安徽省儿童艾滋病患者生存时间及影响因素分析

Survival time and related factors among child HIV/AIDS patients in Anhui province

目的了解安徽省儿童艾滋病患者的生存状况及影响因素。方法采用回顾性队列研究方法,收集“中国艾滋病综合防治信息系统”中报告的截止到2020年12月31日现住址为安徽省的儿童艾滋病患者数据资料,采用寿命表法计算生存率,Cox比例风险模型分析其影响因素。结果共纳入329例儿童艾滋病患者,54例死亡,艾滋病相关病死率为2.2/100人年。Cox比例风险模型分析显示,儿童艾滋病患者生存时间与诊断时疾病状态、是否接受抗病毒治疗有关,诊断时疾病状态为艾滋病的死亡风险是感染者的5.32倍,未接受抗病毒治疗是接受治疗的28.29倍。接受抗病毒治疗儿童艾滋病患者生存时间与诊断时年龄、诊断时疾病状态、治疗前基线CD4^(+)T淋巴细胞计数有关,诊断时年龄<5岁的死亡风险是11~15岁的6.18倍,诊断时疾病状态为艾滋病是感染者的5.07倍,治疗前基线CD4^(+)T淋巴细胞计数介于50~200、<50个/μL分别是>200个/μL的8.40倍和10.99倍。结论抗病毒治疗是影响儿童艾滋病患者生存时间的重要因素,治疗前基线CD4^(+)T淋巴细胞计数水平是影响治疗效果的关键因素。

Objective To examine the survival time of child human immunodeficiency virus(HIV)/AIDS patients and its influencing factors in Anhui province.Methods Follow-up and medication information on all laboratory confirmed AIDS patients aged≤15 years at the diagnosis and being permanent residents of Anhui province were collected from National Comprehensive HIV/AIDS Information Management System up to the end of 2020 and analyzed retrospectively.The survival rate was calculated with life table method and impact factors of survival were assessed using Cox regression model.Results Among a total of 329 child HIV/AIDS patients being followed-up during the period,54 died of AIDS-related diseases and the mortality rate was 2.2/100 person-years.The results of Cox proportional hazards regression analysis showed that for all the child patients,the children with AIDS at the time of first diagnosis and not receiving antiretroviral therapy were at a significantly higher risk of AIDS-related disease mortality,with the hazard ratio(HR)of 5.32(95%confidence interval[95%CI]:2.70-10.47)and 28.29(95%CI:14.63-54.70)compared to those not having AIDS at the first diagnosis and to those receiving antiretroviral therapy;among the child patients with antiretroviral therapy,the risk of AIDSrelated disease mortality were significantly higher for those aged<5 years at the first diagnosis(versus aged 11-15 years:HR=6.18,95%CI:14.63-54.70),having AIDS at the first diagnosis(versus having HIV infection:HR=5.07,95%CI:1.27-20.29),and with the baseline CD4^(+)T lymphocyte count of<50 cells/μL(HR=10.99,95%CI:2.04-59.20)or 50-200 cells/μL(HR=8.40,95%CI:1.35-52.26)compared to the child patients with the baseline count of>200 cells/μL,respectively.Conclusion Among child HIV/AIDS patients in Anhui province,antiretroviral therapy is an important factor for survival and the baseline CD4^(+)T lymphocyte count is the key factor affecting the effect of antiretroviral therapy.