2010—2019年南充市艾滋病抗病毒治疗患者死亡情况及相关因素分析

Analysis of The Death and Related Factors Among HIV/AIDS Patients Receiving Antiretroviral Therapy in Nanchong City From 2010 to 2019

目的了解四川省南充市2010—2019年初始抗病毒治疗HIV/AIDS成人患者死亡情况及其影响因素。方法采用回顾性队列研究的方法,从艾滋病防治基本信息系统选取2010—2019年在南充市首次开始抗病毒治疗(HAART)的HIV/AIDS成人患者,共3382例,采用Cox比例风险回归模型对影响抗病毒治疗HIV/AIDS患者病死率的相关因素进行分析。采用双侧检验,以P<0.05为差异有统计学意义。结果研究对象的年龄为(50.45±14.62)岁,至随访观察终止时间,死亡471例,病死率为4.03/100人年。Cox回归分析结果显示,30~50岁[AHR(95%CI)=2.155(1.206~3.850)]及50岁以上[AHR(95%CI)=4.656(2.589~8.376)]、异性传播[AHR(95%CI)=1.958(1.271~3.017)]、近3个月出现艾滋病相关疾病/症状[AHR(95%CI)=1.515(1.181~1.945)]、WHO临床分期为Ⅲ期[AHR(95%CI)=1.394(1.030~1.886)]/Ⅳ期[AHR(95%CI)=2.034(1.440~2.872)]及药物漏服[AHR(95%CI)=4.175(3.137~5.558)]是患者死亡的危险因素。女性[AHR(95%CI)=0.599(0.465~0.762)]、已婚或同居[AHR(95%CI)=0.660(0.539~0.808)]和启动治疗时CD4+T淋巴细胞计数≥200个/μL是死亡的保护因素。结论为降低南充市HIV/AIDS患者死亡风险,应尽早启动抗病毒治疗,提倡早期发现、早期诊断、进一步扩大抗病毒治疗的覆盖面和提升服务质量,加强追踪随访和管理,关注50岁以上、漏服药物和初始治疗CD4+T淋巴细胞计数较高的对象,以降低HIV/AIDS患者病死率,提高其生存质量。

Objective To examine the death and its influencing factors of adult HIV/AIDS patients receiving initial highly active antiretroviral therapy(HAART)in Nanchong City,Sichuan Province from 2010 to 2019.Methods A retrospective cohort study was conducted to select 3382 adult HIV/AIDS patients from the Basic Information System for HIV/AIDS Prevention and Treatment who initially started HAART in Nanchong City from 2010 to 2019.Cox proportional hazard regression model was used to analyze the related factors influencing the mortality rate of HIV/AIDS patients treated with antiviral therapy.A two-sided tgest was performed.The test levd wasα=0.05.Results The average age of the subjects was(50.45±14.62)years old.At the end of the follow-up observation,471 cases died and the mortality rate was 4.03/100 person-years.The Cox Regression analysis showed the following risk factors of patients′death:30-50 years old(adjusted hazard ratio(AHR):2.155,95%confidence interval(CI):1.206-3.850)and over 50 years old(4.656,(2.589-8.376)),heterosexual transmission(1.958,(1.271-3.017)),AIDS-related diseases or symptoms in recent three months(1.515,(1.181-1.945)),WHO(World Health Organization)clinical stageⅢ(1.394,(1.030-1.886))or stage IV(2.034,(1.440-2.872))and missed medication(4.175,(3.137-5.558)).Female(0.599,(0.465-0.762)),married or cohabiting(0.660,(0.539-0.808))and CD4+T lymphocyte count≥200 cells/μl in the initial treatment were protective factors.Conclusion In order to reduce the death risk of HIV/AIDS patients in Nanchong City,antiviral therapy should be initiated as early as possible,early detection and diagnosis should be advocated,coverage of antiviral treatment should be further expanded,service quality should be improved and follow-up and management should be strengthened.Attention should be paid to those who were over50 years old,who missed taking drugs and had a higher CD4+T lymphocyte count in the initial treatment,to reduce the mortality rate of HIV/AIDS patients and improve their life quality.