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目的了解伊犁地区艾滋病病毒(HIV)感染者的抗病毒治疗效果及其影响因素,为提高生存质量,制定更加合理的治疗方案及控制艾滋病的传播蔓延提供科学依据。方法采用自行设计的调查问卷,对2014年1月至2015年2月开始抗病毒治疗的356例HIV感染者进行调查,同时通过艾滋病抗病毒治疗管理系统收集相关的实验结果和诊疗记录。结果 356例HIV感染者中,抗病毒治疗失败者101例(28.4%),在接受抗病毒治疗的各时间段内,治疗有效者CD4~+T淋巴细胞(简称CD4细胞)计数不断地上升,并在各时间段之间差异有统计学意义(P<0.05);治疗无效者CD4细胞计数变化情况不规律,从治疗第9个月开始不断地下降。通过单因素分析,年龄、治疗方案、最初临床分期(治疗前)、治疗时间、基线CD4细胞计数、病毒载量、漏服情况等,与抗病毒治疗失败相关,均有统计学意义(P<0.05);经过二元Logistic回归分析,接受治疗时间、漏服情况和最初临床分期,是抗病毒治疗的危险因素[比值比(OR)值分别为3.667,2.332,2.181]。结论伊犁地区HIV感染者接受抗病毒治疗前9个月治疗效果较好,随着治疗时间的延长,治疗效果不理想。应有针对性地开展预防艾滋病相关知识的宣传,加强对HIV感染者的管理和随访,可提高该地区抗病毒治疗的效果。
Objective To understand the effect of antiviral therapy and its influencing factors in HIV-infected patients in Yili Prefecture and to provide scientific evidence for improving the quality of life, formulating more reasonable treatment options and controlling the spread of AIDS. Methods A self-designed questionnaire was used to investigate 356 HIV-infected patients who started ART between January 2014 and February 2015. At the same time, relevant experimental results and treatment records were collected through the HIV anti-viral treatment management system. Results Among the 356 cases of HIV-infected patients, 101 (28.4%) failed antiviral therapy and the count of CD4 + T lymphocytes (CD4 cells) in the therapeutically effective group increased continuously during each time period of antiviral therapy. And the difference was statistically significant (P <0.05) between different time periods. The variation of CD4 count in patients with ineffective treatment was irregular and decreased continuously from the 9th month of treatment. Univariate analysis, age, treatment regimen, initial clinical stage (before treatment), treatment time, baseline CD4 cell count, viral load and missed service were all significantly associated with the failure of antiviral therapy (P < 0.05). After binary Logistic regression analysis, the time of treatment, missed service and initial clinical stage were the risk factors for antiviral therapy (odds ratios (OR) were 3.667, 2.332, and 2.181 respectively]. Conclusion The HIV-infected patients in Yili Prefecture received better anti-viral therapy 9 months before treatment, and the treatment effect was not satisfactory with the prolongation of treatment time. Targeted AIDS awareness-related advocacy and better management and follow-up of HIV-infected persons should enhance the effectiveness of ART in the region.