广东省艾滋病患者抗病毒治疗后生存时间分析

Analysis of factors affecting the survival time after AIDS antiretroviral therapy in Guangdong Province

目的分析广东省艾滋病患者接受抗病毒治疗后的生存状况,探讨影响患者治疗后生存时间的因素。方法利用国家统一使用的成人DataFax抗病毒治疗信息收集系统所收集的全省抗病毒治疗数据资料,采用COX比例风险模型对影响广东省艾滋病患者抗病毒治疗后生存时间的因素进行分析。结果共有1 307例接受抗病毒治疗的艾滋病患者纳入分析,其中66.7%的患者在出现艾滋病相关症状后才被检测出H IV阳性;52.3%开始治疗时已经进入临床Ⅲ期,29.9%进入了临床Ⅳ期;88.2%的人开始治疗时CD4+T细胞低于200个/μL。1 307例中死亡80例(6.1%),停药37例(2.8%),失访227例(17.4%),继续治疗963例(73.7%)。80例死亡者中治疗后生存时间最短的只有2 d,最长的3年多,92.5%的死亡发生在治疗后的1年内;963例仍在继续治疗,其中108例(11.2%)治疗已达3年以上。影响患者治疗后生存时间的保护因素是当需要时及时更换方案(RR=0.205)和治疗开始时较高的CD4+T细胞水平(RR=0.341),危险因素为较多的机会性感染(RR=1.149)。结论需要进一步采取措施以监测患者的CD4+T变化及机会性感染情况,及时收治患者,积极预防机会性感染的发生,同时应着重提高治疗者的服药依从性教育,及时监测患者的服药情况,必要时及时调整方案,尽可能延长患者治疗时间。

Objective To analyze the living status of AIDS patients receiving antiretroviral therapy （ART） in Guangdong, and explore factors affecting the survival time after ART. Methods The data of antiretroviral therapy over the Province were collected by the DataFax antiretroviral therapy information searching system commonly used in China. Cox regression analysis was employed for the data to analysis the factors affecting to the survival time after ART. Results A total of 1 307 AIDS patients were analyzed. Of them, 66.7% patients were diagnosed as HIV after the AIDS related symptom emerged; 52.3% patients came into clinical phase Ⅲ and 29. 9% patients came into clinical phase Ⅳ when they began to receive ART; 88.2% patients had a CD4^＋T cell count lower than 200. Among the 1 307 AIDS patients, 80 （6. 1% ） died, 37（2.8% ） stopped taking ARV drugs, 227（ 17.4% ） were lost, 963（73.7% ） continued to get treated. The shortest survival time of ART was 2 days after the ART and the longest time was more than 3 years among the 80 death patients; and 92. 5% patients died in one year after ART. Among the 963 patients with continued ART, 108 （ 11.2% ） have lasted for more than 3 years in the treatment. The protective factors to the survival time after ART was immediate adoption of alternative drugs（ RR = 0. 205 ）, high CD4 ^＋ T cell level at the beginning of therapy （ RR = 0. 341 ）. The dangerous factor was opportunistic infection （ RR = 1. 149）. Conclusion It＇ s needed to take measures to monitor the change of the CD4 ^＋ T cell count and the opportunistic infections, to adopt patient into the ART timely, and to prevent opportunistic infection. It should be emphasized to improve the compliance with treatment regime and establish a system to monitor the adverse reaction of ARV drugs and drug taking so that alternative ARV drugs could be used timely whenever it＇ s necessary. Only by adopting all these measures in a proper way, can the ART be sustained longer.