凉山彝族自治州布拖县2010-2019年抗病毒治疗HIV/AIDS死亡的影响因素分析

Influencing factors on the death of HIV/AIDS patients treated with antiviral treatment in Butuo county,Liangshan Yi Autonomous Prefecture,2010-2019

目的:分析2010-2019年凉山彝族自治州布拖县抗病毒治疗HIV/AIDS的死亡影响因素,为今后制定可持续的抗病毒治疗策略提供参考依据。方法:采用病例对照研究方法,收集2010-2019年布拖县接受抗病毒治疗HIV/AIDS与死亡者基本和随访信息,按病例数2倍抽样组成对照组,采用logistic回归模型分析其死亡的影响因素。结果:研究对象为抗病毒治疗的HIV/AIDS 3355例,死亡组1179例,对照组共2176例。其中,30~49岁占81.34%,男性占69.09%,彝族占99.55%,已婚或同居占91.12%,初中及以下文化程度占95.77%,农民占88.41%。多因素logistic回归分析结果显示,研究对象的死亡风险因素中,年龄≥50岁是18~29岁的5.08倍(95%CI:3.05~8.48)、女性是男性的0.70倍(95%CI:0.52~0.94)、注射吸毒传播途径是异性性传播途径的1.43倍(95%CI:1.06~1.91)、治疗前CD4+T淋巴细胞计数(CD4)≥350个/μl是CD4<200个/μl的0.38倍(95%CI:0.30~0.48)、最近1次使用含洛匹那韦/利托那韦(LPV/r)抗病毒治疗方案是司他夫定(d4T)+拉米夫定(3TC)+奈韦拉平(NVP)/依非韦伦(EFV)方案的0.04倍(95%CI:0.01~0.18)、耐药是不耐药的3.40倍(95%CI:2.13~5.42),无病毒载量结果且未做耐药检测是不耐药的12.98倍(95%CI:10.28~16.40)。结论:年龄、性别、传播途径、治疗前CD4、最近1次抗病毒治疗方案、抗病毒治疗后耐药检测情况是布拖县接受抗病毒治疗HIV/AIDS的死亡影响因素。应扩大病毒载量和耐药检测覆盖面,科学更换抗病毒治疗方案,开展依从性教育和医务人员培训,降低抗病毒治疗HIV/AIDS死亡率。

Objective To understand influencing factors on the deaths of HIV/AIDS patients receiving antireviral treatment in Butuo county of Liangshan Yi Autonomous Prefecture(Liangshan)from 2010 to 2019,to provide data for drug replacement and sustainable antiviral treatment strategy.Methods A matched case-control study was used to collect basic and follow-up information on AIDS death patients receiving antiviral treatment in Butuo county of Liangshan from 2010 to 2019.The control group was formed by sampling twice the number of cases.The logistic regression model was used to analyze the risk factors affecting mortality.Results In 3355 patients of HIV/AIDS treated with antiviral therapy,1179 cases in the death group and 2176 cases in the control group.Including 81.34%were 30-49 years old,69.09%males,99.55%Yi nationality,91.12%were married or cohabitated,95.77%had junior high school education or below,and 88.41%peasants.Amultivariate logistic stepwise regression model showed that among the death risk factors,age≥50 years old was 5.08 times(95%CI:3.05-8.48)that of the 18-29,female was 0.70 times(95%CI:0.52-0.94)than male,the transmission rate of intravenous drug use was 1.43 times(95%CI:1.06-1.91)that of heterosexual transmission,CD4+T lymphocyte(CD4)count≥350 cells/μl before treatment was 0.38 times(95%CI:0.30-0.48)that of CD4<200 cells/μl before treatment,the most recent antiviral treatment regimen containing LPV/r was 0.04 times(95%CI:0.01-0.18)than that of stavudine(d4T)+lamivudine(3TC)+nevirapine(NVP)/efavirenz(EFV)regimen,drug resistance was 3.40 times(95%CI:2.13-5.42)of non-drug resistance,non-viral load and non-drug resistance test results were 12.98 times(95%CI:10.28-16.40)of non-drug resistance.Conclusions Age,gender,transmission route,CD4 before treatment,the latest antiviral treatment program,and drug resistance test after antiviral therapy were the influencing factors of HIV/AIDS death in Butuo county.It is necessary to expand the coverage of viral load and drug resistance test to change the antiviral therapeutic schedule scientifically and carry out publicity and education on the compliance of patients with antiviral treatment and medical staff training in order to reduce the mortality of patients with antiviral treatment.