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].Chinese journal of Epidemiology,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 |
Received:March 26, 2021 |
DOI:10.3760/cma.j.cn112338-20210326-00250 |
KeyWord: 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 |
English Key Word: HIV Antiretroviral therapy CD4+T-lymphocytes Immune recovery Group-based trajectory model |
FundProject:国家科技重大专项(2018ZX10721-102) |
Author Name | Affiliation | E-mail | Yu Hailiang | National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | Yang Yuecheng | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | Zhao Yan | National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | Cao Dongdong | Department of Public Health, Dehong Dai and Jingpo Autonomous Prefecture People's Hospital, Mangshi 678400, China | | Jin Cong | National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | Ye Runhua | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | Cao Yanfen | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | Liu Xuejiao | National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | | Yao Shitang | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | Chen Chen | Department of Environmental Epidemiology, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China | | Duan Song | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | dhduansong@sina.com.cn | Wu Zunyou | National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China | wuzy@263.net |
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Abstract: |
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。 |
English Abstract: |
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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