柳州市女性HIV/AIDS抗病毒治疗后CD4变化情况及其影响因素研究
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摘要
目的了解柳州市女性人类免疫缺陷病毒携带者/艾滋病(human immunodeficiency virus carriers/acquired immune deficiency syndrome,HIV/AIDS)患者抗病毒治疗现状,探讨抗病毒治疗后CD4变化的影响因素,为今后改善该人群抗病毒治疗效果提供了理论依据。方法采用横断面研究的方法 ,在2016年10月～2017年1月间,对柳州市接受病毒治疗的女性HIV/AIDS进行问卷调查,收集患者的相关信息和CD4计数情况,采用多因素有序Logistic回归模型对其抗病毒治疗后CD4计数变化的影响因素进行分析。结果 428名女性HIV/AIDS患者接受抗病毒治疗后12月CD4计数水平明显增加(Z=-16.596,P<0.001),配偶/固定性伴性行为(OR=1.465,95%CI:1.009～2.128,P=0.045)是抗病毒治疗后CD4变化的保护因素,吸食/注射毒品(OR=0.063,95%CI:0.007～0.547,P=0.012)、抑郁分级、治疗前合并机会性感染(OR=0.423,95%CI:0.281～0.636,P<0.001)、治疗前合并肺结核(OR=0.334,95%CI:0.179～0.622,P=0.001)是抗病毒治疗后CD4变化的危险因素。结论本研究结果显示抗病毒治疗12月后CD4计数水平明显增加,同时表明了促进配偶/固定性伴性行为,改变不良生活行为,改善心理健康状况,积极治疗AIDS相关疾病或感染可能有效的改善抗病毒治疗效果。
Objective To understand the status of antiretroviral treatment for female human immunodeficiency virus/acquired immune deficiency syndrome( HIV/AIDS) patients and analyze the influencing factors that affect the CD4 change after antiretroviral therapy(ART),so as to provide theoretical basis for improving the antiviral treatment effect of this group in the future.Methods A cross sectional study was conducted among female HIV/AIDS patients,selected from October 2016 to January 2017.Female patients were interviewed by questionnaire and related data was recorded from The Comprehensive Prevention and Control System of AIDS in China.A model of ordinal logistic regression was performed to analyze the factors that affect CD4 changes after HAART.Results 428 female HIV/AIDS patients received an significant average increase of CD4 count(Z =-16.596,P <0.001).Having sex with spouse or regular sexual partners(OR =1.465,95% CI: 1.009-2.128,P= 0.045) was a protective factor for CD4 increases,using illicit drug(OR = 0.063,95% C/:0.007-0.547,P =0.012),depression,opportunistic infection(OR =0.423,95% CI:0.281-0.636,P<0.001) and tuberculosis( OR = 0.334,95% CI:0.179-0.622,P = 0.001) before ART were high risk factors for CD4 increases.Conclusions The results of this study indicated that the levels of CD4 in female HIV/AIDS patients increased significantly after ART.Promoting sexual behavior with spouse/regular partners,removing the bad life behavior,improving the mental health status,treating AIDS-related diseases and infections may effectivey improve the effect of ART.
Objective To understand the status of antiretroviral treatment for female human immunodeficiency virus/acquired immune deficiency syndrome( HIV/AIDS) patients and analyze the influencing factors that affect the CD4 change after antiretroviral therapy(ART),so as to provide theoretical basis for improving the antiviral treatment effect of this group in the future.Methods A cross sectional study was conducted among female HIV/AIDS patients,selected from October 2016 to January 2017.Female patients were interviewed by questionnaire and related data was recorded from The Comprehensive Prevention and Control System of AIDS in China.A model of ordinal logistic regression was performed to analyze the factors that affect CD4 changes after HAART.Results 428 female HIV/AIDS patients received an significant average increase of CD4 count(Z =-16.596,P <0.001).Having sex with spouse or regular sexual partners(OR =1.465,95% CI: 1.009-2.128,P= 0.045) was a protective factor for CD4 increases,using illicit drug(OR = 0.063,95% C/:0.007-0.547,P =0.012),depression,opportunistic infection(OR =0.423,95% CI:0.281-0.636,P<0.001) and tuberculosis( OR = 0.334,95% CI:0.179-0.622,P = 0.001) before ART were high risk factors for CD4 increases.Conclusions The results of this study indicated that the levels of CD4 in female HIV/AIDS patients increased significantly after ART.Promoting sexual behavior with spouse/regular partners,removing the bad life behavior,improving the mental health status,treating AIDS-related diseases and infections may effectivey improve the effect of ART.
引文
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[12]Karo B,Krause G,Castell S,el al.Immunological recovery in tuberculosis/HIV co-infected patients on antiretroviral therapy:implication for tuberculosis preventive therapy[J].BMC Infect Dis,2017,17(1):517.
[2]朱晓艳,杨兴光,廖玫珍,等.山东省2008-2015年首次接受艾滋病免费抗病毒治疗的HIV/AIDS流行病学特征分析[J].中华疾病控制杂志,2017,21(12):1195-1199.
[3]赵燕,张福杰,刘中夫,等.人类免疫缺陷病毒感染/艾滋病患者抗病毒治疗的公共卫生意义及策略进展[J].中华传染病杂志,2011,4(7):442-446.
[4]Estes JD.Role of collagen deposition in lymphatic tissues and immune reconstruction during HIV-1 and SIV infections[J].Curr HIV/ATDS Rep.2009,6(1):29-35.
[5]Wohl DA,Kendall MA,Feinbreg J,et al.The clinical impact ofcontributing to prescribe antiretroviral therapy in patients with advanced AIDS who manifest no virologic or immunologic benefit[J].PLoS One,2013,8(11):e78676.
[6]Cook JA,Rurke-Miller JK,Cohen MH,et al.Crack cocaine,disease progression,and mortality in a multicenter cohort of HIV-1positive women[J].AIDS,2008,22(11):1355-1363.
[7]Chao C,Jacobson LP,Tashkin D,et al.Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men[J].Drug Alcohol Depend,2008,94(1-3):165-171.
[8]Nel A,Kagee A.Common mental health problems and antiretroviral therapy adherence[J].AIDS Carc,2011,23(11):1360-1365.
[9]Campos LN,Guimaraes MD,Remien RH.Anxiety and depression symptomsas risk factors for non-adherence to antiretroviral therapy in Brazil[J].AIDS Behav,2010,14(2):289-299.
[10]虎永兰.结核病细胞免疫及细胞因子的研究进展[J].青海医药杂志,2012,42(11):78-79.
[11]蒋忠胜.柳州市初始HAART的HIV/AIDS患者抗病毒治疗失败和死亡危险因素的研究[D].南宁:广西医科大学,2014.
[12]Karo B,Krause G,Castell S,el al.Immunological recovery in tuberculosis/HIV co-infected patients on antiretroviral therapy:implication for tuberculosis preventive therapy[J].BMC Infect Dis,2017,17(1):517.