HIV/AIDS患者一线治疗失败的发生率及相关因素分析

目的研究HIV/AIDS患者一线治疗失败的发生率并分析其危险因素,从而对预警治疗失败的发生和提高抗病毒治疗的效果提供依据。方法以2005—2015年在北京地坛医院接受免费抗病毒治疗且发生一线治疗失败的HIV/AIDS患者为研究对象,回顾性分析患者的基本信息、基线特征以及一线治疗失败的发生率,并通过logistic回归分析治疗失败的相关危险因素。结果一线治疗失败率为3.39%。血液传播(OR=3.713)、基线CD4+T淋巴细胞200个/μl(OR=2.167)、病毒载量(viral load,VL)≥5log copies/ml(OR=2.137)、合并机会性感染(opportunistic infectiion,OI)(OR=3.476)是发生一线治疗失败的危险因素。一线治疗失败与性别、年龄、基线是否合并HBV/HCV感染以及从确诊到治疗的间隔长短无关。结论一线治疗失败的发生与血液传播、低基线CD4+T淋巴细胞计数、基线OI和高基线VL有关。今后应该对具有危险因素的患者给予充分重视,必要时优化治疗方案,注意药物间相互作用。

Analysis on incidence and risk factors of first-line treatment failure among HIV/AIDS patients

ObjectiveTo analyze the incidence and risk factors of first-line treatment failure among HIV/AIDS patients who received first-line highly active antiretroviral treatment (HAART). The outcomes of the study aim to provide early warnings to treatment failure and improve the HIV treatment efficacy.MethodsThe evaluation of basic demographic information, baseline characteristics, incidence, and risk factors of treatment failure was conducted retrospectively in HIV/AIDS patients who received free first-line HAART in Beijing Ditan Hospital from 2005 to 2015.ResultsOverall incidence of first-line was 3.39% in our cohort. Blood transmission (OR=3.713), baseline CD4 counts<200 cells/μl(OR=2.167), baseline VL≥5logcopies/ml(OR=2.137), combined with the opportunistic infections(OR=3.476) were risk factors of first regimen failure. Treatment failure was not associated with gender, age, baseline HBV/HCV co-infection and the interval from the confirmation to initial treatment. ConclusionsFirst-line failure was associated with blood transmission, lower baseline CD4 counts, baseline opportunistic infection and higher baseline VL. Adequate attention involving better treatment regimen options and notice of drug interaction is needed to ensure optimal treatment outcomes among HIV/AIDS patients, especially ones with these risk factors.