目的 了解HIV感染者早期及时治疗和初始用药方案对抗病毒治疗死亡及脱失的影响,为有效治疗提供依据.方法 采用回顾性队列研究方法,从艾滋病防治基本信息系统数据库下载2010-2020年广西柳州市HIV感染者抗病毒治疗数据.采用Cox比例风险回归模型分析死亡和脱失的影响因素.结果 共纳入HIV感染者15 713例,18～＜50岁占53.4％,男性占69.4％,农民占61.0％,治疗前CD4计数＜350个/µL占75.1％,总体死亡率4.30/100人年,总体脱失率2.42/100人年.Cox比例风险回归模型分析结果显示,治疗前CD4计数350～＜500个/μL(AHR=0.72,95％CI:0.63～0.81)和 ≥500 个/μL(AHR=0.64,95％CI:0.55～0.76),从 HIV 确证阳性至抗病毒治疗间隔 90～＜180 d(AHR=1.25,95％CI:1.08～1.45)、180～＜365 d(AHR=1.26,95％CI:1.08～1.47)和≥365 d(AHR=1.26,95％CI:1.11～1.44),初始用药方案为 D4T+3TC+EFV/NVP(AHR=1.47,95％CI:1.32～1.63)、AZT/D4T/TDF+3TC+LPV/r(AHR=1.73,95％CI:1.50～1.99)与 HIV 感染者抗病毒治疗死亡有统计学关联(P＜0.05);治疗前CD4计数350～＜500个/μL(AHR=1.32,95％CI:1.16～1.50)和≥500个/µL(AHR=1.28,95％CI:1.10～1.50),从HIV确证阳性至初始用药间隔≥365 d(AHR=1.21,95％CI:1.04～1.40),初始用药方案为 TDF+3TC+NVP(AHR=1.32,95％CI:1.13～1.55)、AZT+3TC+EFV/NVP(AHR=1.43,95％CI:1.26～1.62)、AZT/D4T/TDF+3TC+LPV/r(AHR=1.33,95CI％:1.06～1.67)与HIV感染者抗病毒治疗脱失有统计学关联(P＜0.05).结论 HIV感染者早期治疗和及时治疗以及初始用药方案为TDF+3TC+EFV的抗病毒治疗效果好,但需关注治疗前CD4计数高的HIV感染者在抗病毒治疗中面临较高的脱失风险问题.
Impact of early and timely treatment and initial antiviral treatment regimen on antiviral treatment mortality and attrition among HIV-infected patients in Liuzhou,Guangxi
Objective To understand the impact of early and timely treatment and initial antiviral treatment regimen on mortality and attrition of antiretroviral therapy.Methods A retrospective cohort study was conducted using download data on antiretroviral therapy for HIV-infected patients in Liuzhou City,Guangxi Province,from the database of the Basic Information System for AIDS Control and Prevention(BISAC)from 2010 to 2020.The Cox proportional risk regression model was used to analyze the influencing factors of mortality and attrition.Results A total of 15 713 infected patients were included,including 53.4％aged 18-＜50 years,69.4％male,61.0％farmer,75.1％CD4 count＜350 cells/µL before initial antiviral treatment,the overall mortality rate was 4.30/100 person-years,and the overall attrition was 2.42/100 person-years.The results of Cox regression analysis showed that the influencing factors of mortality were pretreatment CD4 counts of 350-＜500 cells/μL(AHR=0.72,95％CI:0.63-0.81)and ≥500 cells/µL(AHR=0.64,95％CI:0.55-0.76);duration from diagnosis to initial antiviral treatment 91-180 days(AHR=1.25,95％CI:1.08-1.45),181-365 days(AHR=1.26,95％CI:1.08-1.47),and ≥365 days(AHR=1.26,95％CI:1.11-1.44);initial antiviral treatment regimens of D4T+3TC+EFV/NVP(AHR=1.47,95％CI:1.32-1.63)and AZT/D4T/TDF+3TC+LPV/r(AHR=1.73,95％CI:1.50-1.99).Factors affecting attrition were pretreatment CD4 counts of 350-499 cells/µL(AHR=1.32,95％CI:1.16-1.50)and ≥500 cells/μL(AHR=1.28,95％CI:1.10-1.50);interval from HIV positivity confirmation to initial dosing ≥365 days(AHR=1.21,95％CI:1.04-1.40),initial antiviral treatment regimens of TDF+3TC+NVP(AHR=1.32,95％CI:1.13-1.55),AZT+3TC+EFV/NVP(AHR=1.43,95％CI:1.26-1.62)and AZT/D4T/TDF+3TC+LPV/r(AHR=1.33,95CI％:1.06-1.67).Conclusions Early and timely treatment and the initial antiviral treatment regimen of TDF+3TC+EFV have good efficacy,but attention should be paid to the high risk of attrition of HIV-infected people with high CD4 count before treatment.
HIV infectorantiviral therapyearly treatmenttimely treatmentinitial antiviral treatment regimenmortalityattrition
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万方数据
