未抗病毒治疗的HIV/AIDS患者CD4~+T淋巴细胞快速下降和显著下降比例及相关因素
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摘要
目的探讨云南省玉溪市新报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS)在未抗病毒治疗的情况下其CD4~+T值快速下降及显著下降情况,分析其相关因素。方法收集未抗病毒治疗HIV/AIDS历次CD4~+T淋巴细胞计数值、人口学特征、样本来源和可能感染途径等,计算快速下降率和显著下降率并分析相关因素。结果 1 480例HIV/AIDS其CD4~+T值快速下降率和显著下降率分别为42.64%(631/1 480)、52.23%(773/1 480),单因素分析结果显示,CD4~+T值快速下降与性别、文化、年龄、职业、婚姻状况、传播途径、首次CD4~+T值以及首末次检测时间间隔有关,CD4~+T值显著下降与文化、民族、传播途径、首次CD4~+T值以及首末次检测时间间隔有关;经多因素Logistic回归分析表明,女性(OR=1.271,95%CI:1.044~1.674)、已婚(OR=1.460,95%CI:1.093~1.949)、传播途径注射吸毒(OR=1.365,95%CI:1.016~1.833)、首次CD4~+T值>500cell/μL,更容易出现CD4~+T值快速下降,首末次检测时间间隔>18个月更不容易出现CD4~+T值快速下降;传播途径注射吸毒(OR=1.286,95%CI:1.018~1.625)、首次CD4~+T值>500 cell/μL、首末次检测时间间隔≥6个月,更容易出现CD4~+T值显著下降,传播途径为男男性行为(OR=0.426,95%CI:0.199~0.914)更不容易出现CD4~+T值显著下降。结论 HIV/AIDS患者CD4~+T值快速下降和显著下降与性别、婚姻状况、传播途径等因素有关,需加强对女性、已婚、注射吸毒人群的定期随访,及时启动抗病毒治疗。
Objective To examine the proportion of rapid and significant decline of CD4~+T cell counts and related influencing factors among antiretroviral treatment( ART)-naive HIV/AIDS patients newly reported in Yuxi,Yunnan. Methods The information of ART-naive HIV/AIDS patients including all previous CD4~+T cell counts,demo-graphic characteristics,sample source and potential route of HIV transmission were collected,and the rates of rapid and significant CD4~+T decline were counted,and the related factors were statistically analyzed. Results The rates of rapid and significant CD4~+T decline were 42. 64%( 631/1 480) and 52. 23%( 773/1 480) respectively. Univariate logistic regression analyses indicated that rapid decline of CD4~+T cell counts were associated with gender,education,age,occupation,marital status,route of HIV infection,baseline CD4~+T cell counts,and interval between first and last CD4~+T testing,whereas the significant decline of CD4~+T cell counts were associated with education, ethnicity, route of HIV infection, baseline CD4~+T cell counts,and interval between first and last CD4~+T testing. Multivariate logistic regression analyses indicated that females( OR = 1. 271,95% CI: 1. 044 ~ 1. 674),being married( OR = 1. 460,95% CI: 1. 093 ~ 1. 949),HIV transmitted through injected drug use( OR = 1. 365,95% CI: 1. 016 ~ 1. 833),initial CD4~+T cell counts> 500 cell/μL were more likely to lead to a rapid CD4~+T decline,whereas interval between first and last CD4~+T testing > 18 months was less likely to result in a rapid CD4~+T decline; HIV transmitted through injected drug use( OR = 1. 286,95% CI:1. 018 ~ 1. 625),initial CD4~+T cell counts > 500 cell/μL,and interval between first and last CD4~+T testing > 6 months were more likely to contribute to a significant CD4~+T decline,whereas male-to-male contact( OR = 0. 426,95% CI: 0. 199 ~0. 914) were less likely to witness a significant CD4~+T decline. Conclusion Gender,marital status,route of HIV infection were associated with rapid decline and significant decline of CD4~+T cell counts. Therefore,it is important to strengthen the regular follow-up for those being female,married,transmitted through injected drug use and to initiate ART timely.
Objective To examine the proportion of rapid and significant decline of CD4~+T cell counts and related influencing factors among antiretroviral treatment( ART)-naive HIV/AIDS patients newly reported in Yuxi,Yunnan. Methods The information of ART-naive HIV/AIDS patients including all previous CD4~+T cell counts,demo-graphic characteristics,sample source and potential route of HIV transmission were collected,and the rates of rapid and significant CD4~+T decline were counted,and the related factors were statistically analyzed. Results The rates of rapid and significant CD4~+T decline were 42. 64%( 631/1 480) and 52. 23%( 773/1 480) respectively. Univariate logistic regression analyses indicated that rapid decline of CD4~+T cell counts were associated with gender,education,age,occupation,marital status,route of HIV infection,baseline CD4~+T cell counts,and interval between first and last CD4~+T testing,whereas the significant decline of CD4~+T cell counts were associated with education, ethnicity, route of HIV infection, baseline CD4~+T cell counts,and interval between first and last CD4~+T testing. Multivariate logistic regression analyses indicated that females( OR = 1. 271,95% CI: 1. 044 ~ 1. 674),being married( OR = 1. 460,95% CI: 1. 093 ~ 1. 949),HIV transmitted through injected drug use( OR = 1. 365,95% CI: 1. 016 ~ 1. 833),initial CD4~+T cell counts> 500 cell/μL were more likely to lead to a rapid CD4~+T decline,whereas interval between first and last CD4~+T testing > 18 months was less likely to result in a rapid CD4~+T decline; HIV transmitted through injected drug use( OR = 1. 286,95% CI:1. 018 ~ 1. 625),initial CD4~+T cell counts > 500 cell/μL,and interval between first and last CD4~+T testing > 6 months were more likely to contribute to a significant CD4~+T decline,whereas male-to-male contact( OR = 0. 426,95% CI: 0. 199 ~0. 914) were less likely to witness a significant CD4~+T decline. Conclusion Gender,marital status,route of HIV infection were associated with rapid decline and significant decline of CD4~+T cell counts. Therefore,it is important to strengthen the regular follow-up for those being female,married,transmitted through injected drug use and to initiate ART timely.
引文
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[13]琚腊红,吕繁,徐鹏,等.从性别视角分析HIV感染者和艾滋病患者自我歧视状况及其影响因素[J].中华预防医学杂志,2016,50(10):863-868.
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[15]刘小春,李再友,付金翠,等.2006~2013年玉溪市报告HIV感染者/AIDS病例双阳家庭及单阳家庭阳转状况分析[J].预防医学论坛,2015,21(5):354-356.
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[17]李世福,许杰,蔡英,等.两种检测方法评估玉溪市较早发现HIV感染者的效率[J].中国皮肤性病学杂志,2013,27(9):910-912.
[18]Meijerink H,Wisaksana R,Iskandar S,et al.Injecting drug use is associated with a more rapid CD4 cell decline among treatment na6ve HIV-positive patients in Indonesia[J].J Int AIDS Soc,2014,17(1):18844-18851.
[19]李世福,付金翠,李再友,等.静脉注射吸毒人群HIV/HCV混合感染者与HIV单独感染者艾滋病疾病进展比较分析[J].中华微生物学和免疫学杂志,2015,35(9):692-697.
[20]Zhang F,Zhu H,Wu Y,et al.HIV,hepatitis B virus,and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program,2010-12:a retrospective observational cohort study[J].Lancet Infect Dis,2014,14(11):1065-1072.
[2]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 Infect Dis,2011,11(7):516-524.
[3]胡芳琴,吴勇,张展,等.不同CD4+基线值艾滋病患者高效抗逆转录病毒治疗后免疫重建效果观察[J].中华医院感染学杂志,2015,25(24):5521-5523.
[4]AudigéA,Taff P,Rickenbach M,et al.210 Low Post-Seroconversion CD4 count and rapid decrease of CD4 density identify HIV+fast progressors[J].AIDS Res Hum Retroviruses,2010,26(9):997-1005.
[5]Musumeci G,Magnani G,Bon I,et al.HIV-1 early and late diagnosis in the Emilia Romagna Region(Italy):a three-year study[J].New Microbiol,2016,39(4):241-246.
[6]叶润华,段松,项丽芬,等.云南省德宏州无抗病毒治疗史的HIV感染者CD4+T淋巴细胞计数自然变化及其影响因素[J].中华流行病学杂志,2011,32(9):882-887.
[7]于茂河,郭燕,宁铁林,等.天津市未接受抗病毒治疗HIV/AIDS病例CD4+T淋巴细胞计数变化情况及影响因素[J].中国艾滋病性病,2015,21(9):753-756.
[8]李世福,高良敏,蔡英,等.未治疗HIV/AIDS中CD4+T淋巴细胞计数与机会性感染的相关性分析[J].中国皮肤性病学杂志,2017,31(3):28-33.
[9]Wang L,Ge L,Wang L,et al.Causes of death among AIDS patients after introduction of free combination antiretroviral therapy(c ART)in three Chinese provinces,2010-2011[J].Plos One,2015,10(10):e0139998.
[10]谢年华,江洪波,许骏,等.武汉市HIV/AIDS未治疗患者生存质量及影响因素研究[J].中华疾病控制杂志,2015,19(12):1204-1207.
[11]Manolescu L,Marinescu P.Sex differences in HIV-1 viral load and absolute CD4 cell count in long term survivors HIV-1 infected patients from Giurgiu,Romania[J].Romanian Review of Laboratory Medicine,2013,21(2-4):217-224.
[12]Maskew M,Brennan AT,Westreich D,et al.Gender differences in mortality and CD4 count response among virally suppressed HIV-positive patients[J].J Womens Health,2013,22(22):113-120.
[13]琚腊红,吕繁,徐鹏,等.从性别视角分析HIV感染者和艾滋病患者自我歧视状况及其影响因素[J].中华预防医学杂志,2016,50(10):863-868.
[14]杨世江,段松,项丽芬,等.云南省德宏州HIV感染者中病情长期不进展者所占比例及其影响因素[J].中华疾病控制杂志,2012,16(12):1049-1051.
[15]刘小春,李再友,付金翠,等.2006~2013年玉溪市报告HIV感染者/AIDS病例双阳家庭及单阳家庭阳转状况分析[J].预防医学论坛,2015,21(5):354-356.
[16]齐金蕾,罗红兵,马艳玲,等.云南省家庭内配偶经性传播HIV影响因素调查[J].中华流行病学杂志,2012,33(2):173-176.
[17]李世福,许杰,蔡英,等.两种检测方法评估玉溪市较早发现HIV感染者的效率[J].中国皮肤性病学杂志,2013,27(9):910-912.
[18]Meijerink H,Wisaksana R,Iskandar S,et al.Injecting drug use is associated with a more rapid CD4 cell decline among treatment na6ve HIV-positive patients in Indonesia[J].J Int AIDS Soc,2014,17(1):18844-18851.
[19]李世福,付金翠,李再友,等.静脉注射吸毒人群HIV/HCV混合感染者与HIV单独感染者艾滋病疾病进展比较分析[J].中华微生物学和免疫学杂志,2015,35(9):692-697.
[20]Zhang F,Zhu H,Wu Y,et al.HIV,hepatitis B virus,and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program,2010-12:a retrospective observational cohort study[J].Lancet Infect Dis,2014,14(11):1065-1072.