2006—2019年台州市抗病毒治疗的HIV感染者生存状况分析

Survival analysis of HIV-infected patients on antiretroviral therapy during 2006−2019 in Taizhou City

【目的】分析2006—2019年浙江省台州市抗病毒治疗的HIV感染者生存状况及影响因素。【方法】对台州市2006—2019年首次接受抗病毒治疗的HIV感染者进行生存分析,采用Kaplan-Meier(K-M)法计算累积生存率和抗病毒治疗累积成功率,采用单因素和多因素Cox比例风险模型分析抗病毒治疗后HIV感染者生存状况及影响因素。【结果】共纳入2904例研究对象,K-M法估算抗病毒治疗后1、3、5、8年的累积生存率分别为96.9%、94.9%、93.1%和92.1%,抗病毒治疗累积成功率分别为91.3%、85.3%、81.8%和73.8%。多因素Cox回归分析结果显示,与18~30岁年龄组、基线CD4+T淋巴细胞计数>350个/μL、基线无贫血、抗病毒治疗有效、基线无症状体征、传播途径为同性性传播相比,年龄51~60岁(HR=4.94,95%CI:1.66~14.69)、年龄>60岁(HR=9.14,95%CI:3.14~26.63)、基线贫血(HR=2.24,95%CI:1.55~3.23)、基线CD4+T淋巴细胞计数<200个/μL(HR=4.35,95%CI:2.14~8.86)、抗病毒治疗免疫学失败(HR=3.90,95%CI:2.73~5.58)、异性性传播(HR=1.92,95%CI:1.15~3.20)、基线出现症状体征(HR=1.68,95%CI:1.16~2.41)是HIV感染者死亡的独立危险因素。【结论】台州市抗病毒治疗效果较好,各年累积生存率、抗病毒治疗累积成功率较高。需要重点关注年龄大、有贫血的HIV感染者,加强对抗病毒治疗初期效果的监测,并做好“发现即治”工作,从而进一步降低HIV相关病死率。

[Objective]To examine the survival status and explore factors related to death among human immunodeficiency virus(HIV)infected patients receiving antiretroviral therapy(ART)in Taizhou City during 2006‒2019.[Methods]A retrospective cohort study was conducted to analyze the data on HIV-infected patients receiving ART in Taizhou during 2006‒2019.Kaplan-Meier(K-M)method was used to calculate the cumulative survival rate and cumulative treatment success rate.Cox regression model was used to determine survival status and factors associated with ART.[Results]A total of 2904 HIV-infected patients was included.The cumulative survival rate after 1,3,5,and 8 years of ART were 96.9%,94.9%,93.1%and 92.1%,respectively,and the cumulative treatment response rate were 91.3%,85.3%,81.8%and 73.8%,respectively.Compared with aged 18-30 years old,baseline CD4+T cell>350 count/μL,normal hemoglobin level,effective ART,no clinical symptom at baseline,and homosexual transmission,we found that aged 51-60 years old(HR=4.94,95%CI:1.66-14.69),aged over 60 years old(HR=9.14,95%CI:3.14-26.63),anemia at baseline(HR=2.24,95%CI:1.55-3.23),baseline CD4+T cell<200 count/μL(HR=4.35,95%CI:2.14-8.86),ART failure(HR=3.90,95%CI:2.73-5.58),heterosexual transmission(HR=1.92,95%CI:1.15-3.20),and signs of symptom at baseline(HR=1.68,95%CI:1.16-2.41)were risk factors of HIV-related death.[Conclusion]The effect of ART in Taizhou City is confirmed with a high cumulative survival rate and treatment success.We should pay additional attention to senior HIV-infected patients with anemia at baseline and intensively monitor the effect of ART.Interventions such as“treat after discover”are supposed to be implemented more widely to further reduce HIV-related mortality.