云南省文山壮族苗族自治州2012-2015年入组HIV抗病毒治疗者的脱失情况及影响因素

Antiretroviral treatment discontinuation and its influencing factors among HIV-infected patients who initiated ART from 2012 to 2015 in Wenshan prefecture, Yunnan Province

目的分析云南省文山壮族苗族自治州（文山州）2012--2015年人组抗病毒治疗（ART）的HIV感染者治疗脱失情况及影响因素。方法选择文山州2012--2015年4354例人组成年人抗病毒治疗者，采集一般人口学信息、治疗基线状况和初始治疗方案，以及各次随访日期及随访状态，观察至2016年6月底。采用历史性队列研究方法对研究对象脱失情况进行描述，采用寿命表法计算治疗后每6个月的累积维持治疗率；采用Cox比例风险回归模型探讨治疗者脱失的影响因素。结果文山州2012-2015年入组ART者的脱失比例为25．1％（1092／4354），脱失发生率为14．53／100人年。治疗后第6、12、18、24个月末的累积维持治疗率分别为88％、83％、78％、74％。多因素Cox比例风险回归模型分析显示，男性治疗者脱失风险较女性高（HR=1．24，95％CI：1．09-1．41），年龄／〉50岁者治疗脱失风险高于年龄〈30岁者（HR=1．27，95％CI：1．06—1．53），未婚／离异／丧偶者治疗脱失风险为已婚／同居者的1．30倍（HR：1．30，95％CI：1．14-1．48），静脉吸毒途径感染者治疗脱失风险是异性传播感染者的1．49倍（HR：1．49，95％CI：1．23-1．82），基线CD4^＋T淋巴细胞计数〈350个／μl、≥500个／μl者脱失风险均高于基线CD4^＋T淋巴细胞计数为350-499个／μl者，HR（95％CI）值分别为1．34（1．13-1．58）、1．36（1．09—1．71），治疗开始年份为2014年、2015年者脱失风险分别是2012年者的1．25倍（HR：1．25，95％CI：1．04-1．50）和1．26倍（HR：1．26，95％CI：1．02-1．55）。结论文山州HIV感染者的ART脱失率有增加趋势，男性、〉／50岁、婚姻状况为未婚腐异／丧偶、静脉吸毒途径感染、治疗开始时CD4^＋T淋巴细胞计数〈350个／μl或≥500个／μl者为治疗脱失的高风险人群。

Objective To understand the antiretroviral treatment （ART） discontinuation rate and its influencing factors among HIV infected patients who initiated ART between 2012 and 2015 in Wenshan prefecture, Yunnan province. Methods Demographic Characteristics, baseline informations of ART, initial treatment regimens and follow-up status of a total of 4 354 patients who initiated ART from 2012 to 2015 in Wenshan prefecture were collected. A historical cohort study was used to describe the discontinuation incidence rate of ART. Life table was used to estimate cumulative retention rate and Cox proportional hazard model was used to determine the influencing factors of ART discontinuation. Results The percentage and incidence rate of discontinuation were 25.1% （1 092/4 354） and 14.53 per 100 person-years among patients who initiated ART from 2012 to 2015 in Wenshan prefecture. ART retention rates were 88%, 83%, 78%, 74% at 6^th month, 12^th month, 18^th month, 24^th month, respectively. The multivariate Cox proportional hazard regression model showed that male patients were at a higher risk of discontinuation （HR=1.24,95%CI： 1.09- 1.41） than female patients, patients aged 350 years were at a higher risk of discontinuation （HR=1.27, 95% CI： 1.06-1.53） than patients aged〈30 years, discontinuation hazard among patients who were unmarried or divorced or widowed was 1.30 times （HR：1.30, 95% CI： 1.14-1.48） as patients who were married or cohabitation, discontinuation hazard among patients infected with HIV through injection drug use （IDU） was 1.49 times （HR： 1.49, 95%CI： 1.23-1.82） as those infected through heterosexual transmission, patients with a baseline CD4 eell eount〈350/μl （HR=1.34, 95%CI： 1.13-1.58） or ≥500/μl （HR=1.36, 95%CI： 1.09-1.71） were at a higher risk of discontinuation than those with a baseline CD4 cell count from 350/1＊1 to 500/btl, patients initiating ART in 2014 （HR=1.25, 95%CI： 1.04-1.50） or in 2015 （HR=1.26, 95%CI： 1.02-1.55） were at a higher risk of discontinuation than those initiating ART in 2012. Conclusion There is an uptrend for ART discontinuation rate in Wenshan prefecture. Male, 50 years or older, unmarried or divorced or widowed, transmission route as IDU, baseline CD4 count 〈350/μl or≥ 500/μl are risk factors of ART discontinuation.