摘要
目的了解新疆某地异性性传播和注射吸毒人群中人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者和艾滋病(acquired immune deficiency syndrome,AIDS)患者治疗效果的差异,为制定有针对性的干预措施提供依据。方法应用前瞻性队列的研究方法,选择2017年1月—2019年10月在伊宁市第二人民医院接受国家免费抗病毒治疗且感染途径为异性性传播和注射吸毒的HIV感染者和AIDS患者为研究对象并进行随访,利用Kaplan-Meier中的Log-rank检验比较两组间抗病毒治疗失败发生率,应用Cox比例风险模型探讨两组HIV感染者和AIDS患者治疗失败的影响因素。结果本次队列研究中,分别随访异性性传播和注射吸毒者960例和527例,总随访2008.50人·年。异性性传播和注射吸毒HIV感染者和AIDS患者CD4^(+)T细胞计数中位数分别从322个/mm^(3)和309个/mm^(3)增长到616个/mm^(3)和501个/mm^(3)。注射吸毒的HIV感染者和AIDS患者免疫学失败率和病毒学失败率均高于异性性传播HIV感染者和AIDS患者(26.19%vs 10.42%,χ^(2)=64.59,P<0.01;12.52%vs 8.85%,χ^(2)=4.92,P=0.03);注射吸毒HIV感染者和AIDS患者免疫学失败和病毒学失败的风险比异性性传播HIV感染者和AIDS患者高(aHR=2.75,95%CI:2.12~3.56;aHR=1.40,95%CI:1.01~1.96)。基线CD4^(+)T细胞计数200~349个/mm^(3)(aHR=2.07,95%CI:1.17~3.66)、<200个/mm^(3)(aHR=2.51,95%CI:1.39~4.52)、目前使用二线治疗方案(aHR=1.56,95%CI:1.12~2.21)、临床分期为Ⅲ期(aHR=3.01,95%CI:1.72~5.26)、Ⅳ期(aHR=3.85,95%CI:1.38~10.71)为治疗失败的危险因素,年龄30~49岁(aHR=0.67,95%CI:0.46~0.97)、≥50岁(aHR=0.24,95%CI:0.07~0.77)是保护因素。结论经过抗病毒治疗,异性性传播和注射吸毒者中HIV感染者和AIDS患者的免疫学功能均有一定程度的恢复,但异性性传播HIV感染者和AIDS患者治疗效果比注射吸毒者好,且CD4^(+)T细胞计数增长速度较快,因此应加强针对注射吸毒者的监测及提高其治疗依从性,以此提高治疗效果。
Objective To compare the difference in therapeutic effect between heterosexual behavior related HIV/AIDS and injecting drug use related HIV/AIDS in Yining,Xinjiang,and to discuss the factors affecting the treatment outcome.Methods A prospective cohort study was conducted among cases with HIV/AIDS in⁃fected through heterosexual contact or injecting drug,and also received free antiretroviral therapy(ART)in the Second People's Hospital in Yining City from January 2017 to October 2019.The incidence of ART failure between the two groups was compared using the Log-rank test in Kaplan-Meier,and the Cox proportional risk model was applied to explore the factors that influenced ART failure in the two groups.Results In this cohort study,960 cases with heterosexually transmitted HIV/AIDS and 527 cases infected via injecting drugs were followed up,with a total of 2008.50 persons per year.The CD4^(+)T-cell counts increased from 322 cells/μl and 309 cells/μl to 616 cells/μl and 501 cells/μl in heterosexually infected cases and cases infected via injecting drug.Both immunological and viro⁃logic failure rate among injecting drug related HIV/AIDS were higher than those among heterosexually infected indi⁃viduals(26.19%vs 10.42%,χ^(2)=64.59,P<0.01;12.52%vs 8.85%,χ^(2)=4.92,P=0.03).Injecting drug related HIV/AIDS were at higher risk in immunological and virologic failure(aHR=2.75,95%CI:2.12-3.56,aHR=1.40,95%CI:1.01-1.96).Baseline CD4^(+)T-cell counts of 200-349 cells/μl(aHR=2.07,95%CI:1.17-3.66)and less than 200 cells/μl(aHR=2.51,95%CI:1.39-4.52),current use of second-line ART(aHR=1.56,95%CI:1.12-2.21),clinical stage ofⅢ(aHR=3.01,95%CI:1.72-5.26)and stageⅣ(aHR=3.85,95%CI:1.38-10.71)were risk factors for treatment failure,while age of 30-49 years old(aHR=0.67,95%CI:0.46-0.97)and over 50 years(aHR=0.24,95%CI:0.07-0.77)were protective factors.Conclusion After ART,the immunological function of both heterosexually transmitted HIV/AIDS and injecting drug related HIV/AIDS rebuild to a certain extent,but the treatment effect of heterosexually trans⁃mitted HIV/AIDS is better than that of injecting drug related HIV/AIDS with higher elevated CD4^(+)T cell count.Therefore,the monitoring and treatment compliance should be strengthened among injecting drug related HIV/AIDS patients,so as to improve the treatment efficiency.
作者
阿热祖·肉孜呢亚孜
单濛
胡晓敏
倪明健
Arezu ROUZINIYAZI;SHAN Meng;HU Xiao-min;NI Ming-jian(School of Public Health,Xinjiang Medical University,Urumqi,Xinjiang 830054,China;不详)
出处
《中国病毒病杂志》
CAS
2023年第1期27-32,共6页
Chinese Journal of Viral Diseases
基金
国家科技重大专项(2018ZX10715-007)
新疆艾滋病防控研究重点实验室(XJYS1706)。
关键词
异性性传播
注射吸毒
HIV
AIDS
抗病毒治疗
Heterosexual individuals
Injecting drug users
HIV
AIDS
Antiretroviral therapy
作者简介
阿热祖·肉孜呢亚孜,在读硕士研究生,主要从事艾滋病预防控制工作;通信作者:倪明健,E-mail:xjnmj@126.com。
