湖北省2008-2018年艾滋病抗病毒治疗患者生存及影响因素分析

Survival time and influence factors of HAART in Hubei,2008-2018

目的分析湖北省2008-2018年艾滋病抗病毒治疗患者的生存状况,并分析其影响因素。方法通过回顾性队列研究,以湖北省2008-2018年艾滋病抗病毒治疗患者为研究对象,收集生存及死亡信息,利用Cox比例风险模型分析生存时间的影响因素。结果共纳入17322例研究对象,观察期内在治的有83.70%,死亡9.96%,停药3.67%。死亡病例中,因艾滋病相关疾病死亡的占47.65%;所有艾滋病患者第1、2、3、4、5年的累积生存率分别为:96.77%、95.51%、94.73%、94.24%、93.83%。Cox比例风险模型分析显示,文化程度为高中/中专、大专及以上水平的患者死亡风险分别是初中及以下文化患者的3.644倍(95%CI:2.376~5.587)、2.58倍(95%CI:1.641~4.064);职业是家政及服务业的艾滋病患者死亡风险是农民患者的1.414倍(95%CI:1.184~1.690);机会性感染数量1~2种、3种及以上的患者,死亡风险是未患机会性感染患者的0.392倍(95%CI:0.303~0.507)、0.794倍(95%CI:0.620~1.017);WHO临床分期为Ⅲ~Ⅳ期的艾滋病患者,死亡风险是Ⅰ~Ⅱ期的0.520倍(95%CI:0.443~0.611);基线CD4^+T淋巴细胞计数在351~500个/μL、201~350个/μL、≤200个/μL的患者死亡风险是CD4^+T淋巴细胞计数>500个/μL的1.356倍(95%CI:0.493~3.733)、3.419倍(95%CI:1.392~8.396)、11.936倍(95%CI:4.922~28.945);确证-开始治疗时间越长,死亡风险越高;开始治疗时年龄越低,死亡风险越高,初始治疗方案含替诺福韦的比不含的死亡风险低。结论湖北省2008-2018年接受艾滋病抗病毒治疗的患者生存状况较其他省好;文化程度越高、WHO临床分期越低、基线CD4^+T淋巴细胞计数越低、开始治疗时年龄越低、初始治疗方案不含替诺福韦者接受抗病毒治疗后生存时间短。

Objective To analyze the survival status of patients with AIDS after antiviral therapy in Hubei Province from2008-2018,and we analyze its influencing factors.Methods A retrospective cohort study was conducted to collect survivaland death information of patients receiving HIV/AIDS antiviral treatment in Hubei province from 2008 to 2018.Coxproportional risk model was used to analyze the influencing factors of survival time.ResultsA total of 17322 subjects wereincluded in the study.During the observation period,83.70%were treated,9.96%died,and 3.67%were discontinued.Of thedeaths,47.65%were due to AIDS-related diseases.The cumulative survival rates at the 1 st,2 nd,3 rd,4 th and 5 th year were96.77%,95.51%,94.73%,94.24%and 93.83%,respectively,for all AIDS patients.Cox proportional risk model analysisshowed that the death risks of patients with high school/technical secondary school education,junior college education andabove was 3.644 times(95%CI:2.376-5.587)and 2.58 times(95%CI:1.641-4.064)of junior high school and below patients,respectively.The death risk of AIDS patients with housekeeping and service occupations was 1.414 times(95%CI:1.184-1.690)that of farmers.The death risk of patients with one to two kinds,three or more kinds of opportunistic infections was 0.392 times(95%CI:0.303-0.507)and 0.794 times(95%CI:0.620-1.017)for patients without opportunistic infections;the death risk ofWHO clinical stageⅢ-ⅣAIDS patients was 0.520 times(95%CI:0.443-0.611)that of stage I-II;Patients with baseline CD4^+T lymphocyte counts of 351-500/μL,201-350/μL,≤200/μL had a 1.356 times(95%CI:0.493-3.733),3.419 times(95%CI:1.392-8.396),11.936 times(95%CI:4.922-28.945)dying risk of patients with CD4^+T lymphocyte counts of 501-/μL.Thelonger confirmation to treatment begins,the higher the risk of death;The younger age at the beginning of treatment was,and thehigher the risk of death,the death risk of patients with tenofovir in the initial treatment regimen was lower compared to thosewithout tenofovir.ConclusionFrom 2008 to 2018,the survival status of patients receiving anti-viral treatment for AIDS inHubei province was better than that in other provinces.The higher the education level,the lower the WHO clinical stage,the lower the baseline CD4^+T lymphocyte count,the lower the age at the beginning of treatment,and the shorter the survival timeafter the initial treatment regimen without tenofovir.