河南省2003—2005年HIV／AIDS抗病毒治疗随访10年生存状况分析

Analysis on 10 year survival of HIV/AIDS patients receiving antiretroviral therapy during 2003-2005 in Henan province

目的分析河南省艾滋病感染者和艾滋病患者（HIV／AIDS）抗病毒治疗（antiretroviral therapy，ART）10年生存状况及影响长期生存的因素。方法利用国家艾滋病抗病毒治疗数据库，收集河南省2003--2005年接受ART的HIV／AIDS基本情况和治疗随访信息，采用寿命表法和Cox比例风险模型分析生存状况和影响长期生存的危险因素，采用SPSS23．0软件进行统计分析。结果2003--2005年开始ART的2448例HIV／AIDS中，男性占53．5％（1309／2448），女性占46．5％（1139／2448），40。59岁占70．1％（1715／2448），以血液传播为主，占95．5％（2337／2448）；ART后随访10年，死于艾滋病及相关疾病719例，死亡率为3．78／100人年（719／19010人年）；患者第1、3、5、10年累计生存率为0．94、0．86、0．78、0．69。相对于年龄〈40岁组，40～、50-、60～和≥70岁组HR值（95％CI）分另0为1．417（0．903—2．222）、1．834（1．174～2．866）、2．422（1．539～3．810）和3．424（2．053～5．709）；相对于基线CD4^＋T淋巴细胞（CD4）〉350个／μl，CD4〈50、50-199、200～350个／μl的HR值（95％C1）值分别为7．105（5．449—9．264）、4．175（3．249～5．366）和2，214（1．691～2．900）；男性相对于女性HR=1．480（95％CI：1．273—1．172）、没有更换二线治疗HR=11．923（95％凹：9．410—15．104）。结论河南省早期HIV／AIDS接受ART10年后的累计生存率为0．69，男性、年龄较大、基线CD4水平低、未及时更换二线抗病毒药物为影响其长期生存的危险因素。

Objective To understand the survival of HIV/AIDS patients after receiving antiretroviral therapy for 10 year in Henan province and related factors. Methods The database of national integrated management system of HIV/AIDS was used to collect the basic information and foUow-up information of HIV/AIDS patients who received antiretroviral therapy between 2003 and 2005 in Henan province. Software SPSS 23.0 was used to analyze the patients＇ survival and related factors based on the life-table method and Cox proportional hazards model. Results Among the 2 448 HIV/AIDS patients who started antiretroviral therapy during 2003-2005, the men accounted for 53.5%, and women accounted for 46.5%. Up to 70.1% of the patients were aged 40-59 years and 95.5% of the patients had blood borne infections. The patients were observed for 10 years after antiviral treatment, and 719 cases died from AIDS related diseases, with a mortality rate of 3.78/100 per year （719/19 010 per year）. The cumulative survival rates of patients within 1-year, 3 years, 5 years and 10 years were 0.94, 0.86, 0.78, 0.69 respectively. Compared with the patients aged 〈40 years, the HRs of the patients aged 40-, 50-, 60- and ≥70 years were 1.417 （95%CI： 0.903-2.222）, 1.834 （95%CI： 1.174-2.866）, 2.422 （95%CI： 1.539-3.810） and 3.424 （95%CI： 2.053-5.709） respectively. Compared with patients with baseline CD4＋T lymphocyte 〉 350 unit/ul, the FIRs of the patients with CD4^＋T lymphocyte 〈50 unit/μl, 50-199 unit/ul and 200-350 unit/ul were 7.105 （95%CI： 5.449-9.264）, 4.175 （95% CI： 3.249-5.366） and 2.214 （95% CI： 1.691-2.900） respectively. Compared with the women, the HR of the men was 1.480 （95% CI： 1.273-1.172）. Compared with the patients who received second line ART therapy, the HR of patients receiving no second line therapy was 11.923 （95%CI： 9.410-15.104）. Conclusions The cumulative survival rate the HIV/A1DS patients after 10 years of antiretroviral therapy reached 0.69 in Henan. Male, old age, low basic CD4~T lymphocyte count and receiving no second line therapy were the risk factors for long-term survival of AIDS patients.