广西壮族自治区2008-2015年艾滋病病毒感染者基线CD4+T淋巴细胞计数水平对抗病毒治疗脱失的影响

摘要

目的 探讨HIV感染者开始抗病毒治疗(ART)时基线CD4+T淋巴细胞计数(CD4)不同水平对治疗脱失的影响.方法 采用回顾性队列研究方法,从艾滋病防治基本信息系统ART库选取2008-2015年广西壮族自治区(广西)首次开始ART、年龄≥18岁的HIV感染者,分析其ART脱失情况,随访时间截至2016年5月30日.采用Cox比例风险模型分析ART时基线CD4不同水平对ART脱失的影响.结果 共计58 502例HIV感染者进入队列,平均脱失比例为4.8/100人年.在控制了年龄、性别、婚姻状况、感染途径、ART前WHO临床分期、初始治疗方案、目前治疗方案、治疗方案改变、ART开始年份等因素后,基线CD4为200～、351～、≥500个/μl组HIV感染者的脱失风险分别是＜200个/μ1组的1.110(95％CI:1.053 ～ 1.171,P＜0.001)、1.391(95％CI:1.278～1.514,P＜0.001)、1.695(95％CI:1.497 ～ 1.918,P＜0.001)倍.HIV感染者因为依从性差而停药的比例为56.0％(1 601/2 861).结论 随着HIV感染者接受ART时CD4水平提高,ART脱失风险明显增加.为减少ART脱失,应充分考虑开始ART时CD4水平,加强依从性宣传教育和治疗机构人员培训.%Objective To investigate the effect of baseline CD4+T cell count (CD4) on drop-out of antiretroviral therapy (ART) in HIV infected persons.Methods Retrospective cohort was conducted in this study.HIV infected persons aged≥ 18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System,with follow-up conducted till May 30,2016.Cause-specific Cox proportional hazard models were used to evaluate effect of different CD4 on the drop-out of ART in the HIV infected persons.Results A total of 58 502 eligible study participants were included in this retrospective cohort study.The average drop-out ratio was 4.8/100 person-years.After controlling the following baseline covariates:age,sex,marital status,route of HIV infection,WHO clinical stage before ART,initial/current ART regiment,ART regiment adjustment,and year of initiating ART for potential confounding,the adjusted HR of drop-out for HIV infected persons with 200-cells/μl,351-cells/μl and ≥500 cells/μl were 1.110 (95％CI:1.053-1.171,P＜0.001),1.391 (95％CI:1.278-1.514,P＜0.001) and 1.695 (95％CI:1.497-1.918,P＜ 0.001),respectively,in risk for drop-out compared with those with baseline CD4 ＜200 cells/μ 1.Among the HIV infected persons,56.0％ (1 601/2 861) of drug withdrawal was due to poor compliance with medication.Conclusions With the increase of baseline CD4 when initiating ART,the risk for the drop-out in HIV infected persons increased significantly.To further reduce the drop-out of ART,it is important to take CD4 into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.