广西艾滋病抗病毒治疗病毒学失败发生规律及风险因素分析

目的了解广西艾滋病抗病毒治疗病毒学失败情况,探讨发生规律及风险因素。方法用回顾性队列研究方法分析2010年1月1日至2014年12月31日广西抗病毒治疗信息数据库数据。按我国抗病毒治疗方案,病人入组治疗后每年监测1次病毒载量。抗病毒治疗病毒学失败定义为治疗中出现病毒载量400拷贝/m L。使用Lifetable法分别计算治疗6~11月、12~23月、24~59月的病毒学失败发生率。使用COX比例风险回归模型分析影响因素,计算校正P值(AP)和校正风险比(AHR),评估各因素与病毒学失败的关联强度。结果治疗6~11月、12~23月和24~59月的病毒学失败发生率分别为18.8/100人年(88 400/4 711.0)、12.2/100人年(66 700/5 483.0)和1.7/100人年(30 700/17 589.0)。56~岁年龄组患者发生病毒学失败的风险是18~岁年龄组患者的1.163倍(AP=0.024,AHR=1.163,95%CI=1.020-1.327)。静脉吸毒途径感染艾滋病者发生病毒学失败的风险是性途径感染艾滋病者的1.484倍(AP=0.000,AHR=1.484,95%CI=1.262~1.745)。WHO II期和III期患者发生病毒学失败的风险分别是WHO I期患者的1.248倍(AP=0.001,AHR=1.248,95%CI=1.092~1.427)和1.220倍(AP=0.003,AHR=1.220,95%CI=1.069~1.392)。县区级医院治疗患者发生病毒学失败的风险是自治区级医院治疗患者的1.275倍(AP=0.001,AHR=1.275,95%CI=1.101~1.477)。出现漏服药物和毒副反应患者发生病毒学失败的风险分别是不出现该类事件患者的1.239倍(AP=0.000,AHR=1.239,95%CI=1.126~1.363)和1.447倍(AP=0.000,AHR=1.447,95%CI=1.313~1.595)。各因素的风险比在治疗6~11月、12~23月和24~59月3个时段存在差异。结论广西艾滋病抗病毒治疗病毒学失败发生率随着治疗时间延长呈下降趋势。影响病毒学失败的风险因素也随着治疗时间延长而改变。建议根据患者临床特征和治疗时间调整治疗方案。

Incidence of virological failure and risk factors among patients who receiving highly active antiretroviral therapy in Guangxi

Objective Determine the incidence rate of virological failure and explore risk factors among patients who receiving highly active antiretroviral therapy in Guangxi. Methods Guangxi databases of highly active antiretroviral therapy between Jan 1st, 2010 and Dec 31st, 2014 were analyzed by retrospective cohort study. Virological failure incident was defined when HIV-1 virus load test was >400copies/mL in the follow-up. The incidence rate of virological failure among patients in 6-11 months, 12-23months and 24-59months of follow-up were calculated with lifetable, respectively. We used COX proportional hazard regression model to analysis risk factors. Evaluate the correlation between risk factors and virological failure by calculating adjusted P-value(AP) and adjusted Hazard Ratio(AHR).Results The incidence rate of virological failure were 18.8/100 person-years, 12.2/100 person-years and 1.7/100 person-years in 6-11 months, 12-23 months and 24-59 months of follow-up, respectively. Hazard ratio of patients with age >56 years was 1.163 times of those with age 18-29 years (AP=0.024, AHR=1.163, 95% CI=1.020-1.327). Hazard ratio of patients infected with HIV by injecting drug users was 1.484 times of those infected by sex transmission(AP=0.000, AHR=1.484, 95% CI=1.262-1.745). Hazard ratio of patients with WHO stage II and III were 1.248(AP=0.001,AHR=1.248, 95%CI=1.092-1.427) times and 1.220 times (AP=0.003,AHR=1.220, 95%CI=1.069-1.392) of those with WHO stage I, respectively. Hazard ratio of patients treated in country-level hospital was 1.275 times of those treated in provincial-level hospital(AP=0.001,AHR=1.275, 95%CI=1.101-1.477). Hazard ratio of patients who had doses missed and had toxic side effects events were 1.239 times (AP=0.000, AHR=1.239, 95% CI=1.126-1.363) and 1.447 times(AP=0.000, AHR=1.447, 95% CI=1.313-1.595) of patients did not have those events, respectively. There were different between hazard ratios in 6-11 months, 12-23 months and 24-59 months of follow-up. Conclusion The incidence rate of virological failure among patients who receiving highly active antiretroviral therapy in Guangxi decreased when the follow-up times went on. The effects of risk factors in different times of follow-up were different. It is recommended that therapeutic regimen should be adjusted according to clinical characteristics and treatment times of patients.