2005至2021年广东省汕头市某综合医院人类免疫缺陷病毒感染/获得性免疫缺陷综合征患者流行病学特征及高效抗逆转录病毒治疗后生存状况影响因素

Epidemiological characteristics and survival analysis of patients with human immunodeficiency virus infection and acquired immune deficiency syndrome after highly active antiretroviral therapy in a general hospital in Shantou,Guangdong Province from 2005 to 2021

目的分析人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者流行病学特征及高效抗逆转录病毒治疗后生存状况的影响因素。方法采用回顾性队列研究方法,对汕头市中心医院2005年1月1日至2021年12月31日收治的HIV/AIDS患者的流行病学特征进行描述,采用寿命表法、Cox比例风险模型对患者的生存率和影响生存的风险因素进行分析。结果1085例研究对象主要以男性为主(占83.1%),中位年龄[41(29,53)]岁;主要经性传播感染[811例(74.7%)];1012例(93.2%)患者初始接受国家免费一线抗病毒治疗。随访过程中发生血肌酐异常患者15例(1.4%),其中9例患者合并高血压、糖尿病、慢性肾脏疾病。入组观察对象抗病毒治疗第1、3、5和10年累积生存率分别为91%、88%、88%和82%。多因素Cox回归分析显示,年龄≥50岁组患者的死亡风险是<30岁组患者的2.213倍(95%CI:1.188~4.124、P<0.001);CD4^(+)T淋巴细胞≥350个/μl患者、CD4^(+)T淋巴细胞为200~349个/μl患者和CD4^(+)T淋巴细胞为100~199个/μl患者的死亡风险分别为CD4^(+)T淋巴细胞<100个/μl患者的0.325倍(95%CI:0.147~0.721、P=0.006)、0.456倍(95%CI:0.245~0.850、P=0.013)和0.535倍(95%CI:0.292~0.978、P=0.042);接受抗病毒治疗前WHO临床分期为Ⅳ期患者的死亡风险是Ⅰ期患者的3.875倍(95%CI:1.537~9.771、P=0.004)。结论汕头市HIV感染途径以性传播为主,年龄50岁及以上、低CD4^(+)T淋巴细胞计数、WHO临床分期为Ⅳ期均为影响本地区HIV/AIDS患者生存率的主要危险因素;早发现、早治疗是提高该地区HIV/AIDS患者生存率的关键。

Objetctive To investigate the epidemiological characteristics of patients with human immunodeficiency virus(HIV)infection/acquired immune deficiency syndrome(AIDS),and survival conditions and influening factors after highly active antiretroviral therapy(HAART).Methods The epidemiological characteristics of patients with HIV/AIDS from January 1st,2005 to December 31st,2021 were described by retrospective cohort approach,and the survival rates and risk factors affecting survival rates were analyzed by life table method and Cox proportional hazards model,respectively.Results Total of 1085 cases were enrolled,predominately male(83.1%),with the median age of 41(29,53)years old,mainly by sexually transmitted infections[811 cases(74.7%)].Total of 1012 patients(93.2%)received free firstline HAART.There were 15 patients with abnormal serum creatinine levels during follow up after HAART,and 9 of them with hypertension,diabetes mellitus and chronic kidney disease.The cumulative survival ratesof all cases at 1,3,5 and 10 years were 91%,88%,88%and 82%,respectively.Multivariate Cox regressionanalysis showed that the risk of death in patients aged≥50 years old was 2.213 times of that in patients aged<30 years old(95%CI:1.188-4.124,P<0.001).The risk of death of patients with CD4^(+)T lymphocyte≥350 cells/μl was0.325 times of that with CD4^(+)T<100 cells/μl(95%CI:0.147-0.721,P=0.006),patients with CD4T 200-349 cells/μl was 0.456 times of that with CD4^(+)T<100 cells/μl(95%CI:0.245-0.850,P=0.013),patientswith CD4^(+)T 100-199 cells/μl was 0.535 times of that with CD4^(+)T<100 cells/μl(95%CI:0.292-0.978,P=0.042).The mortality risk for patients in WHO clinical stage IV at the initiation of HAART was 3.875 timesof patients in WHO clinical stage I(95%CI:1.537-9.771,P=0.004).Conclusions Sexual transmission isthe major route of HIV infection in Shantou,Guangdong Province.Patients aged 50 years old and above,lowCD4^(+)T cell counts and WHO clinical stage IV are main risk factors affecting survival rate of patients withHIV/AIDS.Early detection and early treatment are the keys to improve the survival rate of patients with HIV/AIDS in this region.