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目的比较不同时机开始抗病毒治疗对艾滋病患者耐药产生的影响。方法对河南省接受一线抗病毒治疗方案>6个月的艾滋病患者进行横断面调查,根据基线免疫水平,将调查对象分为早期治疗组(CD4+T淋巴细胞≥350个/mm3)132例、常规治疗组(CD4+T淋巴细胞201个/mm3~349个/mm3)200例和延迟治疗组(CD4+T淋巴细胞≤200个/mm3)329例。通过多因素Logistic回归,分析抗病毒治疗患者耐药发生的影响因素。结果共调查符合条件的抗病毒治疗患者661例,总耐药率为34.3%(227/661),其中早期治疗组、常规治疗组和延迟治疗组出现耐药突变的比例分别为21.2%(28/132)、35.5%(71/200)和38.9%(128/329)。多因素Logistic回归分析显示,早期治疗(OR=0.31,95%CI 0.19~0.51,P<0.001)、依从性高(OR=0.48,95%CI 0.30~0.78,P=0.003)和含3TC初始治疗方案(OR=0.20,95%CI 0.20~0.40,P<0.001)是影响抗病毒治疗耐药产生的保护因素,治疗时间长(OR=1.90,95%CI 1.22~2.95,P=0.004 3)是影响抗病毒治疗耐药产生的危险因素。结论早期开始抗病毒治疗可减少抗病毒治疗患者耐药毒株的产生,能取得良好的抗病毒治疗效果。
Objective To compare the impact of antiretroviral therapy on drug resistance in AIDS patients at different times. Methods A cross-sectional survey of AIDS patients receiving first-line antiviral therapy in Henan Province for> 6 months was conducted. According to the level of baseline immunity, the subjects were divided into 132 cases of early treatment group (CD4 + T lymphocyte≥350 cells / mm3) 200 cases of conventional therapy group (201 cells / mm3 ~ 349 cells / mm3 of CD4 + T lymphocyte) and 329 cases of delayed therapy group (CD4 + T lymphocyte≤200 cells / mm3). Through multivariate Logistic regression analysis, the influencing factors of drug resistance in patients with antiviral therapy were analyzed. Results A total of 661 patients with antiretroviral therapy were investigated. The total drug resistance rate was 34.3% (227/661). Among them, 21.2% (28.2%) had drug-resistant mutations in the early treatment group, the routine treatment group and the delayed treatment group / 132), 35.5% (71/200) and 38.9% (128/329). Multivariate logistic regression analysis showed that early treatment (OR = 0.31, 95% CI 0.19-0.51, P <0.001), high compliance (OR = 0.48, 95% CI 0.30-0.78, P = 0.003) The long-term treatment (OR = 1.90, 95% CI 1.22-2.95, P = 0.004 3) was a significant protective effect of antiretroviral therapy Impact of anti-viral treatment of drug-resistant risk factors. Conclusion Antiviral therapy can reduce the generation of drug-resistant strains in patients with antiviral therapy at the early stage and achieve good antiviral treatment effect.