Incidence of low-level viraemia and influencing factors in people living with HIV/AIDS in Henan
-
摘要:
目的 通过分析河南省人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者低病毒血症(LLV)发生情况及影响因素,为LLV的预防提供科学支持。 方法 采用回顾性队列研究方法,从中国疾病预防控制信息系统下载河南省抗病毒治疗(ART)数据库,选取现住址为河南省、2003—2022年接受ART、年龄≥18岁、ART时长≥6个月、有至少1次病毒载量(VL)结果的HIV/AIDS作为研究对象,对患者的人口学特征和ART情况进行描述性分析。 运用logistic回归模型分析LLV发生的影响因素,采用χ2检验分析不同水平、不同频次LLV的发生情况及病毒抑制失败(VF)发生的风险。 结果 共纳入44 528例研究对象,病毒持续抑制(VL<50 拷贝/mL)组患者31 143例,LLV组患者13 385例,LLV的发生率为30.06%(13 385/44 528)。 按VL值划分,低(50~199 拷贝/mL)、中(200~399 拷贝/mL)、高(400~999 拷贝/mL)3个水平LLV的发生率分别为15.05%、6.35%和8.66%;按LLV发生频次,只发生1次或间隔发生多次LLV(iLLV)、连续发生2次及以上LLV(pLLV)的发生率分别为23.48%和6.58%。 低、中、高3个水平LLV病毒抑制失败的发生率分别为13.70%(918/6 702)、22.14%(626/2 828)和30.48%(1 175/3 855),iLLV和pLLV病毒学抑制失败的发生率分别为18.01%(1 883/10 453)和28.51%(836/2 932),且不同水平、不同频次VF的发生率差异有统计学意义(均P<0.001)。 多因素非条件logistic回归分析显示,ART治疗年限、基线CD4+T淋巴细胞计数水平、基线时出现疾病症状、基线时患者出现的并发症种类、确诊HIV到开始治疗时间、初始治疗方案以及治疗方案是否发生变化是发生LLV的影响因素。 结论 河南省HIV/AIDS患者LLV发生的风险较高,且会增加VF发生的风险,应尽早开展ART,提高患者依从性。 -
关键词:
- 人类免疫缺陷病毒/获得性免疫缺陷综合征患者 /
- 抗病毒治疗 /
- 低病毒血症 /
- 影响因素
Abstract:Objective To analyze the incidence of low-level viraemia (LLV) and influencing factors in people living with HIV/AIDS (PLWHA) in Henan province and provide evidence for the prevention of LLV. Methods In this retrospective cohort study, the incidence data of LLV in PLWHA with access to ART in Henan were downloaded from China disease prevention and control information system for the descriptive analysis on the demographic characteristics and treatment status of PLWHA. The PLWHA with access to ART from 2003 to 2022, age ≥18 years, ART duration ≥6 months, and at least one VL result were included in the analysis. Logistic regression model was used to analyze the influencing factors, and χ2 test was used to analyze the incidence of LLV at different levels and frequencies and the risk for virus inhibition failure. Results A total of 44 528 PLWHA cases were included in the analysis, in which 31143 were in persistent viral inhibition group (VL<50 copies/mL) and 13385 were in LLV group. The overall incidence of LLV was 30.06% (13385/44528), the incidences of LLV at 50–199 copies/mL, 200–399 copies/mL, 400–999 copies/mL were 15.05%, 6.35% and 8.66%, respectively, based on virus load, and the incidences of iLLV and pLLV were 23.48% and 6.58%, respectively, based on LLV frequency. The incidences of virus inhibition failure for LLV at low, medium and high levels were 13.70% (918/6702), 22.14% (626/2828) and 30.48% (1175/3855), respectively. The incidences of virus inhibition failure for iLLV and pLLV were 18.01% (1883/10453) and 28.51% (836/2932), respectively, and the differences in incidences of virus inhibition failure at different levels and frequencies were significant (P<0.001). Logistics regression analysis showed that the influencing factors for LLV in PLWHA included duration of ART, baseline CD4+T lymphocyte count, baseline disease symptoms, baseline type of complications, onterval from HIV diagnosis to treatment initiation, initial treatment regimen, and possible change of treatment regimen. Conclusion There is a high risk for LLV in PLWHA in Henan, which would increase the risk of virus inhibition failure. It is necessary to start antiviral treatment as earlier as possible and improve patients’ compliance. -
表 1 2003—2022年河南省艾滋病患者不同组别低病毒血症病毒抑制失败发生率比较
Table 1. Comparison of incidence of virus inhibition failure in people living with acquired immune deficiency syndrome with low-level viraemia at different levels in Henan, from 2003 to 2022
组别 总例数
(例)发生VF
(例)VF发生率
(%)χ2值 P值 按LLV水平 433.174 <0.001a LLLV 6 702 918 13.70 MLLV 2 828 626 22.14 104.308 <0.001b HLLV 3 855 1 175 30.48 433.648 <0.001c 按LLV频次 155.922 <0.001d iLLV 10 453 1 883 18.01 pLLV 2 932 836 28.51 注:a. 按照LLV 水平3个分组的比较;b. MLLV与LLLV两组之间的比较;c. HLLV与LLLV两组之间的比较;d. 按照LLV频次2个分组的比较;VF. 病毒抑制失败;LLV. 低病毒血症;MLLV. 中等水平LLV;HLLV. 高水平LLV;LLLV. 低水平LLV;iLLV. 间歇性LLV;pLLV. 持续性LLV 表 2 2002—2022年河南省艾滋病患者发生低病毒血症的单因素分析
Table 2. Univariate analysis on incidence of low-level viraemia in people living with acquired immune deficiency syndrome in Henan, from 2003 to 2022
因 素 总例数(n=44 528) 病毒持续抑制组(n=31 143) LLV组(n=13 385) χ2值 P值 开始治疗时年龄(岁) 741.189 <0.001 青年(≤29) 8 180(18.37) 6 654(81.34) 1526(18.66) 中青年(30~) 11 033(24.78) 7 287(66.05) 3746(33.95) 中年(40~) 12 715(28.55) 8 261(64.97) 4454(35.03) 中老年(≥50) 12 600(28.30) 8 941(70.96) 3659(29.04) 性别 708.838 <0.001 女性 13 823(31.04) 8 476(61.32) 5 347(38.68) 男性 30 705(68.96) 22 667(73.82) 8 038(26.18) 婚姻状况 847.975 <0.001 未婚 8 262(18.55) 6862(83.05) 1 400(16.95) 已婚或有配偶 28 918(64.95) 19241(66.54) 9 677(33.46) 离异或丧偶 7 093(16.93) 4847(68.33) 2 246(31.67) 不详 255(0.57) 193(75.69) 62(24.31) ART治疗年限(年) 161.593 <0.001 ≤2 597(1.34) 559(93.63) 38(6.37) >2 43 931(98.66) 30 584(69.62) 13 347(30.38) 感染途径 4734.151 <0.001 异性传播 18 083(40.61) 14036(77.62) 4047(22.38) 同性传播 8 505(19.10) 7249(85.23) 1256(14.77) 血制品 13 438(30.18) 6401(47.63) 7037(52.37) 其他 4 502(10.11) 3457(76.79) 1045(23.21) 基线CD4+T淋巴细胞计数(个/µL) 532.383 <0.001 <200 15 413(34.61) 9895(64.20) 5518(35.80) 200~ 13 778(30.94) 9590(69.60) 4188(30.40) 351~ 8 343(18.74) 6212(74.46) 2131(25.54) >500 6 994(15.71) 5446(77.87) 1548(22.13) 确诊到治疗时间(年) 434.759 <0.001 <1 34 078(76.53) 24 688(72.45) 9 390(27.55) 1~ 4 784(10.74) 2 929(61.22) 1 855(38.78) >2 5 666(12.72) 3 526(62.23) 2 140(37.77) 基线时是否出现疾病症状 1444.536 <0.001 否 29 795(66.91) 22 569(75.75) 7 226(24.25) 是 14 733(33.09) 8 574(58.20) 6 159(41.80) 基线时患者出现的并发症种类(种) 2 844.929 <0.001 0 27 244(61.19) 21 412(78.59) 5 832(21.41) 1~ 8 462(19.00) 5 324(62.92) 3 138(37.08) ≥3 8 822(19.81) 4 407(49.95) 4 415(50.05) 初始治疗方案 2 050.749 <0.001 一线 37 062(83.23) 27 505(74.21) 9557(25.79) 二线 1 279(2.87) 794(62.08) 485(37.92) 其他 6 187(13.90) 2 844(45.97) 3343(54.03) 治疗方案是否发生变化 3 272.945 <0.001 否 31 392(70.50) 24 480(77.98) 6912(22.02) 是 13 136(29.50) 6 663(50.72) 6473(49.28) 注:括号内数据为构成比(%),括号外数据为病例数(例);ART. 抗病毒治疗;LLV. 低病毒血症 表 3 2003—2022年河南省艾滋病患者发生低病毒血症的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis on incidence of low-level viraemia in people living with acquired immune deficiency syndrome in Henan
因 素 β值 $ s_{\overline x} $ Wald χ2值 P值 OR值(95%CI) ART治疗年限(年) ≤2 1.000 >2 1.243 0.170 53.382 <0.001 3.465(2.483~4.836) 基线CD4+ T淋巴细胞计数(个/μL) <200 0.331 0.037 80.199 <0.001 1.392(1.295~1.497) 200~ 0.269 0.037 52.493 <0.001 1.309(1.217~1.408) 351~ 0.182 0.041 19.379 <0.001 1.199(1.106~1.300) >500 1.000 确诊到治疗时间(年) <1 1.000 1~ 0.267 0.035 56.671 <0.001 1.306(1.218~1.400) >2 0.114 0.034 11.501 <0.001 1.121(1.049~1.197) 基线时是否出现疾病症状 否 1.000 是 0.089 0.030 8.860 <0.001 1.093(1.031~1.158) 基线时患者出现的并发症种类(种) 0 1.000 1~ 0.272 0.033 66.202 <0.001 1.313(1.229~1.402) ≥3 0.384 0.036 111.823 <0.001 1.469(1.368~1.577) 初始治疗方案 一线 1.000 二线 0.317 0.062 26.459 <0.001 1.373(1.217~1.550) 其他 0.460 0.034 185.290 <0.001 1.585(1.483~1.693) 治疗方案是否发生变化 否 1.000 是 0.633 0.026 578.148 <0.001 1.884(1.789~1.984) 注:ART. 抗病毒治疗;OR. 比值比;CI. 置信区间 -
[1] Ryscavage P, Kelly S, Li JZ, et al. Significance and clinical management of persistent low-level viremia and very-low-level viremia in HIV-1-infected patients[J]. Antimicrob Agents Chemother, 2014, 58(7): 3585–3598. DOI: 10.1128/AAC.00076−14. [2] Kim JH, Sinn DH, Kang W, et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology, 2017, 66(2): 335–343. DOI: 10.1002/hep.28916. [3] Elvstam O, Medstrand P, Jansson M, et al. Is low level HIV-1 viraemia associated with elevated levels of markers of immune activation, coagulation and cardiovascular disease?[J]. HIV Med, 2019, 20(9): 571–580. DOI: 10.1111/hiv.12756. [4] 安靓, 劳云飞, 唐松源. 云南省艾滋病抗病毒治疗中HIV低病毒血症发生情况分析[J]. 中国公共卫生,2022,38(7):908–913. DOI: 10.11847/zgggws1132975.An J, Lao YF, Tang SY. Incidence of low-level viraemia among HIV/AIDS patients with antiviral therapy in Yunnan province, 2004-2018: a retrospective analysis[J]. Chin J Public Health, 2022, 38(7): 908–913. DOI: 10.11847/zgggws1132975. [5] 安靓, 劳云飞, 唐松源. HIV低病毒血症对艾滋病抗病毒治疗病毒学失败的影响[J]. 实用医学杂志,2021,37(16):2102–2108. DOI:10.3969/j.issn.1006−5725.2021.16.014.An J, Lao YF, Tang SY. Impact of HIV low-level viraemia on virological failure among HIV/AIDS people receiving antiretroviral therapy[J]. J Pract Med, 2021, 37(16): 2102–2108. DOI: 10.3969/j.issn.1006−5725.2021.16.014. [6] 中国疾病预防控制中心性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册[M]. 4版. 北京: 人民卫生出版社, 2016.National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention. National HIV/AIDS free antiretoviriual therapy manual[M]. 4th ed. Beijing: People's Medical Publishing House, 2016. [7] Gaifer Z, Boulassel MR. Low-level viremia predicts virological failure in HIV-infected omani patients receiving antiretroviral therapy[J]. J Int Assoc Provid AIDS Care, 2020(19). DOI: 10.1177/2325958220979817. [8] Zhang T, Ding HB, An MH, et al. Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort[J]. BMC Infect Dis, 2020, 20(1): 147. DOI: 10.1186/s12879−020−4837−y. [9] Elvstam O, Medstrand P, Yilmaz A, et al. Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment[J]. PLoS One, 2017, 12(7): e0180761. DOI: 10.1371/journal.pone.0180761. [10] Hermans LE, Moorhouse M, Carmona S, et al. Effect of HIV-1 low-level viraemia during antiretroviral therapy on treatment outcomes in WHO-guided South African treatment programmes: a multicentre cohort study[J]. Lancet Infect Dis, 2018, 18(2): 188–197. DOI: 10.1016/S1473−3099(17)30681−3. [11] 王心维, 徐月香, 梁贤君, 等. 广西贵港市HIV感染者低病毒血症发生率及影响因素分析[J]. 广西医科大学学报,2022,39(4):677–681. DOI:10.16190/j.cnki.45−1211/r.2022.04.028.Wang XW, Xu YX, Liang XJ, et al. Analysis on the incidence and influencing factors of low-level viraemia in HIV infected people in Guigang, Guangxi[J]. J Guangxi Med Univ, 2022, 39(4): 677–681. DOI: 10.16190/j.cnki.45−1211/r.2022.04.028. [12] 郭萌, 刘聪, 梅芳华, 等. 湖北省HIV感染者低病毒血症和病毒抑制失败的关联及影响因素[J]. 公共卫生与预防医学,2022,33(6):90–93. DOI:10.3969/j.issn.1006−2483.2022.06.021.Guo M, Liu C, Mei FH, et al. Relationship between low-level viraemia and virus inhibition failure and its influencing factors in HIV-infected patients in Hubei province[J]. J Pub Health Prev Med, 2022, 33(6): 90–93. DOI: 10.3969/j.issn.1006−2483.2022.06.021. [13] 吕海伟, 刘莉, 卢洪洲. 艾滋病低病毒血症的影响因素及临床意义研究进展[J]. 皮肤病与性病,2022,44(1):15–18. DOI:10.3969/j.issn.1002−1310.2022.01.005.Lü HW, Liu L, Lu HZ. Advanced review of influencing factors and clinical significance of Low-level HIV viremia[J]. Dermatol Venereol, 2022, 44(1): 15–18. DOI: 10.3969/j.issn.1002−1310.2022.01.005. [14] Li Q, Chen ML, Zhao HX, et al. Persistent Low-level viremia is an independent risk factor for virologic failure: A retrospective cohort study in China[J]. Infect Drug Resist, 2021, 14: 4529–4537. DOI: 10.2147/IDR.S332924. [15] 李湖. 艾滋病患者抗病毒治疗后低病毒血症临床意义研究[D]. 广州: 广州医科大学, 2019.Li H. Clinical significance of low level viremia in HIV-1 infected patients after highly active antiretroviral therapy[D]. Guangzhou: Guangzhou Medical University, 2019. [16] The Antiretroviral Therapy Cohort Collaboration (ART-CC). Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients[J]. AIDS, 2015, 29(3): 373–383. DOI: 10.1097/QAD.0000000000000544. [17] Sudjaritruk T, Teeraananchai S, Kariminia A, et al. Impact of low-level viraemia on virological failure among Asian children with perinatally acquired HIV on first-line combination antiretroviral treatment: a multicentre, retrospective cohort study[J]. J Int AIDS Soc, 2020, 23(7): e25550. DOI: 10.1002/jia2.25550. [18] Sovershaeva E, Shamu T, Wilsgaard T, et al. Patterns of detectable viraemia among children and adults with HIV infection taking antiretroviral therapy in Zimbabwe[J]. Int J Infect Dis, 2019, 78: 65–71. DOI: 10.1016/j.ijid.2018.10.019. [19] 吕诗韵, 白若靖, 代漫, 等. 抗病毒治疗后低病毒血症患者HIV-1基因型耐药特征分析[J]. 中国艾滋病性病,2022,28(10):1187–1190. DOI: 10.13419/j.cnki.aids.2022.10.16.Lü SY, Bai RJ, Dai M, et al. Features analysis of HIV-1 genotype resistance in patients with low-level viremia after antiretroviral therapy[J]. Chin J AIDS STD, 2022, 28(10): 1187–1190. DOI: 10.13419/j.cnki.aids.2022.10.16. [20] Bandera A, Colella E, Rizzardini G, et al. Strategies to limit immune-activation in HIV patients[J]. Expert Rev Anti Infect Ther, 2017, 15(1): 43–54. DOI: 10.1080/14787210.2017.1250624. [21] 吕海伟, 刘莉, 陈军, 等. HIV低病毒血症的影响因素及其临床意义研究[J]. 皮肤病与性病,2022,44(5):353–358. DOI:10.3969/j.issn.1002−1310.2022.05.001.Lü HW, Liu L, Chen J, et al. Influencing factors and clinical significance of hypoviremia in HIV[J]. Dermatol Venereol, 2022, 44(5): 353–358. DOI: 10.3969/j.issn.1002−1310.2022.05.001. -

计量
- 文章访问数: 170
- HTML全文浏览量: 63
- PDF下载量: 19
- 被引次数: 0