复方新诺明预防治疗对艾滋病患者生存状况的影响

Effect of co-trimoxazole prophylaxis used for AIDS patients under anti-retroviral therapy

目的：了解复方新诺明（CTX）预防治疗对河南省接受国家免费抗病毒治疗（ART）的艾滋病患者生存状况的影响。方法利用“中国疾病预防控制系统-艾滋病综合防治信息系统”收集的河南省2007-2011年加入国家免费ART艾滋病患者资料，根据开始接受ART时既往CTX使用情况，将研究对象分为既往未服用、既往服用过现仍服用和既往服用过现未服用3组，采用Kaplan-Meier法绘制生存曲线，运用Cox比例风险回归模型分析CTX预防治疗对艾滋病患者生存状况的影响。结果13103名艾滋病患者中共有1702名死亡，死亡率为4.46/100人年，开始治疗3个月和12个月内分别死亡455人和970人，死亡率分别为14.15/100人年和7.78/100人年。开始ART时既往未服用、既往服用过现仍服用和既往服用过现未服用CTX三组中以既往服用过现仍服用组的生存期（M＝0.98年，IQR：0.25～2.16）最长，Kaplan-Meier生存曲线显示，开始治疗时既往服用过现仍服用CTX组生存时间长于既往未服用CTX组，死亡率低于既往未服用CTX组， log-rank检验显示，开始治疗12个月内的两组间差异有统计学意义（log-rank＝5.15，P＝0.02）。多因素分析发现，研究对象开始治疗时年龄、性别、婚姻状况、传播途径、确认阳性到开始治疗的时间、基线CD4＋T淋巴细胞计数、临床分期、初始治疗方案、CTX服用情况、开始治疗时年份、基线症状数、最近7 d是否漏服与生存时间存在统计学关联，其中既往使用过现仍服用CTX组的死亡风险低于既往未服用CTX组（调整HR＝0.71，95%CI：0.63～0.80，P＝0.00）。结论艾滋病ART开始时既往CTX预防治疗可以降低艾滋病患者的死亡风险，特别是在开始治疗的第1年内效果明显。

Objective To analyze the situation of survival among AIDS patients under co-trimoxazole prophylaxis as initial anti-retroviral therapy（ART）,in Henan province during 2007-2011. Methods Information on AIDS patients receiving initial ART during 2007-2011 was collected from the Chinese HIV/AIDS Integrated Control System. Kaplan-Meier estimation was used to generate survival curves,and Cox proportional hazard regression model was used to determine associated factors of survival status. According to the previous CTX use before ART,the subjects were divided into 3 groups including who had never taken CTX,who had taken CTX and still taking now,who had taken CTX and not current taking. Results A total of 13 103 eligible AIDS patients were identified. 1 702 patients died within 6 years after the initiation of ART,with the mortality as 4.46/100 person year. Among the 455 patients who died within 3 months and 970 died within 12 months,the mortality rates were 14.15/100 person year and 7.78/100 person year,respectively. The Kaplan-Meier survival curves showed that the survival time and mortality of the patients who had taken CTX was longer AND lower than those patients who had never taken CTX when starting the ART program. Results＆nbsp;from the log-rank test showed that the difference of two groups was statistically significant during 12 months after the ART（log-rank=5.15,P=0.02）. After controlling for other variables,results from multivariable analysis of COX model showed that factors as age,gender,marital status,perion between confirmed diagnosis and receiving the ART,baseline CD4＋T cells count,clinical stage,initial therapy schedule,date when starting the ART,number of symptoms at baseline,use of CTX before starting the ART and ART being skipped in the last seven days etc,were associated with the time of survival in patients after the initiation of ART. Patients who had been taking CTX at ART initiation were at lower risk of death （adjusted HR=0.71,95%CI：0.63-0.80;P=0.00）,compared to those who had never taken the CTX. Conclusion The co-trimoxazole prophylaxis program was associated with the reduced mortality among AIDS patients who were on ART in Henan province,especially during the first year.