南京地区HIV/AIDS患者一线抗病毒治疗失败相关因素分析

目的: 分析南京地区人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）患者一线抗病毒治疗失败的危险因素，提前预警以降低一线治疗的失败率。方法：回顾性分析2016年1月至2019年9月在南京市第二医院感染科门诊启动一线抗病毒治疗并随访至2020年3月的HIV/AIDS患者基线人口学和随访资料，在此期间有耐药基因检测证实一线抗HIV治疗失败、更换含有洛匹那韦/利托那韦（LPV/r）的免费二线方案患者为治疗失败组，以同期病毒持续抑制患者作为对照，通过 Logistic 回归分析治疗失败的相关危险因素。结果：纳入的1 739例HIV/AIDS患者中有44例（2.5%）因病毒学失败更换含LPV/r的二线治疗方案。基线CD4⁺ T淋巴细胞计数<200个/μL (OR=13.105，95% CI：5.025~34.176)和基线病毒载量≥1×10⁵ 拷贝/mL (OR=2.491，95% CI：1.210~5.128)是一线治疗失败的危险因素；一线治疗失败与性别、年龄、婚姻状况、体重指数、传播途径、从确诊到治疗间隔时长、是否有基本医疗保险无关。结论：一线治疗失败的发生与低基线CD4⁺ T淋巴细胞计数和高基线病毒载量有关，具有危险因素的患者需重点关注。

Analysis on risk factors of first-line antiretroviral treatment failure among HIV/AIDS patients in Nanjing

Objective: To analyze the risk factors of the first line antiretroviral treatment failure in patients with HIV/AIDS in Nanjing area in order to reduce the failure rate of first line regimen. Methods: The evaluation of demographic information, follow-up data and risk factors of treatment failure was conducted retrospectively in HIV/AIDS patients who failed to receive free first-line antiretroviral therapy and changed the free second-line regimen containing lopinavir/ritonavir (LPV/r) in Nanjing Second Hospital from January 2016 to September 2019, followed up to March 2020. Results:  Among 1 739 HIV/AIDS patients, 44 (2.5%) switched to second-line treatment with LPV/r due to virologic failure. Baseline CD4⁺T lymphocyte counts <200 cells/μL (OR=13.105, 95% CI: 5.025-34.176) and baseline viral load ≥1×105copies/mL (OR=2.491, 95% CI: 1.210-5.128) were risk factors of first-line treatment failure. First-line treatment failure was not associated with gender, age, marital status, body mass index, route of transmission, interval from the confirmation to initial treatment, or access to essential medical insurance. Conclusion:  First-line regimen failure was associated with lower baseline CD4⁺ T lymphocyte counts and higher baseline viral load. We should focus on patients with these risk factors.［Key words］HIV；AIDS；antiretroviral therapy；first-line antiretroviral treatment；virologic failure；risk factors; CD4⁺ T lymphocyte；viral load