武汉市1994~2022年HIV感染者/AIDS患者的生存时间及其影响因素

Analysis of Survival Time of HIV Infectors/AIDS Patients in Wuhan from 1994-2022 and the Influencing Factors

目的分析武汉市1994~2022年HIV感染者/AIDS患者(HIV/AIDS)生存时间及其影响因素,为进一步制定防治策略提供依据。方法收集国家艾滋病综合防治信息系统中武汉市1994~2022年直报的常住HIV/AIDS流行病学调查和抗病毒治疗数据,采用寿命表法、Cox比例风险回归模型对生存时间及其影响因素进行分析。结果纳入研究的8954例HIV/AIDS共随访47245.4人年,全死因死亡1078例,中位生存时间22.3年;第1、5、10、15、20年生存率分别为92.9%、88.5%、83.5%、78.7%、73.8%;Cox比例风险回归模型分析结果显示,未治疗、男性、较大年龄、无职业、低文化程度、本地户籍、异性性行为传播及注射吸毒传播、医疗机构检测发现及较低CD4基线水平是影响HIV/AIDS生存时间的危险因素,未治疗患者死亡风险为已治疗患者的13.979倍(95%CI:11.883~16.446),无职业患者死亡风险为有职业患者的1.140倍(95%CI:1.004~1.295),本地患者死亡风险是流动人口1.682倍(95%CI:1.415~2.000),医疗机构检测发现的患者死亡风险是自愿咨询检测患者的1.823倍(95%CI:1.421~2.339)。结论应针对50岁及以上、无职业、低文化程度、医疗机构检测发现及低CD4基线水平等危险因素,开展宣传教育提升大众对艾滋病的科学认识,并通过医防协同、社会组织参与等方式促进早检测、早治疗;充分利用HIV/AIDS人群健康大数据,形成多维度全生命周期健康档案,针对不同个体提供包括心理干预在内的精准医疗,延长生存时间和提高生活质量是今后努力的方向。

Objective To analyze the survival time and influencing factors of HIV Infectors/AIDS patients in Wuhan from 1994-2022 and provide evidence for future prevention and control strategies.Methods Data on HIV/AIDS epidemiology and antiviral treatment were collected from 1994 to 2022 by the national HIV/AIDS Comprehensive Prevention and Control Data Information System.The life table method and Cox proportional hazard regression model were used to analyze survival time and its influencing factors.Results A total of 8954 patients with HIV/AIDS were followed up for 47245.4 person-years,with 1078 deaths from all causes,and the median survival time was 22.3 years.The survival rates at 1,5,10,15,and 20 years were 92.9%,88.5%,83.5%,78.7%,and 73.8%,respectively.The results of the Cox proportional hazard regression model analysis revealed that untreated,older age,unemployed,male,low literacy,native,heterosexual and injection drug transmission,being founcl by medical institution examination,and lower CD4 baseline levels were risk factors for HIV/AIDS patient survival time(untreated vs.treated,HR=13.979,95%CI:11.883-16.446;without stable occupations vs.stable occupations:HR=1.140,95%CI:1.004-1.295;locally registered residence vs.mobile patients:HR=1.682,95%CI:1.415-2.000;medical institution testing findings vs.VCT:HR=1.823,95%CI:1.421-2.339).Conclusion For risk factors such as being 50 years old and above,being unemployed,having a low level of literacy,being detected by medical institutions and having a low CD4 baseline level,we should improve the public's scientific understanding of HIV/AIDS through publicity and education and promote early detection and treatment through medical and prevention cooperation and social organization participation.Making full use of healthy big data of HIV/AIDS patients,forming multi-dimensional full-life cycle health files,providing accurate medical care for different individuals,including psychological intervention,and extending life time and improving quality of life are directions for future efforts.