摘要
目的了解HIV感染者抗病毒治疗发生继发性耐药的影响因素，为提高山东省抗病毒治疗效果提供依据。方法按照病例对照研究设计，1：2匹配病例组和对照组，2015年10月进行入户面对面调查。根据山东省级实验室自建的HIV感染者抗病毒治疗耐药数据库和艾滋病综合防治数据信息系统，筛选研究对象。样本量估计为330例（病例110例、对照组220例），研究对象为在山东省存活的HIV感染者、年龄≥15岁、参加抗病毒治疗≥个月并检测病毒载量（VL）。针对VL〉1000拷贝／ml者进行实验室耐药检测，筛选出继发性耐药者作为病例组，非继发性耐药者为对照组。采用EpiData3．1软件和SPSS22．0软件建立数据库，运用非条件逐步logistic回归分析继发性耐药的影响因素。结果研究对象共288例（病例组103例、对照组185例）。病例组年龄为（37．62±1．06）岁，对照组年龄为（37．90±0．74）岁，以男性、已婚／同居者、高中及以下文化程度、汉族为主。多因素logistic回归分析结果显示，与治疗时间〈1年相比，治疗时间1～3年和〉3年的0R值分别为8．80（95％CI：3．69～21．00）、3．00（95％CI：1．20．7．53）；与未漏服相比，漏服比例〉25．0％的OR值为15．41（95％CI：4．59～51．71）；本人领药OR值为0．22（95％CI：0．07～0．74）。结论HIV感染者的治疗时间、漏服比例、本人领药为其抗病毒治疗继发性耐药的影响因素。治疗时间≥1年、漏服药物比例〉25％为继发性耐药的危险因素，本人领药为继发性耐药的保护因素。应加强治疗优化的干预力度，提高HIV感染者本人对服药的认知水平。
Objective To explore the causes of secondary drug resistance among HIV infected persons who were receiving antiretroviral therapy in Shandong province, and provide evidence for the improvement of antiretroviral therapy strategy. Methods A case-control study was designed with 1 ： 2 matching on case and control groups. Household and face-to-face interview were conducted in October, 2015. All the study subjects were screened from both the drug resistant database of antiretroviral therapy of Shandong provincial laboratory and national comprehensive HIV/AIDS database in Shandong. The sample size was estimated as 330 cases including 110 drug resistant and 220 non-drug resistant cases. Subjects were people living with HIV/AIDS （PLWHA） aged 15 or older and received antiretroviral therapy for more than 6 months with records of virus load （VL）. Subjects who presented VL above 1 000 copies/ml would receive drug resistance testing. Subjects who were confirmed resistant to with secondary drug, were selected as case group, the rest subjects with non- secondary drug resistance would form the control group. EpiData 3.1 software and SPSS 22.0 software were used to establish a database. Related influencing factors were analyzed with non- conditional stepwise logistic regression model. Results A total of 288 cases were enrolled, including 103 in the case and 185 cases in the control groups, with average age as （37.62± 1.06） years and （37.90 ± 0.74） years old, respectively. Most of them were male, married/cohabitant, with education level of junior/ senior high school or below and under Han nationality. Results from the multivariate logistic regression model showed that ORs （95%CI） of receiving antiretroviral therapy for 1-3 years, or more than 3 years were equal to 8.80 （3.69-21.00）, 3.00 （1.20-7.53）, compared with receiving antiretroviral therapy less than one year, respectively. OR （95%CI） of Among the PLWHA that with missing rate above 25.0% on medication, the OR appeared as 15.41（4.59-51.71）, compared with not missing medication. OR （95% CI） among those who took the medicine themselves was 0.22 （0.07-0.74）. Conclusions Factors as duration of treatment, missing rate on medication and taking medicine by oneself were of influence on secondary drug resistance. Other factors as duration on antiretroviral therapy longer than 1 year, missing rate above 25.0% on medication, were related to the risk on secondary drug resistance. However, if the medicine was taken by oneself, it served as a protective factor for secondary drug resistance. It is necessary to strengthen the intervention and health education programs related to antiretroviral therapy.
作者
单士馨
孙晓光
朱晓艳
张娜
廖玫珍
黄涛
李瑞
杨特
段青
康殿民
Shan Shixin;Sun Xiaoguang;Zhu Xiaoyan;Zhang Na;Liao Meizhen;Huang Tao;Li Rui;Yang Te;Duan Qing;Kang Dianmin(Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, China;School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250062, China;Key Laboratory of Infectious Disease Control and Prevention of Shandong Province, School of Public Health, Shandong University, Jinan 250012, China)
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2018年第7期943-947,共5页
Chinese Journal of Epidemiology
基金
山东省医药卫生科技发展计划（2013ws0161）
关键词
艾滋病
抗病毒治疗
继发性耐药
病例对照研究
AIDS
Antiretroviral therapy
Secondary drug resistance
Case-control study
