不同年龄成人艾滋病病毒感染者的抗病毒治疗效果分析

发布时间：2019-07-10 11:31

【摘要】：目的探索我国不同年龄成人艾滋病病毒感染者(感染者)在抗病毒治疗36个月内的病毒学效果和免疫学效果,并分析其他影响因素,为我国成人艾滋病抗病毒治疗工作提供参考。方法利用国家抗病毒治疗数据库中成人艾滋病病毒感染者的部分相关数据资料进行回顾性队列研究。在2010年1月1日-2012年12月31日期间初次接受治疗且基线CD4/CD8比值1的成人感染者作为研究对象,并按照基线年龄将其分为3组:18～49岁(参照组)、50～59岁以及≥60岁组。随访研究对象至治疗36个月。通过Logistic模型分析不同年龄组感染者病毒抑制失败率的差异。通过混合效应线性模型分析不同年龄组感染者CD4+T淋巴细胞(CD4)应答特点及差异。通过Kaplan-Meier法分析不同年龄组感染者发生免疫学失败的情况,并应用Cox模型分析差异。结果1.确定5331例成人艾滋病病毒感染者为研究对象,其中18～49岁组4187(78.5%)例、50～59 岁组 632(11.9%)例和≥60 岁组 512(9.6%)例。50～59 岁组发生病毒抑制失败的风险是18～49岁组的1.11倍(95%CI:0.80-1.52),≥60岁组发生病毒抑制失败的风险是18～49岁组的1.25倍(95%CI:0.87-1.79)。50～59岁组CD4计数比18～49岁组平均低16个/mm3(P.001),≥60岁组比18～49岁组平均低26个/mm3(P.001)。50～59岁组发生免疫学失败的风险是18～49岁组的1.44倍(95%CI:0.85-2.42),≥60岁组发生免疫学失败的风险是18～49岁组的1.92倍(95%CI:1.15-3.19)。2。在不同特征的感染者中,与18～49岁组相比,50～59岁组和≥60岁组病毒抑制失败的风险不具有统计学意义(P.005)。3.女性、开始治疗方案含TDF以及病毒抑制失败的感染者中,50～59岁组与18-49岁组在治疗36个月中CD4计数水平相似(P.005),≥60岁组与18～49岁组在治疗36个月中CD4计数水平也相似(P.005)。4.基线CD4计数200个/mm3,男性,已婚或同居,基线CD4/CD8L比值0.30,开始治疗方案含AZT/d4T以及保持病毒抑制的感染者中,与18～49岁组相比,≥60岁组发生免疫学失败的风险均具有统计学意义,对应的aHR值(95%CI)及P值见表16。在不同特征的感染者中,50～59岁组发生免疫学失败的风险也不具有统计学意义(P.005)。结论通过对三所省级传染病专科医院的艾滋病病毒感染者分析发现,治疗36个月中:1.年龄对成人感染者的病毒学效果无显著影响。2.混合效应线性模型分析表明50～59岁和≥60岁感染者CD4计数低于18～49岁感染者。3.≥60岁感染者发生免疫学失败的风险高于18～49岁感染者。
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图片说明：图3.3个年龄组在36个月内不同治疗时间的〔氏校正均数
[Abstract]:Objective To explore the virological and immunological effects of HIV-infected people living with AIDS in our country for 36 months, and to analyze the other factors to provide reference for the anti-virus treatment of adult AIDS in our country. Methods A retrospective cohort study was carried out using some relevant data from the national anti-virus treatment database for adult HIV-infected persons. Adult patients who received initial treatment and baseline CD4/ CD8 ratio 1 were treated as subjects for the first time during the period from 1 January 2010 to 31 December 2012, and were divided into three groups according to the baseline age:18-49 years (reference group),50-59 years of age and 60-year-old. Follow-up study subjects to treatment for 36 months. Logistic model was used to analyze the difference of the failure rate of the virus in different age groups. The response characteristics and differences of CD4 + T lymphocytes (CD4) in different age groups were analyzed by a mixed-effect linear model. A Kaplan-Meier method was used to analyze the immunological failure of patients with different age groups and to use the Cox model to analyze the difference. Results 1. A total of 5,331 adult HIV-infected persons were identified as subjects, of which 4187 (78.5%),632 (11.9%) and 512 (9.6%) in the 60-year-old group were aged between 18 and 49, and the risk of a viral inhibition failure in the 50-59-year-old group was 1.11-fold (95% CI: 0.80-1.52) in the 18-49-year-old group. The risk of viral inhibition failure in the 60-year-old group was 1.25-fold (95% CI: 0.87-1.79) in the 18-49-year-old group. The CD4 count in the 50-59-year-old group was 16/ mm3 (P.001) lower than that in the 18-49-year-old group (P.001). The risk of immunological failure in the 50-59-year-old group was 1.44-fold (95% CI: 0.85-2.42) in the 18-49-year-old group. The risk of immunological failure in the 60-year-old group was 1.92-fold (95% CI: 1.15-3.19) in the 18-49-year-old group. In those infected with different characteristics, the risk of viral inhibition failure in the 50-59-year-old group and the 60-year-old group was not statistically significant (P.005) compared to the 18-49-year-old group. The number of CD4 counts in the 50-59-year-old group and the 18-49-year-old group was similar to that of the 18-49-year-old group in the 36-month period of treatment (P.005), and the CD4 count was also similar between the 60-year-old group and the 18-49-year-old group in the 36-month period (P.005). At baseline CD4 count of 200/ mm3, male, married or cohabiting, baseline CD4/ CD8L ratio 0.30, initiation of treatment with AZT/ d4T and the maintenance of viral inhibition, the risk of immunological failure in the 60-year-old group was statistically significant compared to the 18 to 49-year-old group, The corresponding aHR values (95% CI) and P values are shown in Table 16. The risk of immunological failure in the 50 to 59-year-old group was not statistically significant among those with different characteristics (P.005). Conclusion The analysis of the HIV-infected patients in the three provincial infectious disease specialized hospital found that the treatment for 36 months:1. Age had no significant effect on the virologic effect of adult patients. The linear model of the mixed effect analysis showed that the CD4 counts of those infected with 50-59 and 60-year-old were lower than those in the age of 18-49 years. The risk of immunological failure of the 60-year-old is higher than that of the 18-49-year-old.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.91

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