HIV阳性患者肠道菌群特征对联合抗反转录病毒治疗效果的预测

观察人类免疫缺陷病毒(HIV)阳性患者肠道菌群特征对联合抗反转录病毒治疗(cART)效果的预测作用, 以期为HIV阳性患者的抗病毒治疗获益评估提供辅助手段。

前瞻性选取我院2017年1月至2020年1月收治95例HIV阳性患者为研究对象, 均于治疗前收集患者资料, 分析患者肠道菌群特征, 实施cART治疗, 治疗6个月后评估疗效, 将患者划分为有效组和无效组, 采用回归分析检验HIV阳性患者肠道菌群特征与cART疗效的关系, 并分析肠道菌群特征对cART疗效的预测效能。

95例HIV阳性患者中共有69例cART治疗有效, 26例治疗无效。回归分析结果显示, HIV RNA载量、免疫球蛋白(Ig)A、IgG水平及肠道屎肠球菌、粪肠球菌、大肠埃希菌、乳杆菌、双歧杆菌数量均与HIV阳性患者治疗效果有关(OR=18.964、42 376.484、4.183、8.585、14.358、15.134、9.297、10.223, 均P < 0.001)。受试者工作曲线(ROC)显示, HIV阳性患者肠道屎肠球菌、粪肠球菌、大肠埃希菌、乳杆菌、双歧杆菌数量用于预测cART治疗无效风险的曲线下面积(AUC)均 > 0.80, 均有一定预测效能。

HIV阳性患者cART治疗的总有效率较低, 其疗效与HIV RNA载量、Ig水平及肠道菌群特征密切相关, 其中肠道主要菌群数量可用于预测HIV阳性患者cART治疗无效的风险。

Prediction on efficacy of combined antiretroviral therapy based on intestinal flora characteristics in HIV positive patients

ObjectiveTo observe the predictive effect of intestinal flora characteristics of human immunodeficiency virus(HIV) positive patients on the efficacy of combined antiretroviral therapy(cART), in order to provide auxiliary means for the evaluation of the benefits of antiviral treatment to HIV positive patients.MethodsA total of 95 HIV positive patients treated in our hospital from January 2017 to January 2020 were prospectively selected as the study subjects. The data of patients were collected before treatment, the characteristics of intestinal flora were analyzed, and cART treatment was performed. The efficacy was evaluated after 6 months of treatment. The patients were divided into effective group and ineffective group. Regression analysis was used to examine the relationship between the characteristics of intestinal flora and the efficacy of cART. The predictive effect of intestinal flora characteristics on the cART was analyzed.ResultsOf the 95 HIV positive patients, the treatment was effective to 69 and not to 26 patients. Regression analysis showed that, HIV RNA load, immunoglobulin(Ig) A, IgG expression and the counts of Enterococcus faecium, Enterococcus faecalis, Escherichia coli, Lactobacillus and Bifidobacterium in intestinal flora were related to the treatment effect(OR=18.964, 42 376.484, 4.183, 8.585, 14.358, 15.134, 9.297, 10.223, all P < 0.001). Receiver operating curve(ROC) found the area under the curve(AUC) of the number of Enterococcus faecium, Enterococcus faecalis, Escherichia coli, Lactobacillus and Bifidobacterium in HIV positive patients to predict the risk of ineffective treatment of cART were > 0.80, all with certain predictive efficacy.ConclusionThe total efficiency rate of cART in HIV positive patients is low, and its efficacy is closely related to HIV RNA load, Ig level and intestinal flora characteristics, of which the levels of major intestinal flora can be used to predict the risk of ineffective cART treatment in HIV positive patients.