中國不同性別成人艾滋病抗病毒治療效果的差異
發(fā)布時(shí)間：2018-08-01 14:02
【摘要】：目的探索我國不同性別的成人HIV感染者/AIDS患者抗病毒治療效果的差異,評(píng)價(jià)性別對(duì)病毒抑制率、治療保持率和病死率的影響,為明確發(fā)展中地區(qū)成人HIV感染者/AIDS患者的性別對(duì)抗病毒治療效果的影響及進(jìn)一步明確不同性別抗病毒治療效果差異的原因提供研究依據(jù)。方法使用國家免費(fèi)抗病毒治療數(shù)據(jù)庫中的防治數(shù)據(jù)進(jìn)行回顧性隊(duì)列研究。將2010年1月1日至2011年12月31日期間初次開始抗病毒治療的、18歲以上、以推薦一線治療方案為初始治療方案的HIV感染者/AIDS患者作為研究對(duì)象,隨訪觀察4年,研究終止時(shí)間為2015年12月31日。用Logistic回歸進(jìn)行總體和分層分析,比較不同性別在治療12個(gè)月及48個(gè)月后病毒抑制率、治療保持率的差異,用Kaplan-Meier.法和Cox比例風(fēng)險(xiǎn)模型進(jìn)行總體和分層分析,比較不同性別病死率的差異。納入分析的因素還包括年齡、體重指數(shù)、地區(qū)、婚姻狀況、感染途徑、基線CD4細(xì)胞計(jì)數(shù)、初始治療方案、診斷HIV感染至開始治療時(shí)間。用SAS9.3軟件進(jìn)行數(shù)據(jù)處理和統(tǒng)計(jì)分析。結(jié)果共68646名患者被納入研究,其中67.1%(46083名)為男性患者,32.9%(22563名)為女性患者�？傮w分析結(jié)果表明,女性患者在治療12個(gè)月后(校正OR:1.13,95%CI:1.06-1.21)及 48 個(gè)月后(校正 OR:1.10,95%CI:1.01-1.20)都比男性患者更易達(dá)到病毒抑制。女性患者在治療12個(gè)月后(校正OR:1.15,95%CI:1.08-1.23)及治療48個(gè)月后(校正OR:1.22,95%CI:1.15-1.29)比男性患者更易保持治療。所有研究對(duì)象治療4年的病死率為3.45/100人年,其中女性患者病死率低于男性患者(2.34 vs.4.03/100人年),女性患者死亡風(fēng)險(xiǎn)更小(校正HR:0.71,95%CI:0.66-0.76)。分層分析結(jié)果表明,開始治療年齡18-44歲、農(nóng)村、經(jīng)血液傳播/既往獻(xiàn)血感染、經(jīng)注射吸毒感染、基線CD4細(xì)胞計(jì)數(shù)200-349個(gè)/μ L、診斷至開始治療時(shí)間大于3個(gè)月的患者中女性治療12個(gè)月及48個(gè)月病毒抑制率均高于男性。結(jié)論本研究發(fā)現(xiàn)我國接受抗病毒治療的女性患者比男性患者更易達(dá)到病毒抑制、更易保持治療,女性患者的病死率也明顯低于男性患者。今后可以進(jìn)一步開展研究探索導(dǎo)致抗病毒治療效果性別差異的原因、探索性別對(duì)服藥依從性的影響等。
[Abstract]:Objective to explore the effect of antiviral therapy on HIV / AIDS patients of different genders in China, and to evaluate the effect of sex on viral inhibition rate, treatment retention rate and mortality rate. In order to clarify the effect of gender antiviral therapy in adult patients with HIV / AIDS in developing areas and to further clarify the reasons for the difference of the effect of anti-virus therapy between different sexes. Methods A retrospective cohort study was conducted using the prevention and treatment data from the national free antiviral therapy database. From January 1, 2010 to December 31, 2011, the patients over 18 years of age who first began antiviral therapy between January 1, 2010 and December 31, 2011, were followed up for 4 years. The study was terminated on December 31, 2015. The overall and stratified analysis with Logistic regression was used to compare the difference of virus inhibition rate and treatment retention rate between different genders after 12 and 48 months of treatment. Kaplan-Meier was used. Method and Cox proportional risk model were used to analyze the overall and stratified mortality. Factors included in the analysis included age, body mass index, region, marital status, route of infection, baseline CD4 cell count, initial treatment regimen, and diagnosis of HIV infection to the beginning of treatment. Data processing and statistical analysis are carried out with SAS9.3 software. Results A total of 68646 patients were included in the study, of which 67.1% (46083) were male and 32.9% (22563) were female. The overall analysis showed that female patients were more likely than male patients to achieve viral suppression 12 months after treatment (adjusted OR: 1.1395CI: 1.06-1.21) and 48 months later (adjusted OR: 1.1095 CI: 1.01-1.20). Female patients were more likely to maintain treatment than male patients after 12 months of treatment and 48 months of treatment (OR: 1.2295 CI: 1.15-1.29). The mortality of all subjects was 3.45 / 100 person-years. The mortality of female patients was lower than that of male patients (2.34 vs.4.03/100 person-years), and the risk of death of female patients was lower than that of male patients (adjusted HR0.7195 CI: 0.66-0.76). The results of stratified analysis showed that patients aged 18-44 years, who started treatment in rural areas, were infected by blood transmission / blood donation, and were infected by injecting drug use. The baseline CD4 cell counts of 200-349 cells / 渭 L were significantly higher in women than in men at 12 and 48 months of treatment for more than 3 months from the diagnosis to the beginning of treatment. Conclusion this study found that female patients receiving antiviral therapy were more likely to achieve viral inhibition and maintain treatment than male patients, and the mortality of female patients was significantly lower than that of male patients. Further research can be carried out to explore the causes of gender differences in antiviral efficacy and the effect of exploratory differences on drug compliance.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.91
本文編號(hào)：2157808
[Abstract]:Objective to explore the effect of antiviral therapy on HIV / AIDS patients of different genders in China, and to evaluate the effect of sex on viral inhibition rate, treatment retention rate and mortality rate. In order to clarify the effect of gender antiviral therapy in adult patients with HIV / AIDS in developing areas and to further clarify the reasons for the difference of the effect of anti-virus therapy between different sexes. Methods A retrospective cohort study was conducted using the prevention and treatment data from the national free antiviral therapy database. From January 1, 2010 to December 31, 2011, the patients over 18 years of age who first began antiviral therapy between January 1, 2010 and December 31, 2011, were followed up for 4 years. The study was terminated on December 31, 2015. The overall and stratified analysis with Logistic regression was used to compare the difference of virus inhibition rate and treatment retention rate between different genders after 12 and 48 months of treatment. Kaplan-Meier was used. Method and Cox proportional risk model were used to analyze the overall and stratified mortality. Factors included in the analysis included age, body mass index, region, marital status, route of infection, baseline CD4 cell count, initial treatment regimen, and diagnosis of HIV infection to the beginning of treatment. Data processing and statistical analysis are carried out with SAS9.3 software. Results A total of 68646 patients were included in the study, of which 67.1% (46083) were male and 32.9% (22563) were female. The overall analysis showed that female patients were more likely than male patients to achieve viral suppression 12 months after treatment (adjusted OR: 1.1395CI: 1.06-1.21) and 48 months later (adjusted OR: 1.1095 CI: 1.01-1.20). Female patients were more likely to maintain treatment than male patients after 12 months of treatment and 48 months of treatment (OR: 1.2295 CI: 1.15-1.29). The mortality of all subjects was 3.45 / 100 person-years. The mortality of female patients was lower than that of male patients (2.34 vs.4.03/100 person-years), and the risk of death of female patients was lower than that of male patients (adjusted HR0.7195 CI: 0.66-0.76). The results of stratified analysis showed that patients aged 18-44 years, who started treatment in rural areas, were infected by blood transmission / blood donation, and were infected by injecting drug use. The baseline CD4 cell counts of 200-349 cells / 渭 L were significantly higher in women than in men at 12 and 48 months of treatment for more than 3 months from the diagnosis to the beginning of treatment. Conclusion this study found that female patients receiving antiviral therapy were more likely to achieve viral inhibition and maintain treatment than male patients, and the mortality of female patients was significantly lower than that of male patients. Further research can be carried out to explore the causes of gender differences in antiviral efficacy and the effect of exploratory differences on drug compliance.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.91
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