河南省HIV/AIDS患者低病毒血症发生情况及影响因素分析

姬晓宇; 李宁; 樊盼英; 马彦民; 张国龙; 聂玉刚; 刘露

doi:10.3784/jbjc.202303010079

河南省HIV/AIDS患者低病毒血症发生情况及影响因素分析

Incidence of low-level viraemia and influencing factors in people living with HIV/AIDS in Henan

摘要

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。

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.

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