【摘要】 目的探讨云南省玉溪市新报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS)在未抗病毒治疗的情况下其CD4~+T值快速下降及显著下降情况,分析其相关因素。方法收集未抗病毒治疗HIV/AIDS历次CD4~+T淋巴细胞计数值、人口学特征、样本来源和可能感染途径等,计算快速下降率和显著下降率并分析相关因素。结果 1 480例HIV/AIDS其CD4~+T值快速下降率和显著下降率分别为42.64%(631/1 480)、52.23%(773/1 480),单因素分析结果显示,CD4~+T值快速下降与性别、文化、年龄、职业、婚姻状况、传播途径、首次CD4~+T值以及首末次检测时间间隔有关,CD4~+T值显著下降与文化、民族、传播途径、首次CD4~+T值以及首末次检测时间间隔有关;经多因素Logistic回归分析表明,女性(OR=1.271,95%CI:1.044~1.674)、已婚(OR=1.460,95%CI:1.093~1.949)、传播途径注射吸毒(OR=1.365,95%CI:1.016~1.833)、首次CD4~+T值>500cell/μL,更容易出现CD4~+T值快速下降,首末次检测时间间隔>18个月更不容易出现CD4~+T值快速下降;传播途径注射吸毒(OR=1.286,95%CI:1.018~1.625)、首次CD4~+T值>500 cell/μL、首末次检测时间间隔≥6个月,更容易出现CD4~+T值显著下降,传播途径为男男性行为(OR=0.426,95%CI:0.199~0.914)更不容易出现CD4~+T值显著下降。结论 HIV/AIDS患者CD4~+T值快速下降和显著下降与性别、婚姻状况、传播途径等因素有关,需加强对女性、已婚、注射吸毒人群的定期随访,及时启动抗病毒治疗。更多还原

【Abstract】 Objective To examine the proportion of rapid and significant decline of CD4~+T cell counts and related influencing factors among antiretroviral treatment( ART)-naive HIV/AIDS patients newly reported in Yuxi,Yunnan. Methods The information of ART-naive HIV/AIDS patients including all previous CD4~+T cell counts,demo-graphic characteristics,sample source and potential route of HIV transmission were collected,and the rates of rapid and significant CD4~+T decline were counted,and the related factors were statistically analyzed. Results The rates of rapid and significant CD4~+T decline were 42. 64%( 631/1 480) and 52. 23%( 773/1 480) respectively. Univariate logistic regression analyses indicated that rapid decline of CD4~+T cell counts were associated with gender,education,age,occupation,marital status,route of HIV infection,baseline CD4~+T cell counts,and interval between first and last CD4~+T testing,whereas the significant decline of CD4~+T cell counts were associated with education, ethnicity, route of HIV infection, baseline CD4~+T cell counts,and interval between first and last CD4~+T testing. Multivariate logistic regression analyses indicated that females( OR = 1. 271,95% CI: 1. 044 ~ 1. 674),being married( OR = 1. 460,95% CI: 1. 093 ~ 1. 949),HIV transmitted through injected drug use( OR = 1. 365,95% CI: 1. 016 ~ 1. 833),initial CD4~+T cell counts> 500 cell/μL were more likely to lead to a rapid CD4~+T decline,whereas interval between first and last CD4~+T testing > 18 months was less likely to result in a rapid CD4~+T decline; HIV transmitted through injected drug use( OR = 1. 286,95% CI:1. 018 ~ 1. 625),initial CD4~+T cell counts > 500 cell/μL,and interval between first and last CD4~+T testing > 6 months were more likely to contribute to a significant CD4~+T decline,whereas male-to-male contact( OR = 0. 426,95% CI: 0. 199 ~0. 914) were less likely to witness a significant CD4~+T decline. Conclusion Gender,marital status,route of HIV infection were associated with rapid decline and significant decline of CD4~+T cell counts. Therefore,it is important to strengthen the regular follow-up for those being female,married,transmitted through injected drug use and to initiate ART timely.更多还原