福建省1987—2017年HIV/AIDS诊断病例生存时间和影响因素分析

Survival and its related factors among adolescent and adult HIV/AIDS patients in Fujian province, 1987 – 2017

目的了解福建省艾滋病病毒感染者/艾滋病(HIV/AIDS)病例生存状况的分布特征,探讨生存时间的影响因素。方法将1987年1月1日—2 017年12月31日符合条件的福建省HIV/AIDS诊断病例共计12 079例纳入研究队列,采用回顾性队列研究方法收集HIV/AIDS病例生存状况的相关信息,计算病例的全死因死亡率和标化死亡率。通过寿命表法和Kaplan-Meier法计算病例的生存率和生存时间,利用Cox比例风险模型探索病例生存时间的影响因素。结果福建省HIV/AIDS病例的全死因死亡率为5.37/100人.年(95%CI=5.10～5.64),标化全死因死亡率7.99/100人.年(95%CI=7.40～8.58)。HIV/AIDS病例的平均生存时间为17.0年(95%CI=16.1～17.9),1、5、10和15年的生存率分别为92%、82%、73%和68%。Cox比例风险模型分析显示,婚姻状况为已婚有配偶、离异或丧偶和不详的HIV/AIDS病例的死亡风险分别是未婚的1.248倍、1.481倍和1.914倍,确诊时年龄≥50岁、高中及以上文化程度、首次CD4+T淋巴细胞计数≥200个/mm3和接受抗病毒治疗的HIV/AIDS病例的死亡风险分别是15～49岁年龄组、初中及以下文化程度、首次CD4+T淋巴细胞计数<200个/mm3和未接受抗病毒治疗的2.466倍、0.501倍、0.357倍和0.146倍。结论近年来,福建省HIV/AIDS病例的全死因死亡率进一步降低,未婚、15～49岁年龄组、高中及以上文化程度、首次CD4+T淋巴细胞检测结果≥200个/mm3和接受抗病毒治疗的HIV/AIDS病例的死亡风险相对较低。

Objective To examine the situation and associated factors of survival among human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS)patients registered in Fujian province.Methods We collected data on 12 079 HIV/AIDS patients aged≥15 years at the diagnosis and registered in Fujian province from January 1, 1987 till December 31, 2017 for a retrospective cohort study. We calculated all-cause and standardized mortality rate of the patients. Life table and Kaplan-Meier method were applied to analyze survival rate and time of the patients. Cox proportional hazard model was used to explore factors related to the survival time.Results Among the patients, the all-cause and standardized mortality rate were 5.37(95% confidence interval [95% CI]: 5.10-5.64)and 7.99(95% CI: 7.40-8.58)per 100 person-years;the average survival time was 17(95% CI: 16.1-17.9)years;and the survival rate at 1, 5, 10, and 15 years were 92%, 82%, 73%, and 68%, respectively. The results of Cox proportional hazard analysis indicated that the patients being married or having a permanent heterosexual partner, being divorced or widowed, and with unknown marital status were at 1.248, 1.481, and 1.914 times higher probability of death compared to the unmarried patients;the patients aged≥50 years at the diagnosis had a 2.466 times higher probability of death than the patients aged 15-49 years at the diagnosis;while, in comparison with the patients with the education of junior high school and below, the initial CD4+ T lymphocyte cell count of<200 cells/mm3 at the diagnosis, and not receiving highly active anti-retroviral therapy(HAART), the patients with the education of senior high school and above, the initial CD4+ T lymphocyte cell count of≥200 cells/mm3, and having received HAART had significantly decreased probability of death, with the hazard risk of 0.501, 0.357, and 0.146 respectively.Conclusion The all-cause mortality of HIV/AIDS patients in Fujian province decreased in recent years;the patients being unmarried, aged 15-49 years, with the education of senior high school and above, with the initial CD4+ T lymphocyte cell count of≥200 cells/mm3 at the diagnosis, and receiving HAART were at relatively lower probability of death.