| Objective: By investigating and following up adults with HIV/AIDS in guangxi province who receive HAART in 2007-2014,we grasp the basic characteristics,clinical features,treatment and follow-up status;Realizing the living situation of guangxi AIDS patients after antiviral treatment and treatment effect,survival time after antiviral treatment in patients with HIV/AIDS treatment and its influencing factors;Discussion of highly active antiretroviral therapy in patients with HIV/AIDS the influence factors of virology and immunology treatment effect;Analyze the first-line drug side effects and drug resistance in first-line treatment failure situation and its influencing factors;And establish for first-line treatment failure and drug resistance after replacement of second-line drugs obserational cohort of patients,analyze the treatment effect after 12 months,to reduce the replacement treatment and effective choice second-line drugs over a limited range.Provide prevention measures in accordance with the practical situation in guangxi province so as to improve the survival condition of HIV/AIDS patients,providing reference to enhance the efficacy of HAART.Methods: By retrospective study method,through the information system for the prevention and control of AIDS,collect all guigang area in guangxi from2007 to 2014 for the first time receive antiviral treatment of the basic conditions and treatment of adult patients with HIV/AIDS information,the information about the research object of all eligible,the logical database was founded after the verification,proofreading,then use SPSS 19.0 statistical analysis,using the median or mean(+ /-standard deviation)statistics describe the measurement data,the percentage and frequency statistics describe classification variables;Estimate the object of study of cumulative survival rate and survival curves using the life table method,estimate depict different factors between the survival rate and survival more curve with Kaplan Meier,check the difference by using the log-rank;Virology,immunology treatment effect after antiviral treatment,survival time and the influence factors of drug resistance analysis are conducted by using the Cox proportional hazards model;For first-line treatment failure and after drug resistance change second-line treatment effect the influence factors of the treatment using Logistic regression models were analyzed.Results: 1.Basic characteristics: men more than women,and marital status in the majority with married or cohabiting,majority at the age of 40 ~ 60 age,level of education for primary school and below(90.1%),81.1% of farmers/migrant workers,the infection is given priority to with sexual transmission(89.9%),among them heterosexual sexual transmission accounted for 71%,sexual transmission accounted for 19%.2.Total opportunistic infection rate was 34.8%,located in the top five opportunistic infections are: continuous or intermittent fever(29.7%),thrush(20.8%),skin lesions(19.3%),diarrhea(11.6%),oral hairy leukoplakia(11.1%).3.The end of life and influencing factors: CFR 3.2/100 years,began to antiviral treatment 1 ~ 8 years cumulativesurvival rates were 93.7%,91.1%,89.1%,87.3%,85.3%,83.7%,82.2%,83.7%;Age is smaller,teacher/student/staff/staff/other professions,the higher level of education,same-sex sexual transmission,no history,no history of tuberculosis,hepatitis b,the lower the clinical stage,the less number of baseline symptoms,the less number of opportunistic infections,baseline baseline CD4 + T lymphocyte count level is higher,the initial treatment containing AZT or EFV,follow-up process to replace the second-line anti-viral treatment,compliance of95% or more after AIDS antiviral treatment in patients with a longer survival time.4.Immunology and influencing factors of failure: general immunology failure rate was 29.8%(924/3100).In a multiariable Cox regression model,found that age,unmarried,clinical stage for Ⅳ,baseline symptoms,the more the more number of opportunistic infections,the initial baseline treatment containing AZT or NVP and treatment during the history of tuberculosis(TB),compliance < 95%,appear resistant and replace the second line)in patients with antiviral drugs phenomenon of immunology have a higher risk of failure.Relative to the baseline level of CD4 + T lymphocyte count is 0 ~ 50 / mu l patients,51 ~ 200 / mu l,201 ~ 201 / mu l immunology failure after antiviral treatment in patients with lower risk of(HR 0.55,0.79,respectively),but the351-500 / u l,501-a/u l immunology after antiviral treatment in patients with the risk of failure is 0 ~ 50 patients/mu l high(HR 1.62,3.40,respectively).5.Virological failure and its influencing factors: a cumulative 11.8%(366/3100)of patients virologic failure,general virology failure rate is 5.0/100 years(95% CI:4.5 ~ 4.5).At 12 months and 24 months,48,60 months and 96 months,patients with cumulative virologic failure rate were 6.8%,13.7%,21.7%,27.7%,21.7%.In a multiariable Cox regression model,find unmarried,initial treatment containing AZT,and history of tuberculosis(TB),compliance during thetreatment were < 95%,appear resistant and replace the second-line anti-viral drugs phenomenon of patients have a higher risk of virologic failure.6.The side effects of first-line drugs scheme and drug resistance of first-line treatment failure happens and its influencing factors: change the drug because of adverse reaction of patients has accumulated 738.Replacement cause major adverse reaction in turn have a rash of 135 people,95 people(18.4%),nausea and vomiting(12.9%),appetite change 87 people(11.6%),fatigue,38(5.1%),limb numbness,33(4.4%),shape change,26(3.5%),headache,21(2.8%),13 sleep difficulty(1.8%),limb pain 11(1.5%),adopt different NRTI classes and NNRTI class of drugs,the majority of drug adverse reaction of the difference was statistically significant.First-line treatment failure patients with drug resistance in 53.7% of patients.Age,treatment,treatment time,VL level on genetic testing and CD4 + T cell count have shown involved in the resistance to first-line treatment failure patients.7.Replace the therapeutic effect of second-line drugs:12 months after treatment to achieve virologic suppression of patients was72.3%.Age and duration of treatment is to second-line treatment after 12 months of virologic suppression of the important factors.After HAART CD4 +T lymphocyte count an average growth rate present a descending trend,is7.6818 / L;Viral load present a linear decline,decline of 0.4538 log copies/ml;CD4 + T cell count and viral load of HIV-1 change present a very significant correlation,correlation is 0.867.The 1 year survival rate can reach 87%.Conclusion:(1)guigang area in guangxi AIDS patients is given priority to with the elderly men,close to three 90%(90% farmers/migrant workers,90% of sexually transmitted,90% illiteracy);The total infection rate was 34.8 percent,indicating that most of the HIV/AIDS epidemic had been reached.HIV/AIDS patients have extremely significantly effect of highly active antiretroviraltherapy,and after treatment,the patient’s survival rate,immunology,virology therapeutic effect compared with literature have greatly improved;For first-line treatment failure and after resistance to replace second-line treatments still achieve good treatment effect,therapeutic effect as the extension of time showing a decreasing trend.(2)at the beginning of the age,marital status,clinical stage,the number of baseline symptoms,the baseline number of opportunistic infection,the number of CD4 + T cell level,the initial treatment and during treatment if there is a history of tuberculosis(TB),compliance,and whether any resistance and whether the change in time second-line anti-viral drugs is the main factor of highly active antiretroviral treatment for HIV/AIDS patients.(3)using different NRTI and NNRTI drugs,the difference in the majority of drug toxicity was statistically significant.In patients with first-line treatment failure,53.7 percent of patients had resistance.Age,marital status,treatment options,treatment time,VL levels in gene testing,and the CD4 + T cell count are all shown to be associated with drug resistance.(4)HAART treatment effect is ideal,should be treated as soon as possible,in the process of the treatment should take effective measures to monitor changes in patients with CD4 + T,VL level,opportunistic infection and drug resistance in patients with situation,carefully chosen treatment at the same time,strengthen the drug compliance education,dynamic understanding of patients with drug use situation,found that resistance and adjust the treatment plan in time. |
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