1154例男性HIV感染者疾病转归及其影响因素

Characteristics and influencing factors of disease progression among 1154 male HIV infected patients

目的研究杭州市上城区1154名男性艾滋病毒(HIV)感染者的疾病转归及其影响因素。方法采用回顾性动态队列研究方法,通过国家艾滋病综合防治信息系统收集分析2005—2019年期间在杭州市上城区报告的男性HIV感染者基本信息及随访资料。应用SPSS 23.0和Stata 15.0软件进行数据分析。应用寿命表法计算累计疾病转归率,基于Kaplan-Meier法得到疾病转归曲线并计算平均潜伏期时间和95%CI值。Log-Rank检验进行单因素分析,比较不同组别疾病转归率有无差异,将单因素有差异的(P<0.05)的因素纳入到多因素Cox比例风险回归模型,以探讨研究对象HIV感染疾病转归的影响因素。结果共纳入1154名研究对象,其中228名HIV感染者转归为AIDS(19.76%),平均潜伏期为11.01(95%CI:10.49~11.51)年,HIV疾病转归密度为4.53/100人年。第1年、3年、5年、10年的累计疾病转归率分别为6.26%、14.96%、21.07%、32.39%。多因素Cox比例风险回归分析显示,确诊到治疗时间间隔超过180d的男性HIV感染者疾病转归风险是确诊到治疗时间间隔少于180d的4.33倍(95%CI:3.16~5.93),文化程度为初中、高中或中专、大专及以上的男性HIV感染者疾病转归风险是小学及以下的0.56倍(95%CI:0.36~0.87)、0.53倍(95%CI:0.34~0.81)和0.39倍(95%CI:0.25~0.61),基线CD_(4)^(+)T细胞计数为350~499个/mm 3和≥500个/mm 3的男性HIV感染者疾病转归风险是基线CD_(4)^(+)T细胞计数为200~349个/mm 3的0.53倍(95%CI:0.39~0.73)和0.36倍(95%CI:0.25~0.52)。结论抗病毒治疗、文化程度和基线CD_(4)^(+)T细胞水平是男性HIV感染者疾病转归的影响因素。

Objective To study the characteristics and influencing factors of disease progression among 1154 men infected with HIV in Shangcheng District,Hangzhou City.Methods A retrospective dynamic cohort study was conducted.Information about HIV cases reported in Shangcheng District from 2005 to 2019 was collected from China Integrated Prevention and Control Information System of AIDS.SPSS 23.0 and Stata 15.0 software were used for data analysis.The cumulative disease progression rate was calculated by life table method,the disease progression curves were obtained based on Kaplan-Meier method,and the average latency time and 95%CI were calculated.Log-rank test was used for univariate analysis to compare the difference of disease progression rate in different groups.The factors that differed univariately(P<0.05)were included in a multivariate Cox proportional risk regression model to explore the influencing factors of disease regression of HIV infection in the study population.Results A total of 1154 subjects were enrolled in this study,of which 228 people infected with HIV developed AIDS,accounting for 19.76%of the total study population.The average incubation period was 11.01 years(95%CI:10.49-11.51),and the disease progression density of AIDS was 4.53 per hundred person-years.The cumulative disease progression rate at 1,3,5 and 10 years after diagnosis was 6.26%,14.96%,21.07%,and 32.39%,respectively.Multivariate Cox proportional risk regression analysis showed that the risk of disease progression of male HIV-infected patients with an interval of over 180 days from diagnosis to treatment was 4.33 times that of men with an interval of less than 180 days(95%CI:3.16-5.93),the risk of disease progression of male HIV-infected patients with education level of middle school,high school or secondary school,and college or above were 0.56 times(95%CI:0.36-0.87),0.53 times(95%CI:0.34-0.81),and 0.39 times(95%CI:0.25-0.61)that of patients with education level of elementary school or below,and the risk of disease progression in male HIV-infected patients with baseline CD_(4)^(+)T-cell counts of 350-499 cells/mm 3 and≥500 cells/mm 3 was 0.53 times(95%CI:0.39-0.73)and 0.36 times(95%CI:0.25-0.52)that in patients with baseline CD_(4)^(+)T-cell counts 200-349 cells/mm 3.Conclusion Antiviral therapy,education level and baseline CD_(4)^(+)T cell level are the influencing factors of disease progression of male HIV infected patients.