摘要目的：了解青少年HIv/AIDs患者抗病毒治疗1年内不良反应的发生情况及影响因素。方法检索国家艾滋病综合防治信息系统，收集2003年10月1日至2013年10月31日在湖南省接受抗病毒治疗且治疗时间≥1年的12~24岁HIv/AIDs患者资料，记录患者年龄、性别、感染途径、外周血CD4﹢T淋巴细胞（ CD4细胞）数、婚姻状况、确诊至治疗间隔时间、机会性感染、开始治疗时症状体征、临床分期、初始治疗方案和治疗第1年每个月不良反应发生情况。采用Logistic回归模型分析抗病毒治疗不良反应相关影响因素。结果共纳入559例患者，平均年龄（22±2）岁；男性312例，女性247例；感染途径以性传播为主，占90.9%（508/559）；外周血CD4细胞数≥200个/mm3者占55.1%（300/544）；未婚者占65.5%（366/559）；确诊至治疗间间隔为0~1859 d，平均198 d，中位时间53 d；开始治疗时合并机会性感染者占28.8%（161/559）；有症状体征者占29.7%（166/559）；临床分期为Ⅰ、Ⅱ、Ⅲ、Ⅳ期者分别为266例（50.5%）、124例（23.5%）、99例（18.8%）、38例（7.2%）。男性、女性和12~18岁、19~24岁患者初始治疗方案均以拉米夫定﹢齐多夫定﹢奈韦拉平为主，分别占45.2%（141/312）、37.2%（92/247）、45.9%（45/98）和40.8%（188/461）。用药第1个月不良反应发生率最高，为19.3%（108/559），主要为恶心呕吐（37.0%，40/108）、皮疹（34.3%，37/108）和疲倦（28.7%，31/108）；第2个月不良反应发生率为11.7%（57/486），主要为皮疹（35.1%，20/57）、疲倦（26.3%，15/57）和胃口改变（24.6%，14/57）；其后各月不良反应发生率均低于10.0%。对治疗第1个月不良反应相关因素的单因素分析显示，年龄、性别、感染途径、有无症状体征、是否合并机会性感染、临床分期和CD4细胞数与不良反应的发生有关（均P﹤0.05）；多因素Logistic回归分析结果显示，年龄19~24岁（OR＝1.782，95%CI：1.293~3.554，P＝0.002）、女性（OR＝1.904，95%CI：1.204~3.013，P＝0.006）及开始治疗时有症状体征（OR＝3.025，95%CI：1.902~4.810，P＝0.000）为出现不良反应的危险因素。结论12~24岁HIv/AIDs患者抗病毒治疗1年内不良反应以消化道反应、皮肤病变等为主，治疗第1个月不良反应发生率最高，年龄19~24岁、女性与开始治疗时有症状体征是抗病毒治疗致不良反应的独立危险因素。

abstractsObjective To explore the occurrence of adverse reactions and its influencing factors in the teenagers aged 12 to 24 Years who received 1 Year or more longer antiviral therapY. Methods national Information sYstem for AIDs Control and Prevention was searched and the data of teenagers and Young adults aged 12 to 24 Years with HIv/AIDs treated in Hunan Province from October 1,2003 to October 31,2013 were collected. The information included sex,age,marital status,route of infection,interval between diagnosis and treatment,with or without sYmptoms and signs at the beginning of treatment,opportunistic infection,clinical stages,counts of peripheral blood CD4 ﹢T lYmphocYtes( CD4 cells),initial treatment plan,and the tYpe and incidence rate of adverse reactions in each month during the first Year of treatment. The related factors between antiviral therapY and the adverse reactions were analYzed bY Logistic regression model. Results A total of 559 patients were enrolled into this studY. Of them,312 were males and 247 were females with the average age(22 ± 2)Years. The route of infection was sexual transmission accounting for 90. 9%(508/559). The number of cases with peripheral blood CD4 cell count ≥200 accounted for 55. 1%(300/544). The singles accounted for 65. 5%(366/559). The interval between diagnosis and treatment was from 0 to 1 859 daYs and an average time was 198 daYs,median time was 53 daYs. At the beginning of treatment ,the number of cases with sYmptoms and signs accounted for 29. 7%(166/559), associated opportunistic infections accounted for 28. 8%(169/589),and the clinical stages of Ⅰ,Ⅱ,Ⅲ, andⅣ accounted for 266(50. 5%),124(23. 5%),99(18. 8%),and 38(7. 2%),respectivelY. The initial treatment plans for the patients of male,female,12-18 Years,and 19-24 Years were mainlY lamivudine﹢zidovudime﹢nevirapine,theY accounted for 45. 2%(141/312),37. 2%(92/247),45. 9%(45/98), and 40. 8%(188/461),respectivelY. The incidence of adverse reactions in the first month during the treatment was the highest which accounted for 19. 3%( 108/559 ), including nausea and vomitting (37. 0%,40/108),erYthema(34. 3%,37/108),and fatigue(28. 7%,31/108). The incidence of adverse reactions in the second month during the treatment was 11. 7%( 57/486 ),including erYthema (35. 1%,20/57),fatigue(26. 3%,15/57)and appetite changes(24. 6%,14/57). thereafter,the incidences of adverse reactions of each month were lower than 10. 0%. The results of single factor analYsis for correlative factors of adverse reactions in the first month during the treatment showed age,sex,route of infection,with or without sYmptoms and signs at the beginning of treatment,with or without opportunistic infection,clinical stages and number of CD4 cells were related to the adverse reactions(all P﹤0. 05 ). The result of multi factor Logistic regression analYsis showed age 19-24 Years old(OR=1. 782,95%CI:1. 293-3. 554,P=0. 002),female(OR=1. 904,95%CI:1. 204-3. 013,P=0. 006),with sYmptoms and signs at the beginning of treatment(OR=3. 025,95%CI:1. 902-4. 810,P=0. 000)were the risK factors of the adverse reactions. Conclusions The mail adverse reactions of antiviral therapY in patients aged 12-24 Years during the first Year's treatment were gastrointestinal reaction and sKin lesions. The incidence of the adverse reactions in the first month during the treatment was the highest. Age 19-24 Years,female,and with sYmptoms and signs at the beginning of treatment are the the risK factors of the adverse reactions.