海南省艾滋病抗病毒治疗脱失情况及影响因素分析
Antiretroviral therapy attrition and its influencing factors among HIV-infected patients in Hainan
冯玉婷 1许玉军 1朱考考 1张雯婷1
作者信息
- 1. 海南省第五人民医院(海南医学院附属皮肤病医院)防治科,海南 海口 570100
- 折叠
摘要
目的 了解海南省艾滋病病毒感染者/患者(human immunodeficiency virus/acquired immunodeficiency syn-drome,HIV/AIDS)参加抗病毒治疗(antiretroviral therapy,ART)在治与脱失的现状,分析治疗脱失的影响因素.方法 本研究选取中国疾病预防控制信息系统抗病毒治疗子模块中海南省2005-2022年启动ART治疗的HIV感染者,根据纳入和排除标准共纳入4 286例研究对象,采用Cox比例风险回归模型分析其脱失情况及影响因素.结果 4 286例研究对象中,男性3718例(86.7％),性别比为6.55:1;未婚者占58.4％;年龄为(39.68±13.17)岁;同性性传播占49.8％;WHO临床分期Ⅰ期占84.3％;治疗方案含依非韦伦(efavirenz,EFV)方案占71.7％.共随访19 677.44人年,总体脱失率为0.80/100人年,开始抗病毒治疗第1年内脱失率为21.10/100人年.Cox回归分析显示,开始治疗时间为 2016-2022年(AHR=2.40,95％CI:1.40～4.10),最近一次HIV病毒载量(virus load,VL)检测值20～＜1 000 copies/mL(AHR=3.69,95％CI:2.08～6.54),最近一次VL检测值≥1 000 copies/mL(AHR=15.98,95％CI:9.46～27.01),最近一次VL未检测(AHR=92.90,95％CI:57.68～149.62),确诊到治疗的时间间隔 1～12月(AHR=1.62,95％CI:1.12～2.36),间隔大于 12月(AHR=1.68,95％CI:1.07～2.62)是使HIV感染者接受抗病毒治疗后脱失风险增加的因素.治疗方案含洛匹那韦/利托那韦(lopinavir/ritonavir,Lpv/r)(AHR=0.34,95％CI:0.18～0.66)、含整合酶抑制剂(integrase strand transfer inhibitors,INSTIs)方案(AHR=0.24,95％CI:0.09～0.58)是使HIV感染者接受抗病毒治疗后脱失的风险降低的因素.结论 海南省艾滋病患者抗病毒治疗出现脱失与确诊到治疗的时间间隔长、治疗方案、HIV病毒载量检测结果异常有关.应针对影响抗病毒治疗脱失的因素采取个案化的措施,同时提升抗病毒治疗及时性及治疗管理服务质量,进一步提高抗病毒治疗效果.
Abstract
Objective To investigate the current status and attrition among HIV-infected persons receiving antiretroviral therapy(ART),and to analyze factors affecting attrition in Hainan.Methods In this study,HIV-infected patients who started ART treatment in Hainan Province from 2005 to 2022 were selected from the antiviral treatment submodule of China Disease Prevention and Control Information System.According to the inclusion and exclusion criteria,a total of 4 286 HIV-infected persons were receiving.A Cox proportional hazards regression model was used to analyze factors affecting attrition.Results Among the 4 286 study subjects,3 718 were males(86.7％),with a sex ratio of 6.55:1.Unmarried individuals accounted for 58.4％,and the average age was(39.68±13.17)years.Transmission through homosexual contact accounted for 49.8％,and 84.3％were in WHO clinical stage Ⅰ.Treatment regimens containing Efavirenz(EFV)accounted for 71.7％.During a follow-up of 19 677.44 person-years,the overall attrition rate was 0.80 per 100 person-years,with the first-year post-ART initiation attrition rate being 21.10 per 100 person-years.The results of Cox regression analysis showed that the time of treatment initiation in 2016-2022(AHR=2.40,95％CI:1.40-4.10),and the last HIV viral load(VL)20-＜1 000 copies/mL(AHR=3.69,95％CI:2.08-6.54),the last HIV-1 VL≥1 000 copies/mL(AHR=15.98,95％CI:9.46-27.01),and no last HIV-1 VL test(AHR=92.90,95％CI:57.68-149.62),the time interval from diagnosis to treatment for 1-12 months(AHR=1.62,95％CI:1.12-2.36),and an interval longer than 12 months(AHR=1.68,95％CI:1.07-2.62)were the main factors that increased the risk of attrition.Treatment regimens containing Lopinavir/ritonavir(Lpv/r)(AHR-0.34,95％CI:0.18-0.66)and treatment regimens containing integrase strand transfer inhibitors(INSTIs)(AHR=0.24,95％CI:0.09-0.58)were the factors that reduced the risk of attrition after antiretroviral therapy.Conclusions The attrition of ART in HIV/AIDS patients in Hainan Province is related to a longer interval from diagnosis to treatment,treatment plan,and abnormal HIV viral load test results.Case-based measures should be taken to address factors influencing antiretroviral treatment attrition,while improving the timeliness of antiviral treatment and treatment management service quality to further improve the efficacy of antiviral treatment.
关键词
艾滋病/抗病毒治疗/脱失/影响因素Key words
Acquired immunodeficiency syndrome(AIDS)/antiretroviral treatment/attrition/influencing factors引用本文复制引用
基金项目
海南省卫生健康行业科研项目(21A200271)
出版年
2024
NETL
NSTL
万方数据