高级检索

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

云南省艾滋病抗病毒治疗中HIV低病毒血症发生情况分析

安靓 劳云飞 唐松源

安靓, 劳云飞, 唐松源. 云南省艾滋病抗病毒治疗中HIV低病毒血症发生情况分析[J]. 中国公共卫生, 2022, 38(7): 908-913. doi: 10.11847/zgggws1132975
引用本文: 安靓, 劳云飞, 唐松源. 云南省艾滋病抗病毒治疗中HIV低病毒血症发生情况分析[J]. 中国公共卫生, 2022, 38(7): 908-913. doi: 10.11847/zgggws1132975
AN Jing, LAO Yun-fei, TANG Song-yuan. Incidence of low-level viraemia among HIV/AIDS patients with antiviral therapy in Yunnan province, 2004 – 2018: a retrospective analysis[J]. Chinese Journal of Public Health, 2022, 38(7): 908-913. doi: 10.11847/zgggws1132975
Citation: AN Jing, LAO Yun-fei, TANG Song-yuan. Incidence of low-level viraemia among HIV/AIDS patients with antiviral therapy in Yunnan province, 2004 – 2018: a retrospective analysis[J]. Chinese Journal of Public Health, 2022, 38(7): 908-913. doi: 10.11847/zgggws1132975

云南省艾滋病抗病毒治疗中HIV低病毒血症发生情况分析

doi: 10.11847/zgggws1132975
基金项目: 云南省科学技术厅项目(202001AY070001 – 105)
详细信息
    作者简介:

    安靓(1987 – ),女,四川省安岳县人,研究实习员,硕士在读,主要从事艾滋病抗病毒治疗质量控制工作

  • 中图分类号: R 512.91

Incidence of low-level viraemia among HIV/AIDS patients with antiviral therapy in Yunnan province, 2004 – 2018: a retrospective analysis

  • 摘要:   目的  了解云南省抗病毒治疗中HIV低病毒血症发生的总体情况和变化趋势,为后续相关研究提供参考。  方法  从艾滋病综合防治数据信息管理系统下载既有数据,对2004 — 2018年在云南省接受艾滋病抗病毒治疗(ART)的患者人口学特征和病毒载量(VL)检测结果进行描述性分析,按照治疗方案分为2个子队列进行统计分析。  结果  93944例患者中有21203例发生低病毒血症(LLV),总发生率为22.6 %,其中25.5 %发生了至少2次。按数值水平看,51~199拷贝/mL的发生率最高,然后是400~999、200~399拷贝/mL;按发生频率看,发生单独1次LLV的比例最高,连续2次、间隔2次、连续多次、间隔多次发生LLV的比例依次下降。按随访年分析,开始ART第1年低病毒血症的发生率最高,此后逐年下降。按自然年分析,一线治疗队列中 LLV 51~199拷贝/mL与LLV 200~399拷贝/mL发生率有相同趋势,先上升至2010年的峰值,之后开始下降至2016年谷值,之后又上升;LLV 400~999拷贝/mL与病毒学失败(VF)≥ 1000拷贝/mL发生率相似,2012年前逐年下降,之后平稳维持。二线治疗队列中4种VL检测结果有相同趋势,均在2008 — 2012年有下降趋势,之后平稳维持。  结论  云南省ART人群中LLV发生率较高,应进一步探索LLV对ART治疗效果的影响。
  • 图  1  患者随访年LLV和VF的发生率

    图  2  患者自然年LLV和VF的发生率

    表  1  病例基本人口学特征

    特征一线治疗队列(N = 76736)二线治疗队列(N = 17208)χ2/HP
    n%n%
    性别 2257 < 0.001
     男性 48785 63.6 7561 43.9
     女性 27951 36.4 9647 56.1
    婚姻状况 199.58 < 0.001
     未婚 14583 19.0 2850 16.6
     已婚或同居 50605 65.9 12273 71.3
     离异或分居 7131 9.3 1310 7.6
     丧偶 4072 5.3 741 4.3
     不详 345 0.4 34 0.2
    传播途径 1856.9 < 0.001
     静脉吸毒 13227 17.2 2946 17.1
     同性性传播 3019 3.9 357 2.1
     异性性传播 55890 72.8 13023 75.7
     其他(以不详为主) 4599 6.0 882 5.1
    随访时长(年) 686.86 < 0.001
     < 1 8474 11.0 2599 15.1
     1~3 24407 31.8 6053 35.2
     3~5 18395 24.0 4501 26.2
     > 5 25460 33.2 4055 23.6
    开始治疗年代 3197.7 < 0.001
     < 2012 22136 28.8 1421 8.3
     2012 — 2015 35839 46.7 10040 58.3
     ≥ 2016 18761 24.4 5747 33.4
    开始治疗州市 508.68 < 0.001
     西双版纳州 1606 2.1 307 1.8
     保山市 3521 4.6 920 5.3
     楚雄州 2495 3.3 359 2.1
     大理州 5479 7.1 1318 7.7
     德宏州 7595 9.9 2381 13.8
     迪庆州 157 0.2 20 0.1
     红河州 14511 18.9 3333 19.4
     昆明市 13969 18.2 2873 16.7
     丽江市 668 0.9 121 0.7
     临沧市 5903 7.7 1478 8.6
     怒江州 452 0.6 108 0.6
     普洱市 3364 4.4 728 4.2
     曲靖市 3993 5.2 762 4.4
     文山州 6599 8.6 1489 8.7
     玉溪市 2665 3.5 510 3.0
     昭通市 3073 4.0 364 2.1
     其他省市 686 0.9 137 0.8
    下载: 导出CSV

    表  2  低病毒血症总体发生情况

    特征一线治疗队列(N = 76736)二线治疗队列(N = 17208)
    n%n%
    发生低病毒血症 17 832 23.2 3371 19.6
     病毒载量(拷贝/mL)
      50~199 10 542 59.1 2034 60.3
      200~399 3 413 19.1 666 19.8
      400~999 3 877 19.9 671 19.9
     发生频率
      单独1次 13 119 73.6 2683 79.6
      连续2次 1 891 10.6 347 10.3
      间隔2次 1 670 9.4 217 6.4
      连续多次 557 3.1 71 2.1
      间隔多次 595 3.3 53 1.6
    下载: 导出CSV
  • [1] 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2018版)[J]. 国际流行病学传染病学杂志, 2018, 45(6): 361 – 378. doi: 10.3760/cma.j.issn.1673-4149.2018.06.001
    [2] Günthard HF, Saag MS, Benson CA, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the International Antiviral Society – USA panel[J]. JAMA, 2016, 316(2): 191 – 210. doi: 10.1001/jama.2016.8900
    [3] Department of Health and Human Services. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV[EB/OL]. [2020 – 10 – 15].https://api.hiv.plus/uploads/14bcb965d82f4d8da724fb8799644415.pdf.
    [4] European AIDS Clinical Society. European guidelines for treat-ment of hiv infected adults in Europe[EB/OL]. [2020 – 10 – 15].https://www.eacsociety.org/files/2018_guidelines-9.1-english.pdf.
    [5] World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection[EB/OL]. [2020 – 10 – 15].https://apps.who.int/iris/bitstream/handle/10665/208825/9789241549684_eng.pdf?sequence=1.)
    [6] Ping LH, Jabara CB, Rodrigo AG, et al. HIV-1 transmission during early antiretroviral therapy: evaluation of two HIV-1 transmission events in the HPTN 052 prevention study[J]. PLoS One, 2013, 8(9): e71557. doi: 10.1371/journal.pone.0071557
    [7] Cohen MS, Gamble T, McCauley M. Prevention of HIV transmission and the HPTN 052 study[J]. Annual Review of Medicine, 2020, 71: 347 – 360. doi: 10.1146/annurev-med-110918-034551
    [8] Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy[J]. JAMA, 2016, 316(2): 171 – 181. doi: 10.1001/jama.2016.5148
    [9] Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study[J]. The Lancet HIV, 2018, 5(8): E438 – E447. doi: 10.1016/S2352-3018(18)30132-2
    [10] Pereyra F, Palmer S, Miura T, et al. Persistent low-level viremia in HIV-1 elite controllers and relationship to immunologic parameters[J]. The Journal of Infectious Diseases, 2009, 200(6): 984 – 990. doi: 10.1086/605446
    [11] Joya C, Won SH, Schofield C, et al. Persistent low-level viremia while on antiretroviral therapy is an independent risk factor for virologic failure[J]. Clinical Infectious Diseases, 2019, 69(12): 2145 – 2152. doi: 10.1093/cid/ciz129
    [12] Elvstam O, Medstrand P, Yilmaz A, et al. Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment[J]. PLoS One, 2017, 12(7): e0180761. doi: 10.1371/journal.pone.0180761
    [13] Charuratananon S, Sungkanuparph S. Rate of and predicting factors for virologic failure in HIV-infected patients with persistent low-level viremia under antiretroviral therapy[J]. Journal of the International Association of Providers of AIDS Care (JIAPAC), 2015, 14(1): 12 – 16. doi: 10.1177/2325957414527168
    [14] Elvstam O, Marrone G, Medstrand P, et al. All-cause mortality and serious non-AIDS events in adults with low-level human immunodeficiency virus viremia during combination antiretroviral therapy: results from a Swedish nationwide observational study[J]. Clinical Infectious Diseases, 2020, doi: 10.1093/cid/ciaa413.
    [15] 中国疾病预防控制中心性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册[M]. 4版. 北京: 人民卫生出版社, 2016.
    [16] Zhang T, Ding HB, An MH, et al. Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort[J]. BMC Infectious Diseases, 2020, 20(1): 147. doi: 10.1186/s12879-020-4837-y
    [17] 云南省第三年防治艾滋病人民战争联合评估组. 云南省第三轮防治艾滋病人民战争评估报告[R]. 2016.
    [18] The Antiretroviral Therapy Cohort Collaboration (ART-CC). Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients[J]. AIDS, 2015, 29(3): 373 – 383. doi: 10.1097/QAD.0000000000000544
    [19] Hermans LE, Moorhouse M, Carmona S, et al. Effect of HIV-1 low-level viraemia during antiretroviral therapy on treatment outcomes in WHO-guided South African treatment programmes: a multicentre cohort study[J]. The Lancet Infectious Diseases, 2018, 18(2): 188 – 197. doi: 10.1016/S1473-3099(17)30681-3
    [20] 国务院办公厅. 国务院办公厅关于印发中国遏制与防治艾滋病“十三五”行动计划的通知. 国办发〔2017〕8号)[EB/OL]. (2017 – 02 – 05). http://www.gov.cn/zhengce/content/2017-02/05/content_5165514.htm.
    [21] 云南省人民政府. 关于印发《云南省第四轮防艾人民战争实施方案(2016 — 2020年)》的通知[R]. (云发[2016]17号), 2016.
    [22] Fleming J, Mathews WC, Rutstein RM, et al. Low-level viremia and virologic failure in persons with HIV infection treated with antiretroviral therapy[J]. AIDS, 2019, 33(13): 2005 – 2012. doi: 10.1097/QAD.0000000000002306
    [23] Warren AM, Cheng AC, Watson K, et al. Outcomes following detection of low level plasma HIV RNA in HIV-infected patients previously virologically suppressed on antiretroviral therapy: a retrospective observational study[J]. Sexual Health, 2017, 14(3): 238 – 243. doi: 10.1071/SH16165
    [24] Vandenhende MA, Perrier A, Bonnet F, et al. Risk of virological failure in HIV-1-infected patients experiencing low-level viraemia under active antiretroviral therapy (ANRS C03 cohort study)[J]. Antiviral Therapy, 2015, 20(6): 655 – 660. doi: 10.3851/IMP2949
    [25] Supervie V, Breban R. Brief report: per sex-act risk of hiv transmission under antiretroviral treatment: a data-driven approach[J]. JAIDS Journal of Acquired Immune Deficiency Syndromes, 2018, 79(4): 440 – 444. doi: 10.1097/QAI.0000000000001845
    [26] Yombi JC, Mertes H. Treatment as prevention for HIV infection: current data, challenges, and global perspectives[J]. AIDS Reviews, 2018, 20(3): 131 – 140.
    [27] Iwuji CC, Shahmanesh M, Koole O, et al. Clinical outcomes after first-line HIV treatment failure in South Africa: the next cascade of care[J]. HIV Medicine, 2020, 21(7): 457 – 462. doi: 10.1111/hiv.12877
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  532
  • HTML全文浏览量:  294
  • PDF下载量:  51
  • 被引次数: 0
出版历程
  • 接收日期:  2020-11-02
  • 网络出版日期:  2021-12-13
  • 刊出日期:  2022-07-01

目录

    /

    返回文章
    返回