1985-2016年浙江省温州市艾滋病病毒感染者/艾滋病患者生存时间及影响因素分析

Analysis on survival time of HIV/AIDS cases and related factors in Wenzhou,1985-2016

目的了解1985-2016年浙江省温州市艾滋病病毒感染者/艾滋病患者(HIV/AIDS)生存时间及影响因素。方法采用回顾性队列研究方法,筛选1985年1月1日至2016年12月31日报告、现住址为温州市的HIV/AIDS作为研究对象。收集其全死因死亡相关信息,通过寿命表法计算生存率和全死因病死率,利用Kaplan-Meier比较不同组别生存时间的差异,运用Cox比例风险模型分析生存时间影响因素。结果共有3 381例HIV/AIDS纳入研究队列,累计观察9 885.50人年,全死因病死率为5.20/100人年,全死因病死率从2006年开始下降并呈现持续降低的趋势。平均生存时间为16.35年(95%CI:14.848~17.858)。HIV/AIDS前1、5、10年的累积生存率抗病毒治疗组分别为89.64%、83.60%和80.58%,未接受抗病毒治疗组分别为89.64%、64.44%和40.36%。Cox多因素分析显示,患者确诊时年龄、职业、感染途径、抗病毒治疗、首次CD4计数和样本来源是生存时间的影响因素,15~、30~、45~岁年龄组死亡风险低于60岁以上年龄组,服务人员/学生、疾控机构检测发现、接受抗病毒治疗、首次CD4计数≥100个/mm3者的死亡风险分别低于农民、医疗机构检测发现、未接受抗病毒治疗、首次CD4计数<100个/mm3者。结论温州市HIV/AIDS全死因病死率逐年下降,今后仍要进一步扩大宣传教育,扩大检测以尽早发现HIV感染者,并及时提供抗病毒治疗,延长患者的生存时间,减少死亡的发生。

Objective To understand the all-cause mortality and risk factors among HIV/AIDS cases in Wenzhou, Zhejiang province, from 1985 to 2016. Methods A retrospective cohort study was conducted among HIV/AIDS cases living in Wenzhou and reported from 1 January 1985 to 31 December 2016. All the information about death was collected to calculate the survival rate and all-cause mortality by life table. Kaplan-Meier method was used to compare the survival time of different groups and Cox proportional hazards model was used to analyze the influencing factors of survival time. Results A total of 3 381 HIV/AIDS patients were enrolled in the study cohort. The cumulative person-year was 9 885.50 years and the all-cause mortality rate was 5.20 per 100 person-year. All-cause mortality began to fall in 2006 and showed a continuing downward trend. The average survival time was 16. 35 years （95% CI： 14. 848 - 17. 858）. The cumulative survival rates of HIV/AIDS cases in the first 1, 5 and 10 years were 89. 64%, 83.60% and 80. 58% respectively in the antiviral treatment group, and 89. 64%, 64. 44% and 40. 36% respectively in the untreated group. Cox multivariate analysis showed that age, occupation, route of infection, antiviral treatment, first CD4 count and sample source were the factors influencing the survival time. The death risks in age groups 15 -, 30 -, 45 - years were lower than that in age group ≥60 years. The death risk was lower in patients who were service staff/students and detected by CDC, those received antiretroviral therapy, those with first CD4 count ≥ 100/mm3than in those who were farmers and found by medical institutions, those receiving no antiretroviral therapy and those with first CD4 count 〈 100 /mm3. Condusion The all-cause mortality of HIV/AIDS patients decreased year by year. It is necessary to strengthen the health education about AIDS and HIV antibody detection to improve the rates of early HIV diagnosis and timely treatment to prolong the survival time and reduce the all-cause mortality of patients.