河南省2005至2015年抗病毒治疗艾滋病患者生存状况及影响因素分析

Survival analysis and associated factors of acquired immune deficiency syndrome patients under antiretroviral therapy in He＇ nan Province during 2005 to 2015

目的了解河南省接受免费HAART后艾滋病患者的生存情况及影响因素。方法利用国家艾滋病抗病毒治疗信息系统收集2005年至2015年接受HAART患者的生存和死亡信息，采用SPSS 23.0进行数据分析。结果共收集符合条件的艾滋病患者38 143例，HAART后患者1～5年累计生存率分别为95%、91%、89%、86%和85%。HAART后累计死亡5 704例，总病死率为3.68/100人年（5 704/155 060人年）；1年内死亡1 975例，占34.62%。多因素分析结果显示，相对于入组年龄〈30岁组，入组年龄40～49、50～59、60～69和≥70岁组风险比[HR（95%CI）]分别为1.49（1.22～1.80）、1.88（1.55～2.28）、2.82（2.32～3.42）和4.60（3.75～5.65）；相对于基线CD4＋T淋巴细胞数〉350个/μL，基线CD4＋T淋巴细胞数〈50、50～199和200～349个/μL组HR（95%CI）分别为3.28（2.98～3.61）、2.30（2.09～2.53）和1.39（1.25～1.54）。男性（HR＝1.35，95%CI： 1.28～1.42）、未更换二线治疗（HR＝4.41，95% CI： 4.12～4.73）是艾滋病死亡的危险因素；相对性传播，经血感染HIV是艾滋病死亡的风险因素。结论早期对艾滋病患者实施HAART，对治疗失败的患者及时更换二线治疗是延长生存时间，降低死亡率的关键。

ObjectiveTo study the survival status and the prognostic factors of aquired immune deficiency syndrome （AIDS） patients under the highly active antiretroviral therapy （HAART） in He′nan Province.MethodsSurvival data of AIDS patients were collected from the National HAART reporting system between 2005 and 2015, and analyzed using SPSS 23.0 software.ResultsA total of 38 143 AIDS cases were enrolled in this study. The cumulative survival rate of patients under antiretroviral therapy after 1—5 years were 95%, 91%, 89%, 86% and 85%, respectively. The cumulative death cases were 5 704 and the total mortality was 3.68/100 person years （5 704/155 060 person years）. A total of 1 975 cases died within a year with a percentage of 34.62%. Cox proportional hazard regression model analysis indicated that the hazard ratioc （HR [95%CI]） of death in patients with age of 40-49 years, 50-59 yrears, 60-69 yrears and ≥70 years groups compared to those with age 〈30 years group were 1.49 （1.22-1.80）, 1.88 （1.55-2.28）, 2.82 （2.32-3.42） and 4.60 （3.75-5.65）, respectively. The HR （95% CI） of death in patients with CD4＋ T cell counts 〈50 cells/μL, 50-199 cells/μL, 200-349 cells/μL groups compared to those of ≥350 cells/μL group were 3.28 （2.98-3.61）, 2.30 （2.09-2.53） and 1.39 （1.25-1.54）, respectively. Male （HR=1.35, 95%CI： 1.28-1.42） and not switching to second line therapy （HR=4.41, 95%CI： 4.12-4.73） were the risk factors of death. Compared to sex transmission, blood transmission was the risk factors of death in AIDS patients.ConclusionsThe initiation of early HAART and timely switching to second line therapy for AIDS patients are key to prolong the survival time and to reduce AIDS related death.