天津市1996至2017年未接受治疗的HIV/AIDS患者生存情况分析

Survival of untreated HIV/AIDS patients in Tianjin

目的分析天津市15岁及以上未接受治疗的HIV/AIDS病例诊断后生存时间及影响因素。方法回顾性分析1996年6月28日至2017年5月28日天津市报告至中国艾滋病基本信息系统的≥15岁未治疗的HIV/AIDS病例973例的数据资料,应用寿命表法计算所有患者的生存率,Cox比例风险模型分析生存时间的影响因素。结果973例HIV/AIDS病例中,HIV感染者726例(74.6%),AIDS患者247例(25.4%)。其中男性患者(93.7%,912/973)高于女性患者(6.3%,61/973);汉族占比为92.5%(900/973);文化程度以高中及以下者为主(71.0%,691/973);婚姻状况以未婚(50.4%,490/973)为主;传播途径以同性传播(57.7%,561/973)为主;本市户籍(62.9%,612/973)高于外地户籍(37.1%,361/973);来源以术前输血前检测(36.6%,356/973)为主,74.5%(725/973)的患者进行了首次CD4^+T淋巴细胞计数的检测。平均生存时间为11.03年(95%CI 10.01~12.05年),诊断后1、3、5、10年的生存率分别为:96.8%、88.7%、80.2%、40.5%。因艾滋病引起的相关死亡183例(18.8%)。Cox比例风险模型分析显示,相较于15~35岁患者,年龄>35~50岁(HR=3.077,95%CI 1.868~5.070)及>50岁患者(HR=2.626,95%CI 1.553~4.440)发生艾滋病相关死亡的风险高;相较于高中及以下文化程度,大专及以上患者(HR=0.562,95%CI 0.371~0.851)死亡风险低;注射毒品传播(HR=0.751,95%CI 0.316~0.909)患者的死亡风险低于同性传播患者;来源于检测咨询(HR=0.463,95%CI0.252~0.851)、专题调查(HR=0.263,95%CI0.116~0.593)、羁押人员体检(HR=0.055,95%CI 0.007~0.441)与性病门诊就诊者检测(HR=0.033,95%CI0.005~0.239)的患者发生死亡的风险较术前输血前发现的病例死亡风险低,诊断时首次CD4^+T淋巴细胞计数越高者死亡发生的风险越低(P<0.01)。结论天津市≥15岁未接受治疗的HIV/AIDS患者诊断后平均生存时间为11.03年,诊断时年龄、文化程度、感染途径、病例来源与诊断后首次CD4^+T淋巴细胞计数与患者诊断后的生存时间相关。

Objective To analyze the survival and influencing factors of treatment-naive HIV/AIDS patients aged 15 years or above in Tianjin. Methods The data of 973 untreated HIV/AIDS patients aged 15 years or above who were diagnosed during June 28 1996 to May 28 2017 in Tianjin were retrospectively analyzed. The survival rate of patients was calculated by the life table method, and the factors affecting the survival time were analyzed by the Cox proportional hazard model. Results There were 726 HIV carriers (74.6%) and 247 AIDS patients (25.4%). Among them, there were more males (93.7%, 912/973) than females (6.3%, 61/973);Han nationality accounted for 92.5%(900/973);the education level of most patients was high school or below (71.0%, 691/973);half of the patients were unmarried (50.4%, 490/973);57.7%(561/973) of the patients were infected by men who have sex with men (MSM);62.9%(612/973) were local residents and 37.1%(361/973) were migrants;36.6%(356/973) cases were detected by pre-transfusion tests, and 74.5%(725/973) had initial CD4^+ T count tests. In this series, the average survival time is 11.03 years after diagnosis (95%CI 10.01-12.05 years). The 1, 3, 5, and 10-year survival rates after diagnosis were 96.8%, 88.7%, 80.2% and 40.5%. 183 cases (18.8%) died from AIDS. Cox proportional hazard model analysis showed that compared with patients aged 15 to 35 years, patients aged 35-50 years (HR=3.077, 95%CI 1.868-5.070) and >50 years (HR=2.626, 95%CI 1.553-4.440) had higher risk of AIDS-related deaths;compared with high school education or below, patients with college education or above (HR=0.562, 95%CI 0.371-0.851) had a lower risk of AIDS death;injection drug user (IDU)(HR=0.751, 95%CI 0.316-0.909) had lower risk of death than MSM. Patients detected by the consultation (HR=0.463, 95%CI 0.252-0.851), special investigation (HR=0.263, 95%CI 0.116-0.593), detainee physical examination (HR=0.055, 95%CI 0.007-0.441) and STD clinic visits (HR=0.033, 95%CI 0.005-0.239) had a lower risk of death than those detected by pre-transfusion tests. The initial CD4+ T lymphocyte counts were negatively correlated with the risk of AIDS-related death (P<0.01). Conclusions The average survival time after diagnosis of untreated HIV/AIDS patients aged 15 years or above was 11.03 years in Tianjin. The age, education level, route of infection, detection of HIV infection and the initial CD4^+ T lymphocyte counts are related to the survival time after diagnosis of untreated HIV/AIDS patients.