宁波市2004-2015年抗病毒治疗HIV／AIDS患者生存分析

Survival analysis of HIV/AIDS patients with access to highly antiretroviral therapy in Ningbo during 2004-2015

目的 了解2004-2015年宁波市接受抗病毒治疗的HIV/AIDS患者流行病学特征及生存情况。方法 采用回顾性队列研究方法，对研究对象的流行病学特征进行描述性分析，利用寿命表法计算生存率、Kaplan-Meier法绘制生存曲线、Cox比例风险回归模型分析影响死亡的危险因素。结果 2 347例研究对象中，接受抗病毒初始治疗的年龄中位数为35（IQR：27～45）岁，以男性、本地、已婚或同居、异性性传播、基线CD4＋T淋巴细胞计数（CD4）≤200个/μl、WHO分期Ⅰ期为主。第1、5、7、10年的累计生存率分别为96.75%、92.36%、91.87%、90.02%。多因素Cox比例风险回归模型分析显示，年龄越大死亡危险度越高，接受抗病毒治疗的〉60岁HIV/AIDS患者是≤20岁组的17.34倍（95% CI：2.11～142.71）；基线WHO临床分期Ⅳ期患者死亡危险是Ⅰ期的2.83倍（95% CI：1.67～4.80）；耐药患者死亡风险是不耐药患者死亡风险的3.26倍（95% CI：1.77～6.01）；相较于同性性传播途径，血液传播是患者死亡的危险因素；CD4值越低，死亡风险越大；BMI〈18.5 kg/m2、未婚是患者死亡的独立危险因素。结论 宁波市HIV/AIDS患者抗病毒治疗效果显著，生存率较高。关爱老年人群，针对流行病学特征加强宣传教育，扩大监测范围，早发现早诊断早治疗，提高抗病毒治疗者的依从性是降低病死率的有效措施。

Objective To understand the epidemiology characteristics and survival status of HIV/AIDS patients with access to highly antiretroviral therapy （HAART） in Ningbo during 2004-2015. Methods A retrospective cohort study was conducted among HIV/AIDS patients diagnosed between 2004 and 2015. Life Tables were used to estimate survival rates, and Kaplan-Meier curve with Log rank test were used to describe the survival curves and the Cox proportional hazard model was used to determine predictors of mortality. Results Of the subjects, the median age when starting HAART was 35 years （IQR：27-45 years）. Most of them were males, local residents, married, infected through heterosexual sexual transmission, and their baseline CD4 T cells counts were mainly ≤200 cells/μl, and most of them were at clinical stageⅠ（WHO）. The cumulative survival rate was 96.75% for the first year, 92.36% for the fifth year, 91.87% for the seventh year and 90.02% for the tenth year. The risk of the mortality was 17.34 times higher for those aged 〉60 years compared with those aged ≤20 years （95%CI：2.11-142.71）, 2.83 times higher for those at clinical stage Ⅳ（WHO） compared with those at clinical stageⅠ（WHO） （95%CI：1.67-4.80） and 3.26 times higher for those with drug resistance compared with those without drug resistance （95%CI：1.77-6.01）. Blood transmission, lower CD4＋ T cell level, BMI 〈18.5, unmarried were the risk factors for the mortality. Conclusions The effect of HAART was obvious in the HIV/AIDS patients in Ningbo, their survival rate was high. The finding indicated that it is necessary to strengthen the health care for old population and health education about AIDS prevention and control, and conduct large scale screening. Early discovery, early diagnosis, early treatment and improving treatment compliancy are still the effective ways to reduce the mortality.