玉溪市不同年龄HIV/AIDS病人抗病毒治疗效果对比分析
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摘要
目的了解不同年龄艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗(ART)效果。方法收集玉溪市2005—2016年的ART信息库中随访记录,历史卡片和治疗数据库的相关信息进行回顾性分析,了解不同年龄病人病毒学治疗效果、CD4~+T淋巴细胞(简称CD4细胞)变化及一年内死亡情况。结果 1 930例接受了ART的病人中,218例(11.3%)病毒学治疗失败,不同年龄段在不同治疗基线CD4细胞层次失败率差异无统计学意义;随着年龄增长,CD4细胞上升速率中位数由13.9个/μL/月下降至6.2个/μL/月,差异有统计学意义(H=46.080,P<0.001);不同治疗时基线CD4细胞分层分析发现,治疗时基线<200个/μL组和200～350个/μL组不同年龄段CD4细胞上升速率中位数为12.7～18.8个/μL/月之间和1.5～16.8个/μL/月之间,组间差异分别有统计学意义(H=13.575和9.133,P均<0.05),治疗时基线CD4细胞351～500个/μL和>500个/μL组不同年龄段CD4细胞变化速率差异无统计学意义(H=7.171和3.110,P=0.067和0.157); ART后一年内死于艾滋病相关疾病者占2.8%(54/1 930),其治疗时基线CD4细胞均<200个/μL,其中18～29岁者治疗后一年内死亡率1.7%(7/412),30～39岁者死亡率1.5%(10/650),40～49岁者死亡率3.4%(16/476),≥50岁者死亡率5.4%(21/392),差异有统计学意义(χ~2=15.616,P<0.001)。结论年龄不影响ART后病毒学疗效,但是年龄越大CD4细胞恢复越差,一年内死亡率越高,针对≥50岁感染者应该早发现、早治疗。
Objective To analyze comparatively the effects of antiretroviral treatment(ART) among HIV/AIDS patients in Yuxi city of Yunnan province, and to explore the effect of ages on ART. Methods Data were collected including HIV/AIDS case reporting cards, follow-up cards and ART database between 2005 and 2016, and analysis was made on the difference of virologic efficacy, CD4 dynamic variation and cases who died within one year after ART initiation. Results Among 1 930 HIV/AIDS patients, 218 cases(11.3%) failed in virologic treatment after ART initiation and age was not an influencing factor. CD4 counts seemed less increased in the group aged 50 years and above(6.24 cells/μL/month) than in the group aged between 18-29 years(13.9 cells/μL/month) with the difference significant(H=46.080, P<0.001). Among the groups with the baseline CD4 counts less than 200 and 200-350 cells/μL, CD4 counts seemed less increased with age(12.7-18.8 and 1.5-16.8 cells/μL/month), with significant differences on CD4 counts in different ages(H=13.575 and 9.133, P<0.05). However, in the groups with the baseline CD4 counts of 351-500 and more than 500 cells/μL, there were no differences on CD4 counts increase in different age groups(H=7.171 and 3.110, P=0.067 and 0.157). Among 1 930 HIV/AIDS patients, 54(2.8%) cases died in one year after ART initiation and all of their baseline CD4 counts less than 200, among whom 7 cases(7/412, 1.7%) aged between 18-29 years, 10 cases(10/650, 1.5%) aged between 30-39 years, 16 cases(16/476, 3.4%) aged between 40-49 years, and 21 cases(21/4392, 5.4%) aged 50 years and above, with the difference statistically significant(χ~2=15.616, P<0.001). Conclusion Age might be an influencing factor on CD4 counts increase and death in one year after ART initiation. However, age does not affect virologic efficacy, suggesting that earlier diagnosis and ART initiation can help recover immune function and avoid death rapidly in the elderly group.
Objective To analyze comparatively the effects of antiretroviral treatment(ART) among HIV/AIDS patients in Yuxi city of Yunnan province, and to explore the effect of ages on ART. Methods Data were collected including HIV/AIDS case reporting cards, follow-up cards and ART database between 2005 and 2016, and analysis was made on the difference of virologic efficacy, CD4 dynamic variation and cases who died within one year after ART initiation. Results Among 1 930 HIV/AIDS patients, 218 cases(11.3%) failed in virologic treatment after ART initiation and age was not an influencing factor. CD4 counts seemed less increased in the group aged 50 years and above(6.24 cells/μL/month) than in the group aged between 18-29 years(13.9 cells/μL/month) with the difference significant(H=46.080, P<0.001). Among the groups with the baseline CD4 counts less than 200 and 200-350 cells/μL, CD4 counts seemed less increased with age(12.7-18.8 and 1.5-16.8 cells/μL/month), with significant differences on CD4 counts in different ages(H=13.575 and 9.133, P<0.05). However, in the groups with the baseline CD4 counts of 351-500 and more than 500 cells/μL, there were no differences on CD4 counts increase in different age groups(H=7.171 and 3.110, P=0.067 and 0.157). Among 1 930 HIV/AIDS patients, 54(2.8%) cases died in one year after ART initiation and all of their baseline CD4 counts less than 200, among whom 7 cases(7/412, 1.7%) aged between 18-29 years, 10 cases(10/650, 1.5%) aged between 30-39 years, 16 cases(16/476, 3.4%) aged between 40-49 years, and 21 cases(21/4392, 5.4%) aged 50 years and above, with the difference statistically significant(χ~2=15.616, P<0.001). Conclusion Age might be an influencing factor on CD4 counts increase and death in one year after ART initiation. However, age does not affect virologic efficacy, suggesting that earlier diagnosis and ART initiation can help recover immune function and avoid death rapidly in the elderly group.
引文
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[12] 李世福,付金翠,陈黎跃,等.玉溪市老年人与青年人HIV/AIDS免疫状况及死亡情况对比分析[J].中国皮肤性病学杂志,2014,28(4):382-383.
[13] Hentzien M,Dramé M,Allavena C,et al.Impact of Age-related Comorbidities on Five-year Overall Mortality among Elderly HIV-Infected Patients in the Late HAART Era--Role of Chronic Renal Disease[J].Journal of Nutrition Health & Aging,2016,20(4):408-414.
[14] 董文斌,李世福,赵金仙,等.云南省玉溪市HIV/AIDS死亡者中确证后1年内死亡比例及相关因素分析[J].中国公共卫生,2018,34(12):1592-1598.
[15] Zhang F,Sun M,Sun J,et al.The risk factors for suboptimal CD4 recovery in HIV infected population:an observational and retrospective study in Shanghai,China[J].Bioscience Trends,2015,9(5):335-341.
[16] 江河,朱秋映,蓝光华,等.广西壮族自治区艾滋病抗病毒治疗病人CD4+T淋巴细胞动态趋势及影响因素分析[J].中华流行病学杂志,2015,36(10):1125-1128.
[2] Castelli K,Decks H,Levy JA,et al.Relationship of CD8T cell non-cytotoxic anti-HIV response to CD4 T cell number in untreated asymptomatic HIV-infected individuals[J].Blood,2002,99(11):4225- 4229.
[3] Thompson MA,Aberg JA,Cahn P,et al.Antiretroviral treatment of adult HIV infection:2010 Recommendations of the international AIDS society-USA panel[J].JAMA,2010,304(3):321-333.
[4] 黑发欣,王璐,秦倩倩,等.中国50岁以上人群艾滋病疫情特点及流行因素分析[J].中华流行病学杂志,2011,32(5):526- 527.
[5] 高良敏,陈黎跃,蔡英,等.云南省玉溪市1995—2011年老年HIV/AIDS流行特征[J].中国皮肤性病学杂志,2013,27(2):163-165.
[6] 国家免费艾滋病抗病毒药物治疗编写组.国家免费艾滋病抗病毒药物治疗手册[M].3版.北京:人民卫生出版社,2012.
[7] Politics Program LTU.Antiretroviral therapy for HIV infection in adults and adolescents:recommendations for a public health approach.2006 revision[R].Geneva Switzerland Who,2006:1-132.
[8] Zhang F,Dou Z,Ma Y,et al.Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China:a national observational cohort study[J].Lancet Infectious Diseases,2011,11(7):516-524.
[9] 豆智慧,张福杰,赵燕,等.2002—2014年中国免费艾滋病抗病毒治疗进展[J].中华流行病学杂志,2015,36(12):1345-1350.
[10] Shu S,Li S,Li S,et al.Gaps in the Continuum of HIV Care:Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes[J].Biomed Research International,2016,2016(4):2648923.
[11] Viard JP,Mocroft A,Chiesi A,et al.Influence of Age on CD4 Cell Recovery in Human Immunodeficiency Virus-Infected Patients Receiving Highly Active Antiretroviral Therapy:Evidence from the EuroSIDA Study[J].Journal of Infectious Diseases,2001,183(8):1290-1294.
[12] 李世福,付金翠,陈黎跃,等.玉溪市老年人与青年人HIV/AIDS免疫状况及死亡情况对比分析[J].中国皮肤性病学杂志,2014,28(4):382-383.
[13] Hentzien M,Dramé M,Allavena C,et al.Impact of Age-related Comorbidities on Five-year Overall Mortality among Elderly HIV-Infected Patients in the Late HAART Era--Role of Chronic Renal Disease[J].Journal of Nutrition Health & Aging,2016,20(4):408-414.
[14] 董文斌,李世福,赵金仙,等.云南省玉溪市HIV/AIDS死亡者中确证后1年内死亡比例及相关因素分析[J].中国公共卫生,2018,34(12):1592-1598.
[15] Zhang F,Sun M,Sun J,et al.The risk factors for suboptimal CD4 recovery in HIV infected population:an observational and retrospective study in Shanghai,China[J].Bioscience Trends,2015,9(5):335-341.
[16] 江河,朱秋映,蓝光华,等.广西壮族自治区艾滋病抗病毒治疗病人CD4+T淋巴细胞动态趋势及影响因素分析[J].中华流行病学杂志,2015,36(10):1125-1128.