河南省2005-2008年艾滋病抗病毒治疗评估:患者CD4+T淋巴细胞计数和病毒载量分析

摘要

目的 为评估和预测河南省艾滋病抗病毒治疗状况,分析患者CD4+T淋巴细胞和病毒载量.方法 通过"河南省艾滋病检测实验室网络数据库"收集河南省艾滋病人群2009年CD4+T淋巴细胞计数和病毒载量检测结果及相关信息.对其中未治疗和2005-2008年加入一线抗病毒治疗人群(＞13岁)的检测结果构成比进行横断面研究.结果 在2009年上、下半年河南省未治疗的艾滋病人群中,CD4+T淋巴细胞检测＜200个/μl者均＞20%(χ2=2.059,P=0.151),200～350个/μl者的构成比则由上半年27.61%上升到下半年的29.41%(χ2=4.636,P=0.031),＞350个/μl者的构成比从上半年51.49%下降到下半年的48.60%(χ2=9.767,P=0.002).在未治疗的艾滋病人群中,病毒载量＞10 000 copy/ml和＞30 000 copy/ml者所占百分比分别为34.53%和19.65%.2005-2008年间加入一线抗病毒治疗的艾滋病人群中,治疗时间越长,CD4+T淋巴细胞＞350个/μl者的构成比越高(χ2=148.689,P＜0.001),＜200个/μl者的构成比则越低(χ2=46.686,P＜0.001);同时,病毒载量＜500 copy/ml者的构成比越低(χ2=9.066,P=0.003),＞10 000 copy/ml者的构成比则越高(χ2=6.597,P=0.010).结论 河南省多年来进行的艾滋病一线抗病毒治疗疗效显著,但随着治疗时间的增加,治疗失败的风险也逐渐加大,应及时进行耐药监测,更换治疗方案.同时应加强未治疗人群的检测,加大抗病毒治疗的投入并扩大纳入治疗的范围.%Objective To analyze the CD4 +T cells and virus load in HIV/AIDS affected population and to evaluate the HIV/AIDS antiretroviral therapy programs in Henan province.Methods "Henan HIV/AIDS Testing Laboratory Network Database" was used to collect the data on CD4+ T cells and virus load (VL) value and corresponding information in HIV/AIDS population of Henan in 2009. Cross-sectional studies was used to study the constituent ratio of CD4 + T cells and virus load value in individuals who had not received antiretroviral-treated (ART) and had joined first-line ART between the year of 2005 to 2008 among HIV/AIDS population of Henan. Results As to these people living with HIV/AIDS that had not received ART in the first half and the second half year of 2009, the constituent ratio of individuals whose CD4+T cells were less than 200 cells/μl both accounted for more than 20% (χ2=2.059, P=0.151). The constituent ratio of individuals whose CD4+T cells were in 200-350 cells/μl and more than 350 cells/μl increased from 27.61% to 29.41%(χ2=4.636, P=0.031 ) and decreased from 51.49% to 48.60% (χ2=9.767, P=0.002), respectively.Meanwhile, we saw 34.53% and 19.65% of the patients whose virus load was ＞10 000 copy/mland ＞30 000 copy/ml in this population. Patients that joined first-line ART during 2005-2008 showed the following results: the longer of the therapy time, the higher constituent ratio of individuals whose CD4+ T cells were more than 350 cells/μl (χ2= 148.689, P＜0.001) and the lower constituent ratio of individuals of whose CD4+T cells were less than 200 cells/μl (χ2=46.686,P＜0.001).Simultaneously, the lower constituent ratio of individuals whose viral load was less than 500 copy/ml (χ2=9.066, P=0.003) and the higher constituent ratio of individuals whose virus load was more than 10 000 copy/ml (χ2=6.597, P=0.010). Conclusion Significant curative effect had been achieved in AIDS first-line ART of Henan, but along with the increasing treatment time, the risk of treatment failure also increased. Drug resistance test and changing of treatment protocols were needed. To reach better and more efficient effects on therapy, factors as more detections and investments on ART, expanding the scope of treatment etc. were needed on those people living with HIV/AIDS that had not received ART.