Effect Observation and Influencing Factors Analysis of Rapid Initiation of Antiretroviral Therapy
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摘要:
目的 了解昆明市快速启动艾滋病抗病毒治疗48周患者的成效，同时分析非快速启动的影响因素。 方法 回顾性收集2018年1月至2022年12月昆明市第三人民医院初始接受艾滋病抗病毒治疗患者的资料，确诊到开始治疗时间间隔≤7 d为快速启动组，>7 d为非快速启动组。卡方检验及t检验对比分析2组患者基线人口学及临床特征差异，Logistic回归分析影响因素。卡方检验比较2组患者治疗48周的CD4计数、病毒抑制率、队列保持率及病死率差异。 结果 快速启动率为32.70%，非快速启动组48周失访率更高（χ2 = 11.169，P = 0.001），病死率更高（χ2 = 3.924，P = 0.048）。无配偶患者非快速启动的风险是有配偶患者的1.212倍（P = 0.040）。静脉注射吸毒传播的患者非快速启动的风险是异性性接触传播的2.987倍（P < 0.001）。基线CD4/CD8<0.5的患者非快速启动的风险是CD4/CD8≥0.5患者的1.423倍（P = 0.001），CD4计数≤350 个/μL的患者非快速启动的风险更高（P = 0.047）。治疗48周快速启动组病毒抑制率高于非快速启动组（P = 0.031），CD4/CD8≥0.5的患者比例快速启动组更高（P < 0.001）。 结论 快速启动抗病毒治疗，有利于提高病毒抑制率及队列保持率，降低病死率。对于无配偶，静脉注射传播以及CD4/CD8<0.5的患者应给予更多的干预措施，帮助患者尽快接受抗病毒治疗。 Abstract:Objective To investigate the efficacy of 48 weeks of rapid initiation of HIV antiviral therapy in Kunming, and analyze the influencing factors of Non-rapid initiation. Methods Data of patients initially receiving HIV antiviral treatment in The Third People's Hospital of Kunming from January 2018 to December 2022 were retrospectively collected. The time interval between diagnosis and treatment initiation was ≤7 days in the rapid ART group, and > 7 days in the non-rapid ART group. Chi-square test and T-test were used to compare the baseline demographic and clinical characteristics between the two groups and logistic regression analysis was used to analyze the influence factors. The chi-square test was used to compare the difference of CD4 count, viral inhibition rate, cohort retention rate and mortality between the two groups after 48 weeks of treatment. Results The Rapid ART rate was 32.70%, the Non-rapid ART group has higher loss rate in 48 week（χ2 = 11.169, P = 0.001）, higher mortality（χ2 = 3.924, P = 0.048）. The risk of Non-rapid initiation was 1.212 times higher in patients without a spouse（P = 0.040）. The risk of Non-rapid initiation in patients transmitted by intravenous drug use was 2.987 times that of heterosexual transmission（P < 0.001）. Patients with baseline CD4/CD8<0.5 had a 1.423 times greater risk of Non-rapid initiation than patients with CD4/CD8≥0.5（P = 0.001）, patients with CD4 counts≤350/μL were at higher risk for Non-rapid initiation（P = 0.047）. After 48 weeks of treatment, the virus inhibition rate in the Rapid ART group was higher than that in theNon-rapid ART group（P = 0.031）, the proportion of patients with CD4/CD8≥0.5 was higher in theRapid ART group（P < 0.001）. Conclusion Rapid initiation of antiviral therapy is beneficial to improve viral inhibition rate and cohort retention rate, and reduce mortality. For patients without spouses, with intravenous transmission and CD4/CD8<0.5, more interventions should be given to help patients receive antiviral therapy as soon as possible. -
表 1 快速启动ART与非快速启动者基线特征比较及影响因素分析[（$\bar x \pm s $）/n（%）]
Table 1. Comparison of baseline characteristics and analysis of influencing factors between rapid initiation ART and non-rapid initiation groups [（$\bar x \pm s $）/n（%）]
项目 快速启动组 （n=821） 非快速启动组 （n= 1590 ）单因素分析 多因素分析 F /χ2 P OR（95%CI） P 年龄（岁） 41.60±14.87 41.40±13.61 0.332 0.740 性别 0.363 0.547 男性 555（67.60） 1094 （68.80）女性 266（32.40） 496（31.20） 婚姻状况 7.168 0.028* 已婚 386（47.02） 676（42.51） 1 非婚 435（52.98） 914（57.49） 1.212（1.009～1.456） 0.040* 传播途径 30.537 <0.001* 异性性接触 566（68.94） 1022 （64.28）1 静脉注射吸毒 27（3.29） 151（9.50） 2.987（1.820～4.892） <0.001* 同性性接触 149（18.15） 273（17.17） 1.002（0.747～1.744） 0.990 其它 79（9.62） 144（9.05） 0.942（0.663～1.339） 0.739 HIVRNA（拷贝/mL） 1.667 0.197 ≤ 100000 560（68.21） 1125 （70.75）> 100000 261（31.79） 465（29.25） CD4计数（个/μL） 4.536 0.033* <350 571（69.55） 1171 （73.65）1 ≥350 250（30.45） 419（26.35） 0.827（0.685～0.998） 0.047* CD4/CD8 22.594 0.001* ≥0.5 258（31.43） 358（22.52） 1 <0.5 563（68.57） 1232 （77.48）1.423（1.148～1.785） 0.001* *P < 0.05。 
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表 2 快速启动组与非快速启动组治疗48周的疗效比较[n（%）]
Table 2. Comparison of 48-week treatment efficacy between rapid initiation and non-rapid initiation groups [n（%）]
项目 快速启动组 （n=821） 非快速启动组 （n= 1590 ）Z/χ2 P HIVRNA（拷贝/mL） 4.679 0.031* ≤50 基线 289（35.20） 618（38.87） 48周 786（95.74） 1488 （93.58）>50 基线 532（64.80） 972（61.13） 48周 35（4.26） 102（6.42） χ2 665.418 1064.150 P <0.001* <0.001* CD4（个/μL） 基线 259（135，377） 214（84，358） −5.176 <0.001* 48周 415（266，594） 356（209，542） Z −13.603 −30.104 P <0.001* <0.001* CD4/CD8 17.632 <0.001* ≥0.5 基线 258（31.42） 358（22.51） 48周 451（54.93） 730（45.91） <0.5 基线 563（68.58） 1232 （77.49）48周 370（45.07） 860（54.09） χ2 92.461 193.340 P <0.001* <0.001* *P < 0.05。
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