深圳市宝安区1625名HIV感染者疾病进程特征及其影响因素分析

Characteristics and Influencing Factors of Disease Progression Among 1 625 HIV Patients in Baoan District of Shenzhen City

目的探讨深圳市宝安区艾滋病毒(HIV)感染者的疾病进程特征及其影响因素。方法采用回顾性队列研究方法,通过国家艾滋病综合防治信息系统收集分析2000-01-01/2018-12-31期间报告的现住址为深圳市宝安区的HIV感染者的相关资料。采用Excel 2016软件和SPSS 21.0软件进行数据处理分析,Stata 12.0软件绘制生存曲线和森林图。采用寿命表法计算发病率,Kaplan-Meier法计算潜伏期和绘制累计发病率曲线,Cox比例风险回归模型用于探讨研究对象艾滋病(AIDS)潜伏期的影响因素。结果共纳入1 625名研究对象,其中246名患者进展为AIDS(15.14%)。平均潜伏期为10.15年(95%CI:9.35~10.94年),AIDS发病密度为5.57/100人年。第1年、3年、5年、10年的累计发病率分别为8.38%、15.10%、21.08%、42.33%。多因素Cox比例风险回归分析显示,年龄大的患者以及女性HIV感染者的潜伏期短,发病风险高。接受高效抗逆转录病毒治疗(HAART)和高基线CD4+T细胞水平的HIV感染者的潜伏期长,发病风险低。结论年龄、性别、HAART、基线CD4+T细胞水平是HIV感染者疾病进程的重要影响因素。应加强高危HIV感染者的随访管理工作,采取个性化的防治措施,以延长患者的无症状生存期,提高生命质量。

Objective To explore the characteristics and influencing factors of disease progression among individuals infected with HIV in Baoan district, Shenzhen city. Methods A retrospective cohort study was conducted. Information about HIV cases living in Baoan district reported between January 1, 2000 and December 31, 2018 was collected from China Integrated Prevention and Control Information System of AIDS. Excel2016 and SPSS 21.0 software were used for data processing and analysis,and Stata 12.0 software was adopted for the drawing of survival curves and forest maps. Life table method was used to calculate the incidence, Kaplan-Meier method was applied to calculate incubation period and draw cumulative incidence curve. Cox proportional risk regression model was employed to explore the influencing factors of the incubation period of AIDS. Results A total of 1 625 subjects were enrolled in this study. 246 participants developed AIDS,accounting for 15.14% of the total sample.The average incubation period was 10.15 years(95% CI: 9.35-10.94 years), and the incidence density of AIDS was 5.57/102 person-years. The cumulative incidence at 1, 3, 5, and 10 years after diagnosis was 8.38%, 15.10%, 21.08%, and 42.33%, respectively. Multivariate cox proportional risk regression analysis indicated that older patients and women infected with HIV had shorter incubation period and higher risk of disease onset. Patients receiving highly active antiretroviral therapy(HAART) and those who had higher CD4 + T cell levels at baseline had longer incubation period and lower risk of developing AIDS. Conclusion Age, gender, HAART,and CD4+T cells level at baseline are important factors associated with the disease progression of HIV patients. The follow-up management of high-risk HIV patients should be strengthened.Personalized prevention and treatment measures should be taken to prolong the asymptomatic life span and improve the quality of life of patients.