浙江省台州市HIV感染者抗病毒治疗前后头痛症状发生及其影响因素研究
|
摘要
目的了解浙江省台州市HIV感染者在抗病毒治疗前后头痛症状出现及其变化的影响因素。方法将2009年1月—2016年6月在台州市接受抗逆转录病毒治疗(antiretroviral treatment,ART)的符合纳入标准的HIV感染者纳入本次队列研究。使用logistic模型探索各种头痛发生和转归的可能影响因素。结果本次一共纳入分析2 020人,其中有252人在接受ART前报告头痛,其报告头痛主要与CD4细胞计数、机会性感染和年龄有关。接受抗病毒治疗后,有165人头痛缓解。对于基线未报告头痛的1 768例HIV感染者,有89人在6个月内报告头痛,其主要与年龄较大、基线机会性感染以及依非韦伦(EFV)的使用相关。结论 HIV感染者ART前头痛主要与HIV病情进展相关,多数可在ART后缓解;ART后新发生头痛与EFV的使用、免疫重建炎性综合征等相关,尽早启动ART治疗以及合理选择ART药物有助于减少头痛发生。
OBJECTIVE To understand occurrence and related factors of headaches in HIV infected patients before and after antiretroviral therapy(ART)in Taizhou prefecture, Zhejiang Province. METHODS HIV patients who started ART during January, 2009-July,2016 and met the inclusion criteria were included in the analysis. Logistic regression models were used to explore the potential risk factors. RESULTS A total of 2 020 HIV-infected patients were included. Among them, 252(12.5%)had headaches before ART which was significantly associated with older age, opportunistic infection and lower CD4 cell count. The majority(65.5%, or 165/252) of them had headaches relieved after ART. For those 1768 who did not have headaches before ART, 89(5.0%)had at least a headache within 6 months after ART. Multiple logistic regression analysis indicated that opportunistic infections at baseline, older age, and EFV use were significantly associated with the new occurrence of headache after ART. CONCLUSION A pre-ART headache was mainly related to HIV disease progression and is mostly alleviated by ART. Newly occurred headaches after ART was associated with EFV use and immune reconstitution, suggesting potential benefits of early initiation of ART and appropriate use of antiretroviral drugs to headache remission.
OBJECTIVE To understand occurrence and related factors of headaches in HIV infected patients before and after antiretroviral therapy(ART)in Taizhou prefecture, Zhejiang Province. METHODS HIV patients who started ART during January, 2009-July,2016 and met the inclusion criteria were included in the analysis. Logistic regression models were used to explore the potential risk factors. RESULTS A total of 2 020 HIV-infected patients were included. Among them, 252(12.5%)had headaches before ART which was significantly associated with older age, opportunistic infection and lower CD4 cell count. The majority(65.5%, or 165/252) of them had headaches relieved after ART. For those 1768 who did not have headaches before ART, 89(5.0%)had at least a headache within 6 months after ART. Multiple logistic regression analysis indicated that opportunistic infections at baseline, older age, and EFV use were significantly associated with the new occurrence of headache after ART. CONCLUSION A pre-ART headache was mainly related to HIV disease progression and is mostly alleviated by ART. Newly occurred headaches after ART was associated with EFV use and immune reconstitution, suggesting potential benefits of early initiation of ART and appropriate use of antiretroviral drugs to headache remission.
引文
[1]KIRKLANG K E,KIRKLAND K,MANY W J,et al.Headache among patients with HIV disease:prevalence,characteristics,and associations[J].Headache,2012,52(3):455-466.
[2]SHEIKH H U,CHO T A.Clinical aspects of headache in HIV[J].Headache,2014,54(5):939-945.
[3]EVERS S,WIBBEKE B,REICHELT D,et al.The impact of HIVinfection on primary headache.Unexpected findings from retrospective,cross-sectional,and prospective analyses[J].Pain,2000,85(1-2):191-200.
[4]JOSHI S G,CHO T A.Pathophysiological mechanisms of headache in patients with HIV[J].Headache,2014,54(5):946-950.
[5]DODICK D W.Clinical clues and clnical rules:primary vs secondary headache[J].Adv stud med,2003(3):S550-S555.
[6]RICHMAN D D,FISCHL M A,GRIECO M H,et al.The toxicity of azidothymidine(AZT)in the treatment of patients with AIDS and AIDS-related complex.A double-blind,placebo-controlled trial[J].N Engl j med,1987,4(317):192-197.
[7]APOSTOLOVA N,FUNES H A,BLAS-GARCIA A,et al.Efavirenz and the CNS:what we already know and questions that need to be answered[J].j Antimicrob chemother,2015,70(10):2693-2708.
[8]DAMTIE D,YISMAW G,WOLDEYOHANNES D,et al.Common opportunistic infections and their CD4 cell correlates among HIV-infected patients attending at antiretroviral therapy clinic of Gondar UniversityHospital,NorthwestEthiopia[J].BMCresnotes,2013,6:534.
[9]MARRA C M.Headache in HIV-infected patients:much to consider[J].Headache,2014,54(5):951.
[10]张雪,陈莉华,郭会军,等.152例人类免疫缺陷病毒相关脑病的中医证型初探[J].辽宁中医杂志,2016(08):1589-1591.
[2]SHEIKH H U,CHO T A.Clinical aspects of headache in HIV[J].Headache,2014,54(5):939-945.
[3]EVERS S,WIBBEKE B,REICHELT D,et al.The impact of HIVinfection on primary headache.Unexpected findings from retrospective,cross-sectional,and prospective analyses[J].Pain,2000,85(1-2):191-200.
[4]JOSHI S G,CHO T A.Pathophysiological mechanisms of headache in patients with HIV[J].Headache,2014,54(5):946-950.
[5]DODICK D W.Clinical clues and clnical rules:primary vs secondary headache[J].Adv stud med,2003(3):S550-S555.
[6]RICHMAN D D,FISCHL M A,GRIECO M H,et al.The toxicity of azidothymidine(AZT)in the treatment of patients with AIDS and AIDS-related complex.A double-blind,placebo-controlled trial[J].N Engl j med,1987,4(317):192-197.
[7]APOSTOLOVA N,FUNES H A,BLAS-GARCIA A,et al.Efavirenz and the CNS:what we already know and questions that need to be answered[J].j Antimicrob chemother,2015,70(10):2693-2708.
[8]DAMTIE D,YISMAW G,WOLDEYOHANNES D,et al.Common opportunistic infections and their CD4 cell correlates among HIV-infected patients attending at antiretroviral therapy clinic of Gondar UniversityHospital,NorthwestEthiopia[J].BMCresnotes,2013,6:534.
[9]MARRA C M.Headache in HIV-infected patients:much to consider[J].Headache,2014,54(5):951.
[10]张雪,陈莉华,郭会军,等.152例人类免疫缺陷病毒相关脑病的中医证型初探[J].辽宁中医杂志,2016(08):1589-1591.