广州市HIV阳性男男性行为者服药依从性及其对死亡的影响

Study on medication adherence and its impact on mortality among HIV-positive men who have sex with men in Guangzhou city

目的探讨广州市HIV阳性男男性行为者(men who have sex with men,MSM)接受抗逆转录病毒治疗(antiretroviral therapy,ART)依从性及其对死亡的影响,为提高该人群服药依从性提供数据支持。方法收集2004年2月-2019年3月在广州市某传染病专科医院启动ART,年龄≥15岁的HIV阳性MSM基线和随访信息,采用稳健Poisson回归模型探讨ART过程中服药依从性的影响因素,采用Cox比例风险回归模型分析服药依从性与全因死亡关系。结果共纳入7016例HIV阳性MSM,服药依从性良好者4952例(70.59%),共随访18820.35人·年,随访期间发生死亡36例,死亡密度为0.19/(100人·年)。多因素稳健Poisson回归模型结果显示,开始ART年龄、BMI、贫血程度、CD4^(+)T细胞、初始ART方案与HIV阳性MSM的服药依从性有关。多因素Cox比例风险回归模型分析结果显示,服药依从性不良者全因死亡风险是服药依从性良好者的6.82倍(95%CI:2.83~16.42,P<0.001)。结论广州市HIV阳性MSM的服药依从性水平仍需进一步提高,应针对服药依从性不良的高危人群采取相应的干预措施,以延缓疾病进程,改善预后。

Objective To explore the adherence to antiretroviral therapy(ART)and its impact on mortality among HIV-positive men who had sex with men(MSM)in Guangzhou,and to provide data support for improving medication adherence in this population.Methods Baseline and follow-up information of HIV-positive MSM individuals aged≥15 years who initiated ART in a certain specialized infectious diseases hospital in Guangzhou from February 2004 to March 2019 were retrospectively collected.A robust Poisson regression model was used to explore the influencing factors of patients’medication adherence during ART,and a Cox proportional risk regression model was used to analyze the relationship between medication adherence and all-cause mortality.Results 7016 HIV-positive MSM were included,and 4952(70.59%)had good medication adherence,with a total of 18820.35 person-years of follow-up,and 36 deaths occurred during the follow-up period,with a mortality density of 0.19/100 person-years.The results of multivariate robust Poisson regression model showed that age at ART initiation,BMI,degree of anemia,CD4^(+)T-cell,and initial ART regimen were associated with medication adherence among HIV-positive MSM.The results of Cox proportional risk regression model showed that the risk of all-cause mortality in patients with poor medication adherence was 6.82 times higher than that in those with good medication adherence(95%CI:2.83-16.42,P<0.001).Conclusion The level of medication adherence among HIV-positive MSM in Guangzhou still needs to be further improved,and corresponding interventions should be taken for the high-risk group with poor medication adherence in order to delay the disease process and improve prognosis.