四川省凉山彝族自治州8310例首次接受抗病毒治疗的成年艾滋病患者生存时间及其影响因素

Survival time and associated factors of 8 310 AIDS patients initially receiving antiretroviral treatment of Liangshan Yi Autonomous Prefecture, Sichuan province of China

目的调查四川省凉山彝族自治州（凉山州）首次接受抗病毒治疗成年艾滋病患者的生存时间及其影响因素。方法运用回顾性队列研究方法对中国艾滋病抗病毒治疗信息管理系统中2005--2013年凉山州18岁以上、首次接受艾滋病抗病毒治疗患者的数据资料进行生存分析，采用Cox比例回归风险模型分析研究对象生存时间的影响因素。结果8310例研究对象年龄为（34．59±9．10）岁，经静脉吸毒感染占65．50％（5443例）；从确认HIV抗体阳性到接受抗病毒治疗的时间为（24．68±21．69）个月。436例死于艾滋病相关疾病的研究对象中，28．67％（125例）是在治疗开始后的6个月内病死。接受抗病毒治疗第1、2、3、4、5年的累积生存率分别为97．11％、93．41％、90．61％、88．81％、86．02％。Cox比例风险回归模型分析结果显示，男性艾滋病患者病死的风险高于女性（HR=1．57，95％CI：1．13-2．18）；静脉吸毒感染艾滋病的患者病死的风险高于异性性传播感染者（HR=1．64，95％Ch1．20～2．24）；治疗前最近1年患肺结核的艾滋病患者病死的风险高于无肺结核的患者（HR=1．52，95％CI：1．05～2．21）；在治疗前3个月有艾滋病相关疾病或出现过相关症状的艾滋病患者病死的风险高于未出现的相关疾病或出现过相关症状的艾滋病患者（HR=1．80，95％CI：1．39．2．34）；首次CD4＋T淋巴细胞计数检测结果〈50个／μl（HR=9．79，95％CI：6．03—15．89）、50～199个／μl（HR=3．26，95％CI：2．32～4．59）、200-349个／μL（HR=1．69，95％CI：1．22～2．34）的患者病死的风险均高于／〉350个／μl的患者。结论四川省凉山州艾滋病患者接受抗病毒治疗后累积生存率较高；男性、最近1年患肺结核、静脉吸毒感染、治疗前3个月有艾滋病相关疾病或出现过相关症状、首次CD4＋T淋巴细胞计数较低的艾滋病患者死亡风险较高。

Objective To investigate the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment （ART） of Liangshan Yi Autonomous Prefecture,Sichuan province. Methods A retrospective cohort study was conducted to analyze the information of AIDS patients over 18 years old initially received ART in Liangshan Yi Autonomous Prefecture during 2005-2013, which were downloaded from Chinese AIDS Antiretroviral Therapy DATA Fax Information System. Cox proportion hazard regression model was used to identify impact factors related survival time. Results Among 8 310 ART AIDS patients who initially received ART, their mean age was （34.59±9.10） years old, 65.50% （5 443 cases） were infected with HIV through injecting drug use, the mean time from testing HIV positive to starting ART were （24.68±21.69） months. 436 cases died of AIDS related diseases, 28.67% （125 cases） of them died within the first 6 months of treatment. The cumulative survival rate of receiving ART in 1,2,3,4 5 years were 97.11%, 93.41%, 90.61%, 88.81%, 86.02%, respectively. Multivariate Cox regression analysis showed the male patients receiveing ART were at a higher risk death of AIDS related diseases compared to the females （HR=1.57,95%CI：1.13-2.182）, the patients infected with HIV through injecting drug use were at a higher risk deathcompared to the infected through heterosexual transmission （HR=1.64, 95%CI：1.20-2.24）, before the treatment patients with tuberculosis in recentl year had higher death hazard as compared to those without tuberculosis （HR=1.53,95% CI：1.05-2.21）, in the treatment of the first 3 months of AIDS related diseases or symptoms of AIDS patients had higher death hazard as compared to those not suffer these diseases（HR=l.80,95%CI：l.39-2.34）. The patients with baseline CD4＋T lymphocytes cell counts 〈50/μl （HR=9.79,95% CI：6.03- 15.89）, 50- 199/μl （HR=3.26,95% CI：2.32- 4.59）, 200- 349/μl （HR=1.69,95% CI： 1.22-2.34）,were at a higher risk death than those with CD4 ＋T lymphocytes cell counts ≥350/μl. Conclusion Accumulate survival rate was higher after initial antiretroviral treatment among AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan province. AIDS patients who are males, have tuberculosis in recent year, infected HIV via route of intravenous drug use, with AIDS-related illness or symptoms in 3 months before ART, lower baseline CD4＋T lymphocyte count have higher risk of death.