摘要
目的分析湖北省2017—2023年HIV感染者/艾滋病患者接受抗病毒治疗及时性及影响因素。方法选取中国艾滋病综合防治信息系统中2017—2023年现住址为湖北省的HIV感染者/艾滋病患者,以确诊日期至开始抗病毒治疗时间间隔≤30 d为及时治疗,>30 d为非及时治疗,计算历年治疗及时率,采用Joinpoint regression program4.9.0.0对历年治疗及时率进行时间趋势回归分析,计算年度变化百分比(annual percentage changes,APC)和平均年度变化百分比(average annual percent change,AAPC),评价各区间的全局平均变化趋势;采用Cox单因素及多因素对患者基本特征进行分析,了解治疗及时性的影响因素。结果21332例HIV感染者/艾滋病患者中,男性患者占81.52%;确诊时中位年龄43(28,56)岁,确诊后≤30 d启动抗病毒治疗的比例从2017年的45.12%上升到2023年的67.61%,2017—2023年全省治疗及时率呈上升趋势(AAPC=6.90)。Cox多因素分析显示,女性确诊后治疗及时性更高(HR=1.15,95%CI:1.1~1.21);与≥50岁病例相比,年龄越小,治疗及时性越低,25~<50岁、15~<25、0~<15的HR(95%CI)分别为0.79(0.76~0.83)、0.67(0.63~0.72)、0.55(0.33~0.91);非汉族的治疗及时性低(HR=0.91,95%CI:0.83~0.99);高中或中专、大专及以上学历的治疗及时性低,HR(95%CI)分别为0.92(0.88~0.97)、0.97(0.92~1.02);已婚或有配偶、离异或丧偶的病例治疗及时性低,HR(95%CI)分别为0.89(0.86~0.94)、0.80(0.76~0.85);羁押场所的病例治疗及时性低(HR=0.37,95%CI:0.29~0.47),咨询检测、其他来源的病例治疗及时性高,HR(95%CI)分别为1.09(1.04~1.15)、1.07(1~1.15);首次CD4+T淋巴细胞越低,治疗及时性越高。结论湖北省2017—2023年接受治疗的HIV感染者/艾滋病患者治疗及时性逐年提高,性别、确诊时年龄、文化程度、婚姻状况、感染途径、样本来源、首次CD4+T淋巴细胞情况,是治疗及时性的影响因素。
Objective To analyze the timeliness and influencing factors of antiretroviral treatment(ART)among HIV/AIDS patients in Hubei Province from 2017 to 2023.Methods Data were selected from the National AIDS Comprehensive Prevention and Treatment Information System for HIV-infected individuals and AIDS patients residing in Hubei Province from January 1,2017,to December 31,2023.Timely treatment was defined as the interval between diagnosis and the initiation of ART being≤30 days,and non-timely treatment as>30 days.The annual timely treatment rates were calculated,and a time trend regression analysis of these rates was conducted using the Joinpoint regression program 4.9.0.0.The annual percentage change(APC)and average annual change percentage(AAPC)were computed to evaluate the global average change trend across intervals.Cox univariate and multivariate analyses were used to assess the impact of the patient's basic characteristics such as gender,age at diagnosis,ethnicity,education level,infection route,etc.Results Among the 21332 HIV/AIDS patients,81.52%were male,and the median age at diagnosis was 43 years(range:28-56 years).The proportion of patients initiating antiretroviral therapy within 30 days of diagnosis increased from 45.12%in 2017 to 67.61%in 2023,showing an upward trend in the timely treatment rate from 2017 to 2023(AAPC=6.90).Cox multivariate analysis indicated that females were more likely to initiate treatment in a timely manner after diagnosis(HR=1.15,95%CI:1.1-1.21).Compared to cases aged 50 or above,younger age groups had lower treatment timeliness,with HRs(95%CI)of 0.79(0.76-0.83)for those aged 25~<50,0.67(0.63-0.72)for those aged 15~<25,and 0.55(0.33-0.91)for those aged 0~<15.Non-Han ethnicities showed lower timeliness in treatment initiation(HR=0.91,95%CI:0.83-0.99).Individuals with high school or technical secondary school education,and those with college or higher education,had lower treatment timeliness,with HR(95%CI)of 0.92(0.88-0.97)and 0.97(0.92-1.02),respectively.Married or partnered,and divorced or widowed individuals had lower treatment timeliness,with HR(95%CI)of 0.89(0.86-0.94)and 0.8(0.76-0.85),respectively.Cases in detention facilities had lower treatment timeliness(HR=0.37,95%CI:0.29-0.47).Cases from counseling and testing,and other sources had higher treatment timeliness,with HR(95%CI)of 1.09(1.04-1.15)and 1.07(1.0-1.15),respectively.Lower initial CD4+T lymphocyte counts were associated with higher treatment timeliness.Conclusions The timely treatment among HIV-infected individuals and AIDS patients in Hubei Province has improved year by year from 2017 to 2023.Gender,age at diagnosis,education level,marital status,infection route,sample source,and first CD4+T lymphocyte status are all factors that determine the timely treatment of HIV/AIDS.
作者
郑武
赵丁源
张薇
汤恒
冯晏萌
ZHENG Wu;ZHAO Dingyuan;ZHANG Wei;TANG Heng;FENG Yanmeng(Hubei Provincial Center for Disease Control and Prevention,Wuhan,Hubei 430079,China)
出处
《中国热带医学》
CAS
北大核心
2024年第10期1253-1258,共6页
China Tropical Medicine
基金
湖北省科技厅创新专项项目(NO.2021BCA148)
职业危害识别与控制湖北省重点实验室开放基金项目(NO.OHIC2023G05)。