我国14岁及以下HIV感染儿童生存分析

Survival analysis on HIV-infected children aged 14 years old and younger in China

目的探究我国≤14岁HIV感染儿童全阶段生存情况及相关影响因素。方法选取我国艾滋病病例报告数据库及抗病毒治疗数据库内的HIV感染儿童,采取回顾性队列研究方法探究HIV感染儿童生存情况,采取Cox比例风险回归模型对影响生存时间的因素进行筛选。结果HIV感染儿童8029例,中位生存时间179.75个月,确诊阳性后1、2、5、10年的累积生存概率分别为99.13%、97.95%、90.11%、78.63%。多因素Cox比例风险回归分析发现,未接受抗病毒治疗儿童的死亡风险是接受抗病毒治疗儿童的12.81倍(95%CI:11.40~14.27);男童的死亡风险是女童的1.20倍(95%CI:1.10~1.32);确诊阳性年龄在3~5岁HIV感染的儿童死亡风险是确诊阳性年龄在<2岁儿童的0.67倍(95%CI:0.60~0.76)。西北地区儿童的死亡风险是东北地区儿童的0.52倍(95%CI:0.29~0.95),本地治疗儿童的死亡风险是异地治疗儿童的1.96倍(95%CI:1.48~2.61),未获得关怀服务儿童死亡风险是获得关怀服务儿童的2.07倍(95%CI:1.88~2.29)。结论我国≤14岁HIV感染儿童中位生存时间179.75个月。接受抗病毒治疗、女童、异地治疗、西北地区,获得关怀服务和确诊时年龄较大是HIV感染儿童生存时间的保护因素。

Objective To understand the survival status and related influencing factors of HIV-infected children aged≤14 years old,in China.Methods HIV-infected children were selected from the China's HIV/AIDS Comprehensive Response Information Management System(CRIMS).A retrospective cohort study was conducted to investigate the situation of survival on infected children.Cox proportional hazard regression model was used to screen the factors affecting the survival time.Results This study involved 8029 cases of infected children,with a median survival time of 179.75 months.The cumulative survival probabilities at 1 year,2 years,5 years,and 10 years after the diagnosis,were 99.13%,97.95%,90.11%and 78.63%,respectively.Results from the multivariate Cox proportional hazard regression analysis showed that children who did not receive antiviral therapy were 12.81 times more likely to die than the ones who received the antiretroviral therapy(95%CI:11.40-14.27).Male HIV-infected children were 1.20(95%CI:1.10-1.32)times more likely to die than the female HIV-infected children.The risk of death among HIV positive children at the age of 3 to 5 years was 0.67(95%CI:0.60-0.76)times of those children who were diagnosed at the age of 2 years old or younger.The risk of death among children infected with HIV in Northwest was 0.52(95%CI:0.29-0.95)times higher than the ones from the Northeast areas of China.The risk of death among children who received antiviral treatment(ART)in the residential areas was 1.96(95%CI:1.48-2.61)times than those children who did not.The risk of death from children who did not receive health care services was 2.07 times of those children who did(95%CI:1.88-2.29).Conclusions The median survival time of HIV-infected children aged≤14 years old was 179.75 months,in China.Our findings revealed that initiation of antiviral therapy,female,age,place of receiving ART(out of the residential areas),living in Northwest China,care services and being diagnosed at older age etc.were protective factors influencing the survival time of infected children.