摘要
目的 本研究通过系统评价与Meta分析方法,旨在明确接受cART后HIV/AIDS患者低病毒血症(LLV)的发生率及其影响因素,为临床制定针对性干预策略提供循证依据。方法 系统检索中英文数据库(包括CNKI、万方、维普、CBM、Web of Science、Embase、PubMed及Cochrane Library),建库至2024年7月31日前发表的观察性研究。采用RevMan5.0软件进行Meta分析。结果 共纳入19项研究(中文10篇,英文9篇),涵盖124 218例患者(含LLV第一报表病例23 569例)。Meta分析显示:LLV总发生率为15%(95%CI:11%~20%),其中,中国人群发生率14%(95%CI:10%~17%)显著高于其他国家9%(8%~10%);LLV发生的危险因素包括年龄>50岁(OR=1.39)基线VL>1×10^(5)copies/mL(OR=2.74)、CD4细胞计数<200 cells/μL(OR=1.45)、二线cART(OR=1.97)、cART≥2年(OR=2.46)、中途换药(OR=2.32)、用药依从性不好(OR=3.73)、男性(OR=1.31)(P均<0.001)。CD4细胞计数≥200 cells/μL、没有停药为LLV保护性因素。敏感性分析显示效应量稳定,漏斗图基本对称,提示发表偏倚风险相对低。结论 LLV在经cART治疗HIV/AIDS患者中发生率总体呈中低水平,但中国患者风险较为突出。高基线病毒载量、二线用药、接受cART两年及以上、服药依从性差及免疫抑制状态是核心风险因素。建议对高危人群加强病毒载量监测与用药管理,优化个体化治疗策略以降低LLV风险。
Objective To clarify the incidence of low-level viremia(LLV)and its influencing factors in patients with HIV/AIDS receiving combined anti-retroviral therapy(cART)through a systematic review and meta-analysis,thereby providing an evidence-based foundation for developing targeted clinical interventions.Methods A systematic search was conducted in both Chinese and English databases(including China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,VIP Chinese Journal Service Platform,China Biology Medicine Disc,Web of Science,Embase,PubMed,and the Cochrane Library)for observational studies published from database inception to July 31,2024.Meta-analysis was conducted using RevMan 5.0 software.Results Nineteen studies(10 in Chinese and 9 in English)comprising 124218 patients(including 23569 LLV cases)were included.The meta-analysis showed that the overall incidence of LLV was 15%[95%confidence interval(CD):11%-20%],with a significantly higher rate in the Chinese population of 14%(95%CI:10%-17%)compared to 9%(8%-10%)in other countries.Risk factors for LLV included age>50 years[odds ratio(OR)=1.39],baseline viral load>1×10^(5)copies/mL(OR=-2.74),CD4 cell count<200 cells/μL(OR=1.45),second-line cART(OR=1.97),cART duration≥2 years(OR=2.46),medication switching(OR=2.32),poor medication adherence(OR=3.73),and male sex(OR=1.31)(all P-values<0.001).CD4 cell count≥200 cells/μL and no treatment discontinuation were protective factors against LLV.Sensitivity analysis demonstrated stable effect sizes and the funnel plot was largely symmetrical,indicating a relatively low risk of publication bias.Conclusions The incidenceof LLV in patients with HIV/AIDS receiving cART is generally low to moderate;however,the risk is more pronounced in Chinese patients.High baseline viral load,second-line medications,cART for two years or more,poor medication adherence,and immunosuppressive status are core risk factors.Strengthening viral load monitoring and medication management in highrisk groups and optimizing individualized treatment strategies are recommended to reduce the risk of LLV.
作者
刘艳
刘梅
牟一鑫
张露
吕春容
陈雪宇
邓庆华
LIU Yan;LIU Mei;MOU Yixin;ZHANG Lu;LYU Chunrong;CHEN Xueyu;DENG Qinghua(Chengdu Public Health Clinical Medical Centre,Chengdu 610000,Sichuan,China)
出处
《中国艾滋病性病》
北大核心
2025年第7期810-816,共7页
Chinese Journal of Aids & STD
基金
2024四川省科技厅课题(24KPZP0008)
成都市2023卫生健康卫生委员会课题(2023473)。
