2018-2022年四川省HIV感染者启动抗病毒治疗时间及影响因素分析

The timing of antiretroviral therapy initiation and influencing factors among HIV-infected individuals in Sichuan Province from 2018 to 2022

目的了解2018-2022年四川省新确诊HIV感染者cART时间变化情况及影响因素。方法选取2018-2022年国家艾滋病综合防治信息系统中新确诊的HIV感染者为研究对象。以确诊时间为观察起点,观察终点为2023年12月31日,回顾性分析HIV感染者cART及时性的变化,并通过Cox回归分析了解其影响因素。结果共有143151例纳入分析,cART启动治疗的中位时间为18 d,2018-2022年分别为36 d、19 d、15 d、13 d、13 d。0 d、2~7 d、8~14 d、15~30 d、31~180 d、181~365 d、366 d及以上启动cART分别为0.69%、19.27%、22.61%、22.44%、21.25%、4.39%和2.66%。相较于男性、≥65岁、未婚、文盲和小学、异性性传播、基线CD4细胞<200个/μL、县内报告和启动治疗的HIV感染者,女性、<18岁、50~65岁、已婚有配偶、其他婚姻状态、初中、高中、大学及以上、同性性传播、更高基线CD4细胞水平、未查、市内跨区县更快启动cART的概率更高。结论2018-2022年四川省新报告的HIV感染者快速启动cART方面有所改善。建议加强男性、单身、异性性传播、低文化程度、医务人员/场所主动提供检测、少数民族、晚发现以及跨地区流动HIV感染者的治疗转介。

Objective This study aimed to understand the changes in the timeliness of combination antiretroviral therapy(cART)initiation among newly diagnosed patients with HIV infection in Sichuan Province from 2018 to 2022 and explore the influencing factors.Methods Newly diagnosed individuals with HIV infection recorded in the National Comprehensive HIV/AIDS Prevention and Control Information System between 2018 and 2022 were included.The observation period began on the date of diagnosis and ended on December 31,2023.A retrospective analysis examined changes in the timeliness of cART initiation,and Cox regression analysis was performed to identify the influencing factors.Results A total of 143151 individuals were included in the analysis,with a median cART initiation time of 18 days.The median cART initiation time for each year was 36,19,15,13,and 13 days from 2018 to 2022,respectively.The proportions of individuals initiating cART on the day of diagnosis,2-7 days,8-14 days,15-30 days,31-180 days,181-365days,and more than 365 days were 0.69%,19.27%,22.61%,22.44%,21.25%,4.39%,and 2.66%,respectively.Compared with male individuals,aged 65 or above,unmarried,illiterate or primary school educated,with heterosexual transmission,baseline CD4 cell count of less than 200 cells/μL,and those who are reported and initiated treatment within the county,those who were female,younger than 18 or between 50-65 years old,married,had different marital statuses,had an educational level of junior high school,high school,or university and above,had same-sex transmission,had higher baseline CD4~+T cell counts or were not tested,and were referred from other districts within the same city had a higher probability of earlier c ART initiation.Conclusions Prompt initiation of c ART among newly diagnosed individuals with HIV infection in Sichuan Province improved from 2018 to 2022.Promptly initiating c ART for males,unmarried individuals,those with heterosexual transmission,those with lower educational levels,healthcare workers/places proactively offering testing,individuals from ethnic minorities,those with a delayed diagnosis,and individuals with HIV infections moving across districts is recommended.