河南省2003-2015年抗病毒治疗后死亡的HIV／AIDS病例生存时间及相关因素分析

Survival time of HIV/AIDS death cases after antiretroviral therapy and related factors in Henan province, 2003-2015

目的 了解抗病毒治疗（ART）后死亡的HIV/AIDS病例（死亡病例）生存时间及其相关因素.方法 利用中国艾滋病综合防治信息系统,收集2003年1月至2015年12月接受ART后死亡病例相关信息,采用SPSS 23.0软件和Cox比例风险模型方法,分析死亡病例的生存时间及其相关因素.结果 经ART后共6267例HIV/AIDS死亡,生存时间M=23.85（QR：6.87-50.46）个月.ART〈6个月、7-12个月和13-24个月死亡病例分别为1441例（23.00%）、652例（10.40%）和1052例（16.79%）,〉24个月死亡病例数减少;死亡病例中艾滋病相关死亡5085例（81.1%）,非艾滋病相关死亡799例（12.7%）,意外死亡179例（2.9%）,自杀死亡109例（1.7%）,2003-2015年历年死因构成比差异具有统计学意义（χ……2=864.27,P〈0.01）.ART后12、36、60和120个月时,病例的生存率分别是66.59%、36.62%、19.24%和0.64%.相比于单采血浆感染途径,性途径感染的病例HR值（95%CI）为1.602（1.483-1.732）,相比于基线CD4＋T淋巴细胞计数（CD4）≥350个/μl,CD4〈50个/μl的病例HR值（95%CI）为2.320（2.119-2.539）,相比于更换二线ART方案,未更换者HR值（95%CI）为3.312（3.083-3.558）.结论 病例的死亡时间主要集中在ART前6个月,随着ART时间的延长,生存率提高,死亡病例数减少.而性途径感染、基线CD4水平低、未更换二线ART方案可能是HIV/AIDS死亡的相关危险因素.

Objective To analyze and investigate the survival time of dead HIV/AIDS patients after antiretroviral therapy （ART） and related factors in Henan province. Methods The database of national integrated management system of HIV/AIDS was used to collect the information of dead patients who received ART between January 2003 and December 2015. Software SPSS 23.0 was used to analyze the survival time of dead patients and related factors. Result A total of 6267 AIDS patients died after ART and the average survival time was 23.85 months （QR： 6.87-50.46 months）. Within 6 months, 7-12 months and 13-24 months after ART, the numbers of dead patients were 1441 （23.00%）, 652 （10.40%） and 1052 （16.79%）, respectively. The number of dead cases decreased after 24 months of ART. The number of AIDS-related deaths was 5085 （81.1%）;and 799 （12.7%） deaths were due to other causes, in which 179 （2.9%） were caused by accidents and 109 （1.7%） were caused by suicides. The differences in annual composition ratio of death causes during 2003-2015 had significance （ χ^2=864.27, P〈0.01）. Twelve months, 36 months, 60 months and 120 months after ART, the survival ratios were 66.59%, 36.62%, 19.24% and 0.64% respectively. Compared with patients infected through blood donation, the HR of the patients infected through sexual transmission was 1.602 （95%CI： 1.483-1.732）. Compared with patients with initial level of CD4＋T lymphocyte≥350 unit/μl, the HR of patients with initial level of CD4＋T lymphocyte〈50 unit/μl was 2.320 （95%CI： 2.119-2.539）. Compared with patients receiving second line ART, the HR of patients receiving no second line ART was 3.312 （95%CI： 3.083-3.558）. Conclusion The AIDS related deaths mainly occurred in the first six months after ART. As the increase of duration of ART,the death rate decreased. Sexual transmission, low initial level of CD4＋T lymphocyte and receiving no second line ART were the risk factors for the deaths of HIV/AIDS patients.