2004—2022年河南省新乡市15岁以上接受艾滋病抗病毒治疗患者生存状况及影响因素分析

Analysis on survival status of AIDS patients over 15 years old receiving antiretroviral therapy and its influencing factors, Xinxiang city, Henan province from 2004 to 2022

目的 了解河南省新乡市15岁以上接受艾滋病抗病毒治疗患者的生存状况及影响因素。方法 从中国疾病预防控制信息系统免费艾滋病抗病毒治疗(ART)数据库中选取2004—2022年新乡市15岁以上HIV/AIDS患者,采用回顾性队列研究方法,分析患者生存状况,采用Cox比例风险模型探讨接受ART患者死亡风险的相关影响因素。结果共纳入研究对象2 274例,中位生存时间为18.0年,接受ART治疗满1年的患者累计生存率为93%。多因素Cox比例风险模型分析显示,接受治疗时的年龄30~<50岁组(AHR=2.316,95%CI:1.283~4.180)及≥50岁(AHR=4.227,95%CI:2.296~7.782),WHO临床分期为Ⅲ期(AHR=1.771,95%CI:1.306~2.401)及Ⅳ期(AHR=1.837,95%CI:1.285~2.626),初始治疗方案为齐多夫定+去羟肌苷+奈韦拉平(AHR=1.901,95%CI:1.169~3.092)、奈韦拉平+拉米夫定+司他夫定及其他(AHR=2.368,95%CI:1.404~3.992)者死亡风险较高;已婚有配偶者(AHR=0.592,95%CI:0.362~0.969),大专及以上学历者(AHR=0.746,95%CI:0.510~1.092),样本来源于重点人群(AHR=0.618,95%CI:0.479~0.796),基线CD4细胞计数200~<350个/μL(AHR=0.712,95%CI:0.593~0.939)、350~<500个/μL(AHR=0.577,95%CI:0.376~0.887)、≥500个/μL(AHR=0.245,95%CI:0.118~0.510)者死亡风险较低。结论 新乡市接受ART患者的生存率较低,应针对50岁及以上、未婚、样本来源于医疗机构、WHO临床分期为Ⅲ期及Ⅳ期、学历为初中及以下、基线CD4细胞计数<200个/μL者,加强健康知识宣教及随访关怀,提高其服药依从性,从而延长生存时间,提高患者的生命质量。

Objective To understand the survival status and influencing factors of AIDS patients over 15 years old receiving antiretroviral therapy(ART) in Xinxiang city, Henan province. Methods HIV/AIDS patients over 15 years old were selected from the Free ART Database, Chinese Disease Control and Prevention Information System, and a retrospective cohort study was used to analyze the survival status of patients. Cox proportional risk model was used to explore the related influencing factors of death risk among those receiving ART. Results In total, 2 274 patients were included in the study, and the median survival time was 18.0years. The cumulative survival rate of those receiving ART was 93%. Multivariate Cox proportional risk model analysis showed that the 30-<50 years old group(AHR=2.316, 95%CI: 1.283-4.180) and ≥50 years old group(AHR=4.227, 95%CI: 2.296-7.782), stage III based on WHO clinical staging method(AHR=1.771, 95%CI: 1.306-2.401) and stage IV(AHR=1.837, 95%CI:1.285-2.626), and the initial treatments with zidovudine +desoxyinosine +nevirapine(AHR =1.901, 95% CI: 1.169-3.092),nevirapine+lamivudine+stavudine and others(AHR=2.368, 95%CI: 1.404-3.992) had a higher risk of death. The patients being married or having a permanent heterosexual partner(AHR=0.592, 95%CI:0.362-0.969), education level with college degree or above(AHR=0.746,95%CI: 0.510-1.092), sample from key population(AHR=0.618, 95%CI: 0.479-0.796), baseline CD4 cell count 200-<350/μL(AHR=0.712, 95%CI: 0.593-0.939), 350-<500/μL(AHR=0.577, 95%CI: 0.376-0.887), ≥500/μL(AHR=0.245, 95%CI: 0.118-0.510) had a lower risk of death. Conclusions The survival rate of patients after ART in Xinxiang city is relatively low. The patients aged 50 and above, being unmarried, with samples from medical institutions, with stage III and stage IV based on WHO clinical staging method, with junior high school education or below, and those with baseline CD4 cell counts<200/μL should be targeted for strengthening health education and follow-up care, and improving their medication compliance so as to extend the survival time and improve the quality of life of patients.