病病毒 抗病毒治疗 CD4+T淋巴细胞 免疫重建 轨迹分析模型 |
| 英文关键词: HIV Antiretroviral therapy CD4+T-lymphocytes Immune recovery Group-based trajectory model |
| 基金项目:国家科技重大专项（2018ZX10721-102） |
| 作者 | 单位 | E-mail | | 俞海亮 | 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 杨跃诚 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 赵燕 | 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 曹东冬 | 德宏傣族景颇族自治州人民医院公共卫生科, 芒市 678400 | | | 金聪 | 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 叶润华 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 曹艳芬 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 刘雪娇 | 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | | | 姚仕堂 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 陈晨 | 中国疾病预防控制中心环境与健康相关产品安全所环境流行病学室, 北京 100021 | | | 段松 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | dhduansong@sina.com.cn | | 吴尊友 | 中国疾病预防控制中心性病艾滋病预防控制中心, 北京 102206 | wuzy@263.net |
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| 中文摘要: |
| 目的 分析德宏傣族景颇族自治州（德宏州）成年人HIV/AIDS开始抗病毒治疗（ART）后CD4+T淋巴细胞（CD4）纵向变化特征及其影响因素。方法 对德宏州2007-2016年开始ART的成年人HIV/AIDS的回顾性队列随访至2018年12月31日。免疫重建良好的定义为HIV/AIDS经ART后CD4恢复至基本正常（>500个/μl），据此将HIV/AIDS分为4个组，采用轨迹分析模型描述和分析每组ART后CD4免疫重建情况，采用多因素logistic回归分析其影响因素。采用SAS 9.4软件进行统计学分析。结果 研究对象共7 605例HIV/AIDS，开始ART年龄M（P25，P75）为36（30，43）岁，男性4 641例（61.0%），汉族3 232例（42.5%），小学及以下文化程度4 624例（60.8%），随访时间M（P25，P75）为6.1（4.1，8.1）年。CD4未恢复正常组、CD4基本恢复正常组、CD4恢复正常组和CD4维持正常组的构成比分别为34.4%（2 617）、39.8%（3 030）、20.6%（1 562）和5.2%（396）。与CD4未恢复正常组作为对照组相比，开始ART年龄<35岁、女性、中学及以上文化程度、性传播感染途径、基线无机会性感染、开始ART时CD4≥200个/μl、含替诺福韦（TDF）标准的ART方案、确诊到开始ART时间<1年是促进HIV/AIDS的CD4免疫重建良好的影响因素。结论 德宏州ART后HIV/AIDS的CD4免疫重建情况呈多种状况，在基线CD4较高水平时开始ART有助于CD4恢复至正常水平。建议尽早开始ART，注意随访和关注CD4水平变化。 |
| 英文摘要: |
| Objective To analyze the longitudinal characteristics of CD4+T lymphocytes (CD4) among the adult HIV/AIDS on antiretroviral therapy (ART) and the related factors. Methods A retrospective cohort of adult HIV/AIDS starting ART in Dehong Dai and Jingpo Autonomous Prefecture (Dehong) in 2007-2016 was followed up to December 31, 2018. Group-based trajectory models were utilized to identify CD4 subgroups based on immune recovery (whether and when CD4 reached the average level of >500 cells/μl). The demographics and information at ART baseline were described, and the related factors were analyzed with polytomous logistic regression. The SAS 9.4 software was used for statistical analysis. Results A total of 7 605 adults with HIV/AIDS were included, of which the median (P25,P75) age at ART were 36 (30,43) years old, 61.0% were male, 42.5% were Han nationality, and 60.8% with the education of primary school or below. The follow-up duration M (P25,P75) was 6.1 (4.1,8.1) years. HIV/AIDS in Dehong showed four CD4 trajectory subgroups from low to high:below the average level, primary recovery to a normal level, full recovery to a moderate level, and normal steady level, accounting for 34.4%, 39.8%, 20.6%, and 5.2%, respectively. When compared with corresponding control groups, age <35 years at ART, female, education of middle school or above, sexual transmission, no opportunistic infection, CD4 ≥ 200 cells/μl, baseline regimen with tenofovir (TDF) and time from HIV diagnosis to ART <1 year were the related factors facilitating the higher CD4 subgroups. Conclusions The various CD4 immune recoveries of HIV/AIDS were changing patterns after ART. Starting ART with a high CD4 level was beneficial to CD4 recovery to normal level during the follow-up period. Early initiation of ART and exceptional attention to CD4 immune recovery should be encouraged after the ART. |
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