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

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

安靓^{1, 2},
劳云飞¹,
唐松源²

1.
云南省传染病医院云南省艾滋病关爱中心，昆明 650301
2.
昆明医科大学

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
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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

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

1.
Yunnan AIDS Care Center/Yunnan Provincial Infectious Disease Hospital, Kunming, Yunnan Province 650301, China

摘要

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。
- 艾滋病 /
- 抗病毒治疗 /
- 低病毒血症
Abstract: Objective To examine general situation and change trend of low-level viraemia (LLV) among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients under antiviral therapy (ART) in Yunnan province and to provide evidences to further relevant studies. Methods From the Data and Information Management System for Integrated HIV/AIDS Prevention and Control of Chinese Center for Disease Control and Prevention, we extracted demographical, clinical and viral load (VL) detection data on all HIV/AIDS patients receiving ART at the age of more than 15 years in Yunnan province during the period from 2004 through 2018. The incidence of LLV among the HIV/AIDS patients with different ART regimens was analyzed statistically. Results Of the 93 944 HIV/AIDS patients included in the study, 21 203 (22.6%) were detected with LLV. Among the patients with LLV, 25% were detected with LLV at least two times; the most detected LLV level was 51 – 199 copies/mL, followed by 400 – 999 and 200 – 399 copies/mL; the once-only LLV was detected most frequently and the detection frequency decreased in turn for successive two times, discontinuous two times, successive several times, and discontinuous several times; the detected incidence of LLV was the highest during the first year of ART and the incidence declined yearly after the initiation of ART. During the retrospective observation period among the 76 736 HIV/AIDS patients receiving first-line ART, the detected frequency of 51 – 199 and 200 – 399 copies/mL LLV increased first, with the highest frequency in 2010, then declined, with the lowest frequency in 2016, and increased again; the detected frequency of 400 – 999 copies/mL LLV and virologic failure (VF) of ≥ 1 000 copies/mL decreased yearly before 2012 and then remained at a stable level. While among the 17 208 HIV/AIDS patients receiving second-line ART, the detected frequencies of the four levels of LLV mentioned above varied similarly, with a decreasing trend between 2008 – 2012 and a stabilization later after. Conclusion The detected incidence of LLV is relatively high among HIV/AIDS patients with different ART regimen in Yunnan province. The effect of LLV on outcomes of ART needs to be explored.
- AIDS /
- antiviral therapy /
- low-level viraemia

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图 1 患者随访年LLV和VF的发生率

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图 2 患者自然年LLV和VF的发生率

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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/H 值	P 值
特征	n	%	n	%	χ²/H 值	P 值
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

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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）
特征	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

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