2005---2014年河南省15岁以上艾滋病患者抗病毒治疗后生存分析

Survival analysis of AIDS patients of 15 years or above years old after initiation antiretroviral treatment in Henan province during 2005 to 2014

目的了解河南省艾滋病患者抗病毒治疗后生存状况，并探讨生存时间的影响因素。方法在“中国疾病预防控制系统一艾滋病综合防治信息系统”中下载河南省接受国家免费抗病毒治疗的≥15岁患者数据库，采用回顾性研究方法。纳入标准：2005年1月到2014年12月首次接受国家免费艾滋病抗病毒治疗，开始治疗时年龄为≥15岁，有完整的基线信息和随访信息。采用寿命表法计算患者生存率，采用Cox比例风险回归模型分析患者抗病毒治疗后生存时间的影响因素。结果本研究共纳入30376例研究对象，随访观察期内因艾滋病相关疾病死亡3927例，病死率为3．2／100人年（3927／122350．6）。开始抗病毒治疗1、5、10年的累积生存率分别为93．7％、85．3％和78．4％。多因素分析显示，男性（HR=1．28，95％CI：1．20～1-37）、年龄越大（HR=1．20，95％CI：1．16～1．24）、除结婚或同居外的其他婚姻状况（HR=1．20，95％CI：1．12—1．29）、基线时症状数越多（HR=1．1l，95％CI：1．07～1．14）、初始治疗方案为司坦夫定（D4T）或齐多夫定（AZT）＋去羟肌苷（DDI）＋奈韦拉平（NVP）或依非韦伦（EFV）（HR=1．12，95％CI：1．04～1．20）、最近1次随访显示近7d漏服抗病毒药物（HR=18．36，95％CI：17．08～19．74）的艾滋病患者抗病毒治疗后死亡风险大；同性性传播途径（HR=0.59，95％CI：0．40～0．87）、基线CD4＋T淋巴细胞计数水平越高[相对于0～200个／μl组，201～350个／μl组、351—500个／μl组和501～个/μl组，HR（95％CI）值分别为0．57（0．53～0．62）、0．43（0．37—0．49）、0．33（0．27～0．40）]、教育程度越高（HR=0．89，95％CI：0．83～0．95）的艾滋病患者抗病毒治疗后死亡风险小。结论河南省艾滋病患者抗病毒治疗后生存率较高，开始治疗的年龄越大、男性、初始治疗方案为D4T或AZT＋DDI＋NVP或EFV、基线CD4＋T淋巴细胞计数水平越低、最近1次随访显示近7d漏服抗病毒药物的艾滋病患者抗病毒治疗后生存时间较短。

[Abstract] Objective To investigate the survival rate of AIDS patients after receiving antiretroviral therapy（ART） in Henan province and to determine factors associated with survival status. Methods Database of AIDS patients receiving ART were downloaded from China Information System for Disease Preventioin and Control-AIDS, retrospective study method was conducted to analyze the information. Inclusion criteria： initially received national free ART during January, 2005 to December, 2014; aged 15 years or above; and with relatively complete baseline information and follow-up information. The accumulated survival rate of AIDS patients was calculated by life table method and the influencing factors were analyzed by Cox proportional hazard model. Results Total 30 376 AIDS patients were enrolled in this study. During the follow-up period, a total of 3 927 cases died from HIV/AIDS related diseases. The mortality of all patients was 3.2/100 person year. After 1, 5, 10 years after the initiation of ART, the rates of accumulate survival rate were 93.7%, 85.3%, and 78.4%, respectively. Stepwise regression was used to conduct the time multiple factors analysis, the results showed that man （HR=l.28, 95%CI： 1.20-1.37）, older age （HR=1.20, 95%CI： 1.16-1.24）, others marital status except man＇age or cohabitation （HR=l.20,95%Ch 1.12-1.29）, more number of symptoms （HR= 1.11, 95% Ch 1.07-1.14）, initial treatment were main stavudine （D4T） or zidovudine （AZT）＋ didanosine（DDI）＋ nevirapine （NVP） or efevirenz （EFV） （HR=I.12, 95% Ch 1.04-1.20）, missing drug in the past 7 days （HR=18.36,95%CI： 17.08-19.74） among AIDS patients had high mortality risk, homosexuality sexual transmission （HR=0.59, 95%CI： 0.40-0.87）, higher baseline count of CD4＋T lymphocyte（relative to 0-200 cells/μl group, HR（95%C1） were 0.57（0.53-0.62）, 0.43（0.37-0.49）, 0.33 （0.27-0.40） in 201-350 cells/μll group, 351-500 cells/μl group, and ≥501 cells/μl group, respectively）, higher educations （HR=0.89, 95% Ch 0.83-0.95） had low mortality risk. Conclusion Survival rate was higher after initial antiretroviral treatment among AIDS patients in Henan province. AIDS patient will have shorter survival time after antiviral treatment under one or more following conditions： higher age, male, initial treatment with D4T or AZT ＋ DDI ＋ NVP or EFV, lower baseline CD4＋T lymphocyte count, ever missed antiviral drugs in past 7 days of latest follow-up.