重庆市艾滋病综合防治示范区2016至2021年接受抗病毒治疗患者生存分析

Survival analysis of patients receiving antiretroviral treatment in integrated HIV/AIDS prevention and treatment demonstration zone of Chongqing,China,2016-2021

目的:了解重庆市示范区人类免疫缺陷病毒(human immunodeficiency virus,HIV)/艾滋病(acquired immunodeficiency syndrome,AIDS)患者抗病毒治疗的生存状况,探索影响患者生存的影响因素。方法:采用回顾性队列研究方法对示范区2016至2021年≥18岁、首次接受抗病毒治疗患者进行生存分析,采用寿命表法计算生存率,采用Cox比例风险模型分析影响死亡的危险因素。结果:共纳入研究对象21506例,共计随访54919.63人年,全因死亡率为3.67/100人年;开始抗病毒治疗12、36、≥72个月的累积生存率分别为94.09%、88.65%、82.98%。多因素Cox比例风险回归模型分析显示,女性死亡风险是男性的0.54倍;开始治疗时年龄≥60岁的死亡风险是18~30岁的4.38倍;经同性性传播感染死亡风险是异性性传播感染的0.65倍;基线CD4^(+)T细胞为200~349个/μL组和≥350个/μL组死亡风险是0~199个/μL组的0.61倍和0.49倍;确诊至治疗间隔时长为31~90、91~365、>365 d的死亡风险是<30 d的1.25、1.56、1.74倍;使用其他一线治疗方案和二线治疗方案患者的死亡风险是标准一线治疗方案的1.47、1.65倍。结论:重庆市示范区艾滋病抗病毒治疗患者死亡率进一步下降,开始治疗时年龄≥60岁、基线CD4^(+)T细胞计数低、确诊至首次治疗间隔时间长的患者死亡风险较高,建议加强艾滋病早发现、早治疗。

Objective:To investigate the survival status of patients living with human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS)receiving antiretroviral therapy in the integrated HIV prevention and treatment demonstration zone of Chongqing,China,and to explore the factors influencing patients’survival.Methods:A retrospective cohort study was performed to analyze the survival of patients aged≥18 years who received antiretroviral treatment for the first time in the demonstration zone from 2016 to 2021.The survival rate was calculated by using the life-table method.The risk factors affecting death were analyzed using a Cox proportional hazards model.Results:A total of 21506 subjects were included in the study.A total of 54919.63 person-years were followed up.The all-cause mortality rate was 3.67/100 person-years.The cumulative survival rates of 12,36,and≥72 months since the initiation of antiretroviral therapy were 94.09%,88.65%,and 82.98%,respectively.The multivariable Cox proportional hazards regression analysis showed that the death risk of women was 0.54 times that of men.The risk of death for patients with treatment initiated at age of≥60 years was 4.38 times that of those with treatment initiated at age of 18-30 years.The death risk of homosexually transmitted infection was 0.65 times that of heterosexually transmitted infection.In terms of the baseline number of CD4^(+)T cells,the risks of death in the groups of 200-349 cells/μL and≥350 cells/μL were 0.61 and 0.49 times that of the group of 0-199 cells/μL,respectively.In terms of the interval between diagnosis and treatment,compared with the group of<30 days,the groups of 31-90 days,91-365 days,and>365 days were 1.25,1.56,and 1.74 times more likely to die of HIV/AIDS,respectively.The death risks with other first-line treatments and second-line treatments were 1.47 and 1.65 times that with standard first-line treatments,respectively.Conclusion:The mortality rate is decreased in patients with HIV/AIDS receiving retroviral therapy in the Chongqing demonstration zone.Early detection and treatment of HIV/AIDS should be strengthened for patients with a high risk of death,those with treatment beginning at age of≥60 years,a low baseline CD4^(+)T cell count,and a long interval between diagnosis and first treatment.