贵州省1995-2018年HIV/AIDS生存时间及其影响因素分析

Survival time and related factors on HIV/AIDS patients in Guizhou province from 1995 to 2018

目的了解1995-2018年贵州省HIV/AIDS生存时间及影响因素。方法采用回顾性队列研究的方法,从"艾滋病防治基本信息系统"中下载1995-2018年贵州省报告的所有现住址为贵州省的HIV/AIDS报告卡。进行统计分析,运用寿命表法计算生存率、Kaplan-Meier法计算生存时间、Cox比例风险模型分析HIV/AIDS生存时间的影响因素。结果纳入研究对象HIV/AIDS 53232例,死亡率为8.53/100人年(14210/166679.18);生存时间中位数为10.20(95%CI:9.91~10.48)年,第1、5、10、20年的累积生存概率分别为0.85、0.68、0.51、0.36、0.19;多因素Cox比例风险模型分析结果显示,男性(与女性相比,aHR=0.757,95%CI:0.727~0.788)、未接受过抗病毒治疗(与接受过抗病毒治疗相比,aHR=0.173,95%CI:0.165~0.181)、首次CD4+T淋巴细胞(CD4)<200个/μl(与首次CD4≥200个/μl者相比,aHR=0.410,95%CI:0.387~0.435)、≥45岁(与<45岁者相比,aHR=1.506,95%CI:1.193~1.901)、文盲(与高中及以上学历者相比,aHR=0.904,95%CI:0.832~0.982)、未婚(与离异或丧偶者相比,aHR=0.896,95%CI:0.848~0.946)、异性性传播(与同性性传播者相比,aHR=0.555,95%CI:0.487~0.632)、苗族等少数民族(与汉族相比,aHR=1.185,95%CI:1.114~1.262)、农民/民工(与家政/待业者相比,aHR=0.874,95%CI:0.834~0.916)均是影响病例生存时间的因素。结论贵州省HIV/AIDS死亡率较高,近年来并未出现明显的下降趋势,男性、≥45岁、文化程度较低、少数民族、首次CD4检测<200个/μl等是影响HIV/AIDS生存时间的因素。应该针对具有这些特征的病例加强治疗和随访管理,以提高其生存质量。

Objective To examine the survival time and related factors on HIV/AIDS patients in Guizhou province from 1995 to 2018.Methods A retrospective cohort study was conducted to analyze the HIV/AIDS case from 1995 to 2018 in Guizhou province with data gathered from the"Chinese National Comprehensive HIV/AIDS Prevention and care Information system".Survival rate was calculated by life table and survival time was estimated by Kaplan-Meier.Related factors on survival time were analyzed by Cox regression model.Results A total of 53232 HIV/AIDS cases were included in the study,with the mortality rate as 8.53/100 person-years(14210/166679.18),median survival time as 10.20(95%CI:9.91-10.48)years,and survival rates of 1,5,10 and 20 years as 0.85,0.68,0.51,0.36,0.19 respectively.Results from the multivariate Cox regression analysis showed that factors as:being male(compared with females,aHR=0.757,95%CI:0.727-0.788),with antiviral treatment(ART)(compared with those without ART,aHR=0.173,95%CI:0.165-0.181),CD4<200 cells/μl[compared with CD4+T cells(CD4)≥200 cells/μl,aHR=0.410,95%CI:0.387-0.435],age≥45(compared with age<45,aHR=1.506,95%CI:1.193-1.901),illiterate(compared with having high school education or above,aHR=0.904,95%CI:0.832-0.982),unmarried(compared with divorced or widowed,aHR=0.896,95%CI:0.848-0.946),through heterosexual transmission(compared with homosexual transmission,aHR=0.555,95%CI:0.487-0.632),ethnic minorities(compared with Hans,aHR=1.185,95%CI:1.114-1.262),and farmers/migrant workers(compared with domestic/unemployed,aHR=0.874,95%CI:0.834-0.916,)etc.,were related to the survival time of HIV/AIDS,in Guizhou province.Conclusions The mortality rate of HIV/AIDS in Guizhou province appeared relatively high,but with no obvious downward trend seen in the last years.Factors as being male,age≥45,low education level,ethnic minorities,CD4<200 cells/μl were identified as related to the HIV/AIDS survival time.We would suggest that treatment and follow-up management programs should be strengthened to improve the quality of life among these patients.