云南省保山市1990-2020年HIV/AIDS病例生存分析

Survival analysis among HIV-infected individual and AIDS patients in Baoshan,Yunnan,1990-2020

目的通过对云南省保山市1990—2020年艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS)生存时间及其影响因素进行全面分析,为提高HIV/AIDS病人生存质量提供科学依据。方法运用回顾性队列研究方法,计算1990—2020年保山市6838例HIV/AIDS病人的生存率;用Cox比例风险模型分析生存时间的影响因素。结果6838例HIV/AIDS病人,全死因死亡1757例(25.69%),平均生存时间为19.51年(95%CI:18.51~20.51);随着防控措施的强化,相对于2005年以前的第一个时期,后三个时期5年生存率均有所升高而死亡风险均下降。多因素Cox比例风险模型分析发现,HIV/AIDS生存的相关影响因素包括性别(男比女:HR=1.223,95%CI=1.094~1.367)、确诊年龄(40~<50岁比15~<25岁:HR=1.743,95%CI=1.110~2.739;50~<60岁比15~<25岁:HR=2.092,95%CI=1.306~3.351;≥60岁比15~<25岁:HR=3.179,95%CI=1.984~5.094)、感染途径(经注射吸毒传播比经异性传播:HR=0.694,95%CI:0.58~0.83)、样本来源(医疗机构其他就诊者检测比羁押人员:HR=1.584,95%CI=1.283~1.955)、抗病毒治疗(未接受ART比接受ART:HR=17.159,95%CI=15.062~19.547)、首次CD4细胞值(CD4为200~<350个/μL比<200个/μL:HR=0.536,95%CI=0.459~0.627;350~<500个/μL比<200个/μL:HR=0.390,95%CI=0.323~0.472;≥500个/μL<200个/μL:HR=0.350,95%CI=0.286~0.427)。结论在云南防治艾滋病政策和措施不断完善的背景下,保山31年来HIV/AIDS病人生存率得到较大提升,但男性、确诊年龄大、异性性途径传播、样本来源为医疗机构其他就诊者检测、未接受抗病毒治疗和首次CD4结果低是HIV/AIDS生存的危险因素,需要进一步精准防控。

Objective To provide scientific basis for improving the quality of life of HIV-infected individuals and AIDS patients(HIV/AIDS),by analyzing survival time from1990 to 2020 and its related factors among HIV/AIDS.Methods A retrospective cohort study was conducted to analyze the data of HIV/AIDS cases.The life table method was used to calculate the survival probability of 6838 HIV/AIDS in Baoshan from 1990 to 2020.Cox proportion hazard regression model was used to identify the factors related with survival time.Results Among the 6838 cases,1757(25.69%)died of all causes.The average survival time was 19.51 years[95%confidence interval(95%CI)=18.51-20.51].Compared to the first period before 2005,the 5-year survival rates increased and the risk of death reduced in the last three periods,due to intensified prevention and control measures.Multivariate Cox regression analyses showed that the influencing factors for the survival of HIV/AIDS cases were gender(male vs.female,HR=1.223,95%CI=1.094-1.367),age(40-<50 years old vs.15-<25 years old:HR=1.743,95%CI=1.110-2.739;50-<60 years old vs.15-<25 years old:HR=2.092,95%CI=1.306-3.351;≥60 years old vs.15-<25 years old:HR=3.179,95%CI=1.984-5.094),transmission(injecting drug use transmission vs.heterosexual transmission:HR=0.694,95%CI:0.58-0.83),source of sample(hospital admission vs.prison inmates:HR=1.584,95%CI=1.283-1.955),antiretroviral therapy(ART naïve vs.ART:HR=17.159,95%CI=15.062-19.547),and level of baseline CD4+T cell count(200-<300 cells/μL vs.<200 cells/μL:HR=0.536,95%CI=0.459-0.627;350-<500 cells/μL vs.<200 cells/μL:HR=0.390,95%CI=0.323-0.472;≥500 cells/μL vs.<200 cells/μL:HR=0.350,95%CI=0.286-0.427).Conclusions The survival of HIV/AIDS in Baoshan has been greatly improved in the past 31 years,based on the background of the improvement of policies and measures for prevention and control of HIV/AIDS in Yunnan.The risk factors for the survival of the cases were male,old aged diagnosis,heterosexual transmission,hospital admission,not receiving antiretroviral therapy and level of baseline CD4 cell count.More precisely should be paid attention,which can extend the survival time of HIV/AIDS patients.