Comparison Of Antiretroviral Therapy Effect Of HIV/AIDS Among Heterosexual Individuals And Injecting Drug Users And Markov Model Study

Objective 1.To study the difference in HIV/AIDS treatment effect between heterosexual individuals and injecting drug users and the factors affecting the treatment effect in Yili,Xinjiang;2.To construct a Markov model to analyze the disease progression of HIV/AIDS after receiving antiviral therapy and its influencing factors.Methods A prospective cohort study conducted among HIV/AIDS infected through heterosexual contact and injecting drug,and who received antiretroviral therapy at the Second People’s Hospital of Yining City from January 2019 to October 2020.The rates of antiretroviral therapy failure between the two groups was compared using the Log-rank test in Kaplan-Meier,and the Cox proportional risk model was applied to explore the factors that influence treatment failure in the two groups of HIV/AIDS.Compare the treatment effects and analyze the factors effecting the differences of the treating effect and a continuous CD4+T lymphocyte count level-based A Markov model based on CD4+T-lymphocyte count in discrete time states was constructed to analyze the progression pattern of AIDS.Results In this cohort study,960 and 527 heterosexually transmitted and injecting drug users were followed up,respectively,the total number of observation person years was 2008.50 person years.CD4+T-cell counts increased from 322/μL and309/μL to 616/μL and 501/μL in heterosexual individuals and injection drug users,respectively.Both immunological and virologic failure rate among injecting drug users are higher than heterosexual individuals[26.19%vs.10.42%(X~2=64.588,P<0.001),12.52%vs.8.85%(X~2=4.917,P=0.027)].The growth of CD4~+T cell counts among injecting drug users is lower than heterosexual individuals.Injecting drug users are at higher risk than heterosexual individuals in immunological and virologic treatment effect[a HR=2.75(95%CI:2.12～3.56),a HR=1.40(95CI:1.01～1.96)].Baseline CD4+T-cell counts of 200-349 cells/μL(a HR=2.07,95%CI:1.17～3.66),<200 cells/μL(a HR=2.51,95%CI:1.39～4.52),current use of second-line regimens(a HR=1.56,95%CI:1.12 to2.21),and clinical stage III(a HR=3.01,95%CI:1.72～5.26),and stage IV(a HR=3.85,95%CI:1.38～10.71)were risk factors for treatment failure,and age 20-49 years(a HR=0.67,95%CI:0.46～0.97),>50 years(a HR=0.24,95%CI:0.07～0.77)were protective factors.2.Markov model:1491 HIV/AIDS were included,with a total follow-up of 2224.5 person-years.S1 having the longest total length of stay of 201.34months and S4 having the highest probability of death.The results of multifactorial analysis showed that the transition intensity of S1 to S2 increased in those≥50 years old(a HR=1.56,95%CI:1.09～2.25);the intensity of S1→S2,S2→S3 was higher in injecting drug users(a HR=1.66,95%CI:1.37～2.01;a HR=1.65,95%CI:1.21～2.25)and lower in S2→S1 and S3→S2(a HR=0.80,95%CI:0.68～0.94;a HR=0.73,95%CI:0.58～0.92)compared with heterosexual individuals;compared with baseline CD4+T lymphocyte counts≥500/μL,the transition intensity of S1→S2 was higher in those with baseline CD4+T lymphocyte counts of 350-499/μL,200-349/μL and≤199/μL(a HR=1.66,95%CI:1.25～2.21;a HR=2.10,95%CI:1.61～2.73;a HR=2.66,95%CI:1.97～3.59);the S1→S2of those with baseline CD4+T lymphocyte counts of 350-499/μL,200-349/μL and≤199/μL The intensity of metastasis was lower in those with baseline CD4+T-lymphocyte counts≥500(a HR=0.71,95%CI:0.56～0.89;a HR=0.66,95%CI:0.53～0.82;a HR=0.60,95%CI:0.47～0.77);S2→S3 was higher in those with baseline CD4+T-lymphocyte counts<200/μL than in those with baseline CD4+T-lymphocyte counts≥500(a HR=2.06,95%CI:1.20～3.55);the transition intensity of S2→S3 was higher in those who in stage II than those in stage I(a HR=1.44,95%CI:1.05～1.97).Conclusion After antiretroviral therapy,the immunological function of HIV/AIDS in heterosexual individuals and injecting drug users has recovered to a certain extent,but the treatment effect of heterosexually transmitted HIV/AIDS is better than that in injecting drug users,and the growth rate of CD4~+T cell count is higher than that of injecting drug users.Therefore,we should strengthen the monitoring of injecting drug users and improve their treatment compliance,so as to improve the treatment effect.After ART,HIV/AIDS tends to metastasize more to adjacent immune better state metastases,and patients who are older(≥50 years old),infected by injecting drug use,and have lower baseline CD4+T lymphocyte count levels are at greater risk of immune deterioration.