Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004–2016 in Yunnan, China: an observational cohort study
Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004–2016 in Yunnan, China: an observational cohort study
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DOI：
10.1016/j.glohj.2020.04.001
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发表时间：
2020-06
期刊：
影响因子：
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通讯作者：
Peicheng Wang;Junfang Xu;Bingbing Guo;Jason Wang;Liangmin Gao;Qianyun Wang;J. Jing;F. Cheng
中科院分区：
文献类型：
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作者：
Peicheng Wang;Junfang Xu;Bingbing Guo;Jason Wang;Liangmin Gao;Qianyun Wang;J. Jing;F. Cheng
背景本研究旨在探讨抗逆转录病毒治疗（ART）失败的人类免疫缺陷病毒（HIV）患者临床指标的变化及影响治疗时间的因素。方法回顾性分析2004-2016年ART治疗失败的HIV患者9418例，分为治疗时间≤3年的组1 （n1= 5218）和治疗时间≤3年的组2 （n2= 4200）。从电子健康记录数据库中提取患者随访数据，包括年龄、CD4计数、病毒载量、葡萄糖、肌酐和甘油三酯水平。采用重复测量的协方差分析对生化指标进行分析，采用多元logistic回归模型对不同治疗时间的1组和2组HIV患者队列中提取的相关数据进行比较。结果初始CD4细胞计数中位数为175.0个/μl（四分位数范围为77.0 ~ 282.0），组1的初始CD4细胞计数低于组2 （P< 0.05）。总胆固醇（TC）组效与时间效应显著交互作用（P< 0.05）。HIV患者血红蛋白水平的变化也与治疗时间显著相关（P= 0.001）。初始CD4计数（odds ratio [OR] = 0.756）、女性性别（OR= 0.713）、Zerit (d4T) （OR= 1.443）、TC （OR= 1.285）、天冬氨酸转氨酶水平（OR= 1.002）与死亡HIV患者生存时间有显著相关性（P< 0.05）。此外，初始CD4计数（OR= 1.456）、年龄（OR= 1.022）、时间间隔（OR= 0.903）、患者生活状况（OR= 0.597）、d4T （OR= 2.256）、甘油三酯（OR= 0.930）和血红蛋白水平（OR= 0.997）与HIV患者停药治疗时间有显著相关性（P< 0.05）。结论初始生化指标可影响HIV患者的生存和治疗时间。全面了解患者的生理生化指标，可以降低停药概率，延长HIV患者的生存时间。
BackgroundThis study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus (HIV) patients in whom antiretroviral therapy (ART) was unsuccessful.MethodsIn this retrospective study, a total of 9,418 HIV patients who failed in ART during 2004–2016 were included and divided into two treatment groups—Group 1 (treatment time ≤3 years,n1= 5,218) and Group 2 (treatment time > 3 years,n2= 4,200). Patient follow-up data, including age, cluster of differentiation 4 (CD4) count, and viral load, glucose, creatinine, and triglyceride levels, were extracted from electronic health record databases. Covariance analysis for repeated measures was used to analyze the biochemical indicators, and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.ResultsThe median initial CD4 count was 175.0 cells/μl (interquartile range, 77.0–282.0), while the initial CD4 counts for Group 1 were lower than those for Group 2 (P< 0.05). A significant interaction between group and time effects was observed (P< 0.05) in total cholesterol (TC). Changes in hemoglobin level among HIV patients were also significantly associated with treatment time (P= 0.001). The initial CD4 count (odds ratio [OR] = 0.756), female sex (OR= 0.713), Zerit (d4T) (OR= 1.443), TC (OR= 1.285), and aspartate aminotransferase level (OR= 1.002) were significantly associated with the survival time of dead patients with HIV (P< 0.05). Additionally, the initial CD4 count (OR= 1.456), age (OR= 1.022), time interval (OR= 0.903), patient's living status (OR= 0.597), d4T (OR= 2.256), and triglyceride (OR= 0.930) and hemoglobin levels (OR= 0.997) were significantly associated with the treatment time of HIV patients with drug withdrawal (P< 0.05).ConclusionThe initial biochemical parameters can affect the survival and treatment time of HIV patients. With a comprehensive understanding of the physiological and biochemical indicators of patients, we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.