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目的探讨浙江省台州市未接受抗病毒治疗的HIV感染者CD4+T淋巴细胞计数自然变化速率及相关影响因素。方法对1996-2011年台州市报告发现的无抗病毒治疗史或接受抗病毒治疗前至少有过两次CD4+T淋巴细胞计数检测的HIV感染者进行回顾性队列研究,描述CD4+T淋巴细胞计数自然变化速率,并运用Lo-gistic回归分析其影响因素。结果共纳入研究对象412例,CD4+T淋巴细胞计数月均自然变化速率中位数M=-2.9(IQR:-9.7～1.6);286例(69.4%)HIV感染者末次CD4+T淋巴细胞计数结果低于首次;130例(31.6%)HIV感染者末次CD4+T淋巴细胞计数较首次水平下降≥30%,即显著下降。Logistic多因素回归分析显示,HIV感染者CD4+T淋巴细胞计数显著下降与年龄、职业、首次CD4+T淋巴细胞计数水平及首末次检测时间间隔存在关联。结论浙江省台州市HIV感染者CD4+T淋巴细胞计数自然变化总体平缓,但部分感染者CD4+T淋巴细胞计数快速下降且与多种因素有关。应定期随访检测HIV感染者CD4+T淋巴细胞计数水平,密切观察变化速率,以评估其病情进展并适时启动抗病毒治疗。
Objective To investigate the natural rate of CD4 + T lymphocyte count and its related factors in HIV-infected patients who did not receive antiviral therapy in Taizhou, Zhejiang Province. Methods A retrospective cohort study was conducted on HIV-infected patients without prior history of antiviral therapy or at least two CD4 + T-cell counts before antiviral therapy reported in Taizhou in 1996-2011 to describe the role of CD4 + T lymphocytes The natural rate of change was counted and the influencing factors were analyzed by Lo-gistic regression. Results A total of 412 subjects were enrolled in this study. The median monthly natural mean change rate of CD4 + T lymphocyte count was M = -2.9 (IQR: -9.7 ~ 1.6). The last CD4 + T lymphocytes in 286 (69.4%) HIV- Counting results were lower than the first time; the final CD4 + T lymphocyte count in 130 cases (31.6%) of HIV-infected patients was significantly lower than the first level by more than 30%. Logistic multivariate regression analysis showed that the significant decrease of CD4 + T lymphocyte count in HIV-infected patients was correlated with age, occupation, first-time CD4 + T-lymphocyte count and the first and last time interval. Conclusion The natural changes of CD4 + T lymphocyte count in HIV-infected persons in Taizhou City, Zhejiang Province are generally mild. However, CD4 + T lymphocyte count of some HIV-infected patients declines rapidly and is related to many factors. Regular follow-up detection of HIV-infected patients with CD4 T lymphocyte count levels, close observation of the rate of change to assess the progress of their disease and start antiviral therapy timely.