Therapeutic Effects And Influencing Factors Among HIV/AIDS Patients Received HAART

BackgroundThe ultimate goal of HAART is observably decrease of HIV-related morbidity and mortality; and the delay of the disease progression. With the help of combination medicine, the results are immune system reconstitution, suppression of plasma HIV RNA levels to below the limit of detection and the improve of quality of life. Since HAART has rolled out, it can observably drop HIV-related morbidity and mortality from1995-1997in America, respectively was60%-80%and44%. Although the startup of our antiviral therapy was later than other developed countries, in recent years we has obtained some achievements, given that HIV-related fatality has decreased from27-30/100person-years to4-5/100person-years.ObjectivesThis study aims to explore the therapeutic effects and influencing factors of HIV/AIDS patients who received HAART in Nanjing City and provide a scientific basis for the comprehensive treatment of AIDS.MethodsTotal140adult HIV/AIDS were admitted into the Department of Infectious Disease, The Second Hospital of Nanjing between January1st,2009and December31,2011. The health archives were set up according to baseline epidemiological investigation and laboratory test results. It would be good for us to assess present disease stages of patients. It included sociodemographic characteristic, previous medical history, clinical feature, CD4+T cell counts, virus load and biochemical markers. Then patients were followed up every three months, we had more attention on the change of CD4+cell counts, virus load, side effects, opportunistic infections and medicine changes. The questionnaires of investigation came from the information system of National AIDS prevention and control, the administration of antiviral therapy. Collected data were analysed by EpiData3.02, SPSS13.0, EpiCalc2000softwares.ResultsMost patients were male (104,74.3%),36(25.7%) were female. The average age (±SD) was38.5±10.3years. The median of baseline CD4+cell count was178.5(IQR:46.8-269.0), no one could below the detection limit of viral load. The median follow-up time was15months (IQR:9.0-23.0). The CD4+cell counts showed an upward trend, especially in the first three months (the median was249.5, IQR:95.5-350.0), which ascensional range was71.0. The ratio of CD4+<200would continuously decrease along with the prolonging of therapeutic time (χ2=41.396,,P<0.001). Compared with baseline, the number of patients whose virus load<50had greatly increased, the ratio of virus load>10000would also continuously decrease along with the prolonging of therapeutic time (χ2=115.626, P<0.001).The multivariate COX analysis showed that the baseline CD4+cell counts of patients were significantly related to therapeutic effect (HR=2.00,95%CI:1.05-3.97, P=0.047). We constructed a five-state Markov model to predict the changes of CD4+cell counts for the next three months. The CD4+cell counts present a significantly increasing tendency in patients with s2and s4. There were216cases immune system improvement, and60cases immune system deterioration. During study period, death mainly happened in the first three months after starting treatment. The multivariate COX analysis showed that age (HR=1.52,95%CI:1.03-2.47, P=0.040) and the baseline CD4+cell counts (HR=2.79,95%CI:1.34-5.18, P=0.031) were significantly related to survival. ConclusionThe antiviral therapy could availably improve patients’health status, one of the major determinant was the baseline CD4+cell counts. So as to seize the timing of treatment, raise the efficiency, the CD4+cell counts should be periodically detected after patients had a confirmed HIV infection. In the course of treatment there were serious side effects, it also prompted us that relevant prevention measures should be given; side effects management should be strengthened.