urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2022-21-5-67-73urmj-1086Research ArticleИНФЕКЦИОННЫЕ БОЛЕЗНИINFECTIOUS DISEASESСтруктура летальных исходов и показатели выживаемости у ВИЧ-инфицированных пациентов с иммунологической неэффективностью антиретровирусной терапииMortality patterns and survival rates in HIV-infected patients with immunological ineffectiveness of antiretroviral therapyБалыкчиноваТ. В.BalykchinovaT. V.

Татьяна Владимировна Балыкчинова, врач-инфекционист

Екатеринбург

Tat'jana V. Balykchinova, Infectious diseases doctor

Ekaterinburg

spilnik.tatyana@yandex.ruЖуковВ. В.ZhukovV. V.

Вячеслав Владимирович Жуков, кандидат медицинских наук

Екатеринбург

Vjacheslav V. Zhukov, Ph.D. in medicine

Ekaterinburg

slavaic@list.ruСвердловский областной центр профилактики и борьбы со СПИДРоссияSverdlovsk Regional Center for the Prevention and Control of AIDSRussian FederationСвердловский областной центр профилактики и борьбы со СПИД; Уральский государственный медицинский университетРоссияSverdlovsk Regional Center for the Prevention and Control of AIDS; Ural State Medical UniversityRussian Federation2022041120222156773Copyright © Балыкчинова Т.В., Жуков В.В., 20222022Балыкчинова Т.В., Жуков В.В.Balykchinova T.V., Zhukov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1086

Введение. Ввиду отсутствия критериев для определения случая иммунологической неэффективности антиретровирусной терапии, данные по анализу летальных исходов неоднородны. Необходим анализ выживаемости, структуры летальных исходов, клинико-лабораторных показателей. Цель работы – выявить особенности структуры летальных исходов и провести анализ выживаемости у ВИЧ-инфицированных пациентов с иммунологической неэффективностью антиретровирусной терапии в Свердловской области. Материалы и методы. Проведено ретроспективное исследование пациентов с ВИЧ-инфекцией с CD4+ T-лимфоцитами < 350 кл/мкл на начало лечения и при дальнейшем наблюдении. Сформированы две группы: основная – умершие пациенты (357 человек), контрольная – выжившие пациенты (1846 человек). Результаты. В основной группе пациентов преобладали мужчины и пациенты возраста 39 лет (Q1–Q3: 35–44 лет). У пациентов с инъекционным путем передачи ВИЧ чаще случался летальный исход. При сравнении средних показателей CD4+ T-лимфоцитов и вирусной нагрузки на момент начала АРВТ статистически значимых различий не выявлено. При оценке частоты летальных исходов у пациентов с CD4 < 50 кл/мкл на начало АРВТ шансы наступления смерти выше (ОШ 1,523; 95 % ДИ 1,236–1,785). Вероятность летального исхода быстро увеличивалась к 5-летнему сроку (60 мес.) от начала АРВТ до 26,9 % ± 1,5, а к 120-месячному сроку (10 лет) достигала 43,6 ± 6,8 %. Средний срок развития летального случая от момента начала лечения составил 82 мес. (95 % ДИ: 78,87–85,56 мес.). Обсуждение. Поднимается вопрос о предикторах неблагоприятных клинических исходов у пациентов с иммунологической неэффективностью АРВТ, а также в выявлении отличий в прогнозе течения заболевания с общей когортой пациентов с ВИЧ на АРВТ. Проведение проспективного исследования позволит получить полную картину течения заболевания у данной группы пациентов. Заключение. Высокая вероятность летального исхода у пациентов с иммунологической неэффективностью АРВТ в первые пять лет наблюдения от начала АРВТ требует повышенного внимания от специалистов с точки зрения лечения и диспансерного ведения.

Introduction. Due to the lack of criteria for determining the case of immunological non-response to ART, data on the analysis of deaths in this group of patients are heterogeneous. We analyzed the structure of deaths, clinical and laboratory indicators, and also conducted a survival analysis. Materials and methods. We conducted a retrospective study of HIV-infected patients who had a level of CD4+ T-lymphocytes at the beginning of treatment < 350 cl/mcl and further after that. Two groups were formed: the main one-deceased patients – 357 people; control one-surviving patients – 1846 people. Results. Men and older patients significantly prevailed in the main group of patients. Drug-addicted patients were more likely to have a fatal outcome. When comparing the average indicators of CD4+ T-lymphocytes and viral load at the time of the onset of ART, no statistically significant differences were found. When assessing the frequency of deaths in patients with extremely severe immunodeficiency (CD4 < 50 cells/μl.) at the beginning of ART, the chances of death were significantly higher (OR 1.523; 95 % CI 1,236–1,785). The probability of death increased rapidly by the 5-year period (60 months) from the beginning of ART to 26.9 % ± 1.5, and by the 120-month period (10 years) it reached 43.6 ± 6.8 %. The average development period of a fatal case from the moment of the start of treatment was 82 months (95 % CI: 78.87–85.56 months). Discussion. The question is raised about the predictors of adverse clinical outcomes in patients with immunological inefficiency of ART. A prospective study will provide a complete picture of the course of the disease in this group of patients. Conclusion. The high probability of death in patients with immunological non-response to ART in the first 5 years of follow-up from the beginning of ART requires increased attention from specialists in terms of treatment and dispensary management.

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The authors declare that there are no conflicts of interest present.