江苏省丹阳市2005—2020年初始抗病毒治疗HIV感染者死亡和脱失情况

Death and attrition among HIV-infected patients receiving initial antiretroviral treatment in Danyang,Jiangsu,2005-2020

目的了解江苏省丹阳市初始抗病毒治疗HIV感染者死亡和脱失情况及其影响因素。方法本研究选取中国疾病预防控制信息系统艾滋病综合防治数据中江苏省丹阳市2005—2020年首次开始抗病毒治疗的HIV感染者,根据纳入和排除标准最终共纳入413例HIV感染者进行研究,采用Cox比例风险回归模型分析初始抗病毒治疗HIV感染者的死亡和脱失情况,探索影响抗病毒治疗HIV感染者病死率和脱失率的相关因素。结果本研究最终结局为正在治疗314例,转出28例,死亡58例,失访1例和停药12例。413例HIV感染者,平均年龄为45岁(18~84岁),男女比例为3.8∶1,共随访1516.75人年,总体病死率为3.82/100人年,总体脱失率为0.86/100人年。主要流行病学特征为已婚或同居占64.6%,异性性传播占63.0%,治疗前CD4^(+)T淋巴细胞计数≥200 cells/μL占52.3%,抗病毒治疗初始方案为EFV+3TC+TDF占50.9%。Cox回归模型分析结果显示,使抗病毒治疗患者死亡风险增加的因素有:年龄≥40岁(AHR=4.21,95%CI:1.58~11.17)、治疗前CD4^(+)T淋巴细胞计数<200 cells/μL(AHR=2.63,95%CI:1.37~5.08)和未检测CD4^(+)T淋巴细胞(AHR=3.66,95%CI:1.13~11.84);而女性的风险降低(AHR=0.37,95%CI:0.15~0.92)。治疗前CD4^(+)T淋巴细胞计数<200 cells/μL(AHR=0.21,95%CI:0.04~0.99)和已婚或同居(AHR=0.20,95%CI:0.04~0.93)脱失率风险较低。结论江苏省丹阳市艾滋病抗病毒治疗后死亡率较高和脱失率较低,仍需提高治疗前CD4^(+)淋巴细胞检测和抗病毒治疗及时性以及治疗管理服务质量来进一步减少死亡。

Objective To understand the mortality,attrition and influencing factors among HIV-infected persons receiving initial antiretroviral therapy(ART)in Danyang City,Jiangsu Province.MethodsAccording to the inclusion and exclusion criteria,a total of 413 HIV-infected persons receiving initial antiretroviral therapy were selected from National AIDS Comprehensive Treatment and Prevention System in Danyang City,Jiangsu Province from 2005 to 2020.Cox proportional hazard regression model was employed to analyze the mortality and attrition of HIV-infected patients with initial antiviral treatment,and to explore influencing factors.ResultsThere were 314 cases were undergoing treatment,28 were transferred out,and 58 cases were death,1 lost to follow-up and 12 cases were attrition.There were followed up for 1516.75 person-years by 413 HIV-infected patients,average age was 45(18-84)years,and a male to female ratio of 3.8∶1.The mortality and ART attrition rates among all patients were 3.82/100 person-years and 0.86/100 person-years,respectively.The main epidemiological characteristics were married or cohabiting accounted for 64.6%,heterosexual transmission accounted for63.0%,CD4^(+)T lymphocyte count≥200/μL accounted for 52.3%,and EFV+3TC+TDF accounted for 50.9%.Cox regression model analysis results showed that the main factors that increased the risk of mortality were aged≥40 years(AHR=4.21,95%CI:1.58-11.17),CD4^(+)T lymphocyte count<200 cells/μL before treatment(AHR=2.63,95%CI:1.37-5.08),and undetected CD4^(+)T lymphocytes(AHR=3.66,95%CI:1.13-11.84).While the risk of mortality was lowed in women(AHR=0.37,95%CI:0.15-0.92).In addition,CD4^(+)T lymphocyte count<200 cells/μL before treatment(AHR=0.21,95%CI:0.04-0.99)and married or cohabiting(AHR=0.20,95%CI:0.04-0.93)were low risk factors of attrition.ConclusionThe mortality rate was still high,but the attrition rate was low among HIV-infected persons receiving initial antiretroviral therapy in Danyang,Jiangsu Province,an economically developed area in China.We should improve the detection of CD4^(+)lymphocytes before ART,take the timeliness of the initiation ART and improve service management to reduce mortality of HIV-infected persons.