2010—2014年中国新报告HIV感染者和艾滋病患者抗病毒治疗及时性及影响因素分析

An analysis of factors associated with timeliness of antiretroviral therapy initiation among newly diagnosed HIV/AIDS from 2010 to 2014 in China

目的 分析2010—2014年中国新报告HIV感染者和艾滋病患者（HIV/AIDS）抗病毒治疗时间与及时性及其影响因素.方法 选取国家艾滋病综合防治数据信息系统的病例报告数据库中HIV/AIDS为研究对象.纳入标准：确诊病例和临床诊断病例;中国内地籍病例;2010年1月1日至2014年12月31日期间新报告病例;年龄≥14岁;随访期间首次CD4＋T淋巴细胞≤350个/μl的检测日期为2010年1月1日至2014年12月31日.共有177971例病例纳入本研究.从数据库中采集病例的人口学特征、感染途径、样本来源、CD4＋T淋巴细胞水平等信息.采用χ2检验进行影响研究对象及时入组治疗的单因素分析,采用多因素二分类非条件logistic回归模型分析治疗及时性的影响因素.结果 177971例患者中,男性130679例（73.4%）,总治疗及时率为55.0%（97915例）,符合抗病毒治疗标准的患者15 d之内入组治疗比例从2010年的26.4%（4319/16388）上升到2014年的39.7%（20212/50889）,入组治疗比例最高的是通过非规范采血感染的患者,为38.0%（945例）;30 d之内入组治疗比例从2010年的43.2%（7077/16388）上升到2014年63.0%（32070/50889）,入组治疗比例最高的是通过异性传播感染的患者,为58.3%（73098例）.女性、初中及以上学历、汉族、农民和已婚有配偶者及时入组治疗的可能性较高,OR值分别为1.08、1.09、1.13、1.05和1.12;25~34、35~44、45~54、≥55岁组研究对象及时入组治疗的可能性高于15~24岁者,OR值分别为1.13、1.31、1.46和1.51;经同性传播、注射吸毒和性接触＋注射毒品感染的病例及时入组治疗的可能性低于经异性传播感染的病例,OR值分别为0.86、0.59和0.72;样本来源为医疗机构、羁押场所的病例入组治疗的可能性低于样本来源为检测咨询的病例,OR值分别为0.90和0.29;CD4＋T淋巴细胞计数为50~99、100~199、200~350个/μl的病例及时入组治疗的可能性低于CD4＋T淋巴细胞计数为0~49个/μl病例,OR值分别为0.84、0.64和0.40.以上P值均〈0.05.结论 2010—2014年我国符合抗病毒治疗标准的HIV/AIDS入组治疗及时率逐年提高.男性、未婚或离异、低年龄、注射吸毒、来源于医疗机构和羁押场所以及高CD4＋T淋巴细胞水平与及时入组治疗存在相关性.

Objective To analyze timeline of antiretroviral therapy （ART） initiation among newly diagnosed HIV/AIDS from 2010 to 2014, as well as influencing factors. Methods Data from the Chinese HIV/AIDS Comprehensive Response Information Management System was used to collect newly diagnosed HIV/AIDS cases from January 1, 2010 to December 31, 2014. Inclusion criteria of HIV/AIDS were confirmed cases and clinically diagnosed HIV positive, Chinese mainland cases, 14 years old and above, the first CD4 ＋T lymphocyte ≤350 cells/μl in the follow up period. A total of 177971 HIV/AIDS cases were included in this study. The general demographic characteristics （gender, age, ethnicity, education, occupation, etc.）, infection routes, sample sources, CD4 ＋ T lymphocyte level and other information were collected from the database. Chi square test was used to analyze univariate factor of the timeliness of ART initiation. Multivariate logistic regressions were used to analyze potential factors associated with timeliness of ART initiation. Results Out of the 177971 cases, 130679 （73.4%） were males. The proportion of the timeliness of ART initiation was 55% （97915）. The proportion of timeline of ART within 15 d increased from 26.4% （4319/16388） in 2010 to 39.7% （20212/50889） in 2014. The highest proportion was in the group of patients infected by illegal blood （plasma） donation, which was 38% （945）. The proportion of timeline of ART within 30 d increased from 43.2% （7077/16388） in 2010 to 63% （32070/50889） in 2014. The highest proportion was in the group of patients infected by heterosexual transmission, which was 58.3%（73098）. Multivariate logistic regression analysis on timeliness of ART showed that the factors of timeliness of ART initiation of HIV/AIDS as follow. The possibility of timeliness of ART among patients who were female, education of junior high school and above, ethnic group of Han, farmers, married were higher, with OR values at 1.08, 1.09, 1.13, 1.05 and 1.12. The possibilities of timeliness of ART in group of patients aging 25-34, 35-44, 45-54 and ≥55 years old were higher than that of the group of patients aging 15-24 years old, with OR values at 1.13, 1.31, 1.46 and 1.51, respectively. The possibilities of timeliness of ART among the homosexuals, injection drug use and sexual contact plus injection drug use cases were lower than that of the heterosexuals, with OR values at 0.86, 0.59 and 0.72, respectively. The possibilities of timeliness of ART among patients whose HIV diagnosis from hospitals and detention centers were lower than that of patients whose HIV diagnosis from volunteer testing and counseling, with OR values at separately 0.90 and 0.29. The possibilities of timeliness of ART among patients whose CD4 ＋T lymphocyte at 50-99, 100-199, 200-350 cells/μl were lower than that of the patients whose CD4＋T lymphocyte count at 0-49 cells/μl, with OR values at 0.84, 0.64 and 0.40, respectively. All the P values above was〈0.05. Conclusion The proportion of timeliness of ART increased annually from 2010 to 2014. Those who were men, unmarried or divorced, at younger age, injection drug use, diagnosis from hospitals and detention centers and high CD4＋T lymphocyte levels were related to the timeliness of ART.