贵州省男男性行为者中的HIV/AIDS病人接受抗病毒治疗后的生存分析

Survival analysis on HIV/AIDS MSM patients receiving antiretroviral therapy in Guizhou province

目的了解贵州省男男性行为者(MSM)中的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人),在接受抗艾滋病病毒治疗(ART)后的生存时间及其影响因素。方法回顾性分析贵州省2006年至2015年接受抗病毒治疗的MSM HIV/AIDS病人的生存时间,计算累计生存概率,运用COX回归分析其影响因素。结果共收集MSM HIV/AIDS病人1 671例,开始治疗时的年龄为14~72(30.6±9.5)岁,未婚占73.3%(1225/1 671)。治疗后病人的随访时间M=16.0(QR:6.0~33.0)个月。在发生死亡的49例中,有63.3%(31/49)的病人在开始治疗后的6个月内死亡;第1、3、5年的累计生存率分别为0.98、0.96和0.95。多因素COX回归结果显示:病人开始治疗时年龄越小死亡风险越大;开始治疗时的CD4+T淋巴细胞计数越低死亡风险越大;治疗前患有肺结核、有疾病症状体征的病人死亡风险更高。结论抗病毒治疗延长了MSM AIDS病人的生存时间。建议针对年龄小、CD4+T淋巴细胞计数低、治疗前患有肺结核或已有疾病症状体征的病人,加强临床诊疗和医学随访。

Objective To understand the survival time and related factors among HIV/AIDS MSM patients receiving antiretroviral therapy（ART）in Guizhou province.Methods A retrospective analysis was conducted to analyze the information of HIV/AIDS MSM patients receiving ART.Life table was applied to calculate the survival status.The related factors were identified with Cox proportional hazards regression model.Results A total of 1671 patients was included with the median age between 14-72（30.6±9.5）years old,and 73.3% unmarried.The median length of ART follow-up was 16.0（QR：6.0-33.0）months.49 cases died and 63.3% of them died within the first6 months of ART initiation.Cumulative survival rates of the patients receiving ART in 1,3,5years were 0.98,0.96,0.95,respectively.Results from multivariate Cox regression showed that age,baseline CD4＋T cell count,pulmonary tuberculosis,the symptoms of other diseases were the risk factors related to death of the patients.Conclusion ART can prolong the survival time of HIV/AIDS MSM patients.It is necessary to conduct effective treatment and special attention should be paid to the patients with young age,lower baseline CD4＋T cell count,pulmonary tuberculosis and the symptoms of other diseases.