凉山州四县抗病毒治疗HIV/AIDS患者的生存分析

Survival of HIV infected patients Receiving antiretroviral therapy in Four Counties in Liangshan Prefecture

目的分析凉山州布拖、美姑、越西、昭觉四个重点县抗病毒治疗HIV/AIDS患者的生存情况及影响因素。方法利用回顾性队列研究方法,通过国家艾滋病综合防治信息系统收集四县截至2019年底报告,在2005-2020年接受治疗,年龄≥15岁的患者信息,采用寿命表法计算生存率,采用Log-rank检验进行单因素分析,利用Cox比例风险回归模型进行多因素分析。结果四县患者以男性(61.0%)、已婚或同居(77.7%)为主,开始治疗平均年龄为(33.74±8.40)岁。截至2020年12月31日,治疗患者病死率为2.2/100人年,治疗1、3、5、10、15年的生存率为97.6%、93.3%、88.3%、77.7%、76.3%。Cox分析结果显示女性(a HR=0.58,95%CI:0.51~0.66)、治疗前BMI≥18.5 kg/m^(2)(a HR=0.58,95%CI:0.52~0.66)、治疗前HBsAg阴性(a HR=0.81,95%CI:0.72~0.90)、基线CD4细胞≥200个/μL、确证至启动治疗时间间隔<1个月的病例死亡风险更低,而开始治疗年龄在40岁以上、静脉吸毒(a HR=1.34,95%CI:1.19~1.52)、初始治疗方案为TDF/AZT+3TC+NVP(a HR=1.21,95%CI:1.05~1.39)、治疗随访机构在县级及以上医院的病例死亡风险更高。结论四县HIV/AIDS患者病死率逐渐下降,但与国内外发达地区尚有一定的差距。在后续工作中,应加强重点人群主动检测工作,对ART患者进行分类管理,推进"早发现,早治疗"工作。

Objective To analyze the survival and influencing factors of HIV/AIDS patients treated with antiviral therapy in Butuo, Meigu, Yuexi and Zhaojue counties of Liangshan Prefecture. Methods A retrospective cohort study was conducted to collect information from four counties as reported by the end of 2019 by the National AIDS comprehensive prevention information system. Eligible criteria included aged over 15 years old and being treated between2005-2020. The survival rate was calculated using the life-table method. Univariant analysis was conducted by Log-rank test, and Cox proportional hazards regression model was used for multivariate analysis. Results The patients in the four counties were mainly male(61.0%), married or cohabiting(77.7%), and the average age of starting treatment was(33.74 ±8.40) years. As of December 31, 2020, the mortality of treated patients was 2.2/100 person-years, and the survival rates of1, 3, 5, 10, and 15 years were 97.6%, 93.3%, 88.3%, 77.7%, and 76.3%. Cox analysis showed that people being women(a HR=0.58, 95%CI: 0.51-0.66), with a BMI ≥18.5 kg/m^(2) before treatment(a HR=0.58, 95%CI: 0.52-0.66), HBsAg negative before treatment(a HR=0.81, 95%CI: 0.72-0.90), with the baseline CD4 ≥ 200/μL, and with an interval between confirmation and initiation of ART less than 1 month had a lower risk for mortality. The death risk increased when patients started treatment over 40 years old, being intravenous drug abuse(a HR=1.34, 95%CI: 1.19-1.52), with an initial treatment regimen containing TDF/AZT+3 TC+NVP(a HR=1.21, 95%CI: 1.05-1.39), and treatment follow-up institutions being in hospitals or above. Conclusion The mortality of HIV/AIDS patients in the four counties decreased, but there was still a gap in mortality compared with developed areas within the country and worldwide. We should strengthen the active detection among key populations, provide tailored management to ART patients, and promote the work of "early detection and early treatment".