Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer

Objective:Long-term survivors(LS)of non-small cell lung cancer(NSCLC)without driver alterations,displaying an overall survival(OS)of more than 3 years,comprise around 10%of cases in several series treated with chemotherapy.There are classical prognosis factors for these cases[stage,Eastern Cooperative Oncology Group(ECOG),etc.],but more data are required in the literature.In this multi-center study,we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization.Methods:In the first step,we conducted a clinical-pathological characterization of the patients.Afterwards,we carried out a genetic analysis by comparing LS to a sample of short-term survivors(SS)(with an OS less than 9 months).We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS,and later confirmed these with reverse transcription-polymerase chain reaction(RT-PCR)for the rest of the samples.Results:A total of 94 patients were included,who were mainly men,former smokers,having adenocarcinoma(AC)-type NSCLC with an ECOG of 0-1.We obtained an initial differential transcriptome expression,displaying 5 over-and 33 under-expressed genes involved in different pathways:namely,the secretin receptor,surfactant protein,trefoil factor 1(T FF1),serpin,Ca-channels,and Tolllike receptor(TLRs)families.Finally,RT-PCR analysis of 40(20 LS/20 SS)samples confirmed that four genes(surfactant proteins and SFTP)were significantly down-regulated in SS compared to LS by using an analysis of covariance(ANCOVA)model:SFTPA1(P=0.023),SFTPA2(P=0.027),SFTPB{P=0.02),and SFT PC(P=0.047).Conclusions:We present a sequential genetic analysis of a sample of NSCLCLS with no driver alterations,obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

Bone Marrow Transplant Long-Term Survivors’ Satisfaction with Quality of Life: Comparison with a Control Group

Purpose: To evaluate the global quality of life (QoL) of survivors with 10-year or more post-transplant, and to identify risk factors that interfere with well-being. Methods: This is a prospective analytic transversal study with 214 survivors of Bone Marrow Transplant (BMT) and 264 healthy people identified among blood donors, treated as the control group, of both sexes, 18 years or older. The protocol includes a demographic-socioeconomic questionnaire, World Health Organization Quality of Life (WHOQOL) and the Karnofsky Performance Status Scale. Results: 53.7% of the survivor group members are satisfied with their QoL. A similar result can be found in the control group (54.2%). Chronological maturity, anxiety, sexual difficulty, and being a provider are factors that interfere negatively in the QoL of male survivors. In female survivors, the risk factors are anxiety, low educational level, not having a stable partner, being a provider, and not being Caucasian. Conclusions: Survivors are as satisfied with their QoL as the control group. QoL is understood as a perceptive process composed of objective (functional and relational capacity) and subjective phenomenon (perceptive composition).

Clinical Significance of Pulmonary Function Tests in Long-Term Survivors after Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation

We retrospectively assessed long-term pulmonary function in adults surviving for ≥5 years after myeloablative allogeneic hematopoietic stem cell transplantation and identified risk factors for late-onset noninfectious pulmonary complications. Among 174 patients undergoing transplantation for hematologic malignancies between May 1994 and December 2004, 81 long-term survivors were evaluated. Pulmonary function tests (PFTs) were performed before conditioning, 3 months and 1 year after transplantation, and then annually. Eight patients (10%) had abnormal pulmonary function before transplantation, but this was not associated with late changes in PFTs. Patients with chronic graft-versus-host disease (GVHD) showed a significant decline of lung function after 3 years when compared with patients without chronic GVHD. Abnormal pretransplantation lung function was associated with pulmonary chronic GVHD according to National Institutes of Health criteria (score 0, n = 58;score 1, n = 14;score 2, n = 6;score 3, n = 3). Five patients with late-onset noninfectious pulmonary complications showed a decline of lung function at 1 year after transplantation. Only chronic GVHD was significantly related to late-onset noninfectious pulmonary complications. In conclusion, abnormal lung function before transplantation may be associated with a decline in pulmonary function within 1 year after transplantation, but late-onset noninfectious pulmonary complications could not be predicted from pretransplantation lung function.

Technology-based psychosocial support for adolescent survivors of leukemia:An example intervention for nurse specialists

Technology-based interventions are thought to be one of the innovative alternatives for improving the psychosocial health of adolescent survivors.This article outlines an example of technology-based psychosocial intervention for adolescent survivors of leukemia.This technology-based psychosocial support intervention consists of five separate modules related to personal development,coping skills,and a healthy lifestyle.intervention can be applied to adolescents(aged 12-18 years)who have completed leukemia treatment at least 2 years ago and are disease free.Psychosocial interventions are crucial to improving adolescent survivors’psychosocial well-being in long-term follow-up.It is thought that psychosocial interventions can be effective on survivors’self-efficacy,coping skills,and quality of life,and survivors will be satisfied with the program.Regarding the model of childhood cancer survivorship care,this intervention can be integrated into the follow-up program and guide pediatric oncology nurses in preparing support programs for adolescent survivors.

Health-Related Quality of Life in HIV-positive Women on Long-Term Antiretroviral Therapy—A Study from Bangalore, South India

Introduction: Lifelong Anti-Retroviral Therapy (ART) promotes good quality of life and health among HIV-positive men and women. However, simplified newer and effective ART has not increased retention in care, or long-term ART adherence, especially among women. There are many factors that impede long-term adherence in women. This includes among other things female gender, depression, greater than once-daily dosing, longer time since HIV diagnosis, and patient beliefs. This study measures the quality of life in women whose ART durations range from one to fifteen years, using the standardized WHO Quality of Life questionnaire. Material and Methods: One hundred and fourteen women were divided into three groups based on ART duration. Group 1 had 37 women on ART for less than five years, Group 2 had 48 women on ART from 5 to 10 years and Group 3 had 29 women on ART for more than ten years. They were administered the WHO Quality of Life (QOL) questionnaire, which assesses QOL in six domains. QOL was considered poor in scores between 4 - 9.9, medium in scores of 10 - 14.9 and good in scores of 15 - 20. Results: Scores in all 3 groups were more than 85% in five domains and around 74.5% in the psychological domain. Domain mean scores were Physical 18 (CI 17.63 - 18.37), Psychological 14.9 (CI 14.55 - 15.25), Independence 18.6 (CI 18.33 - 18.87), Social relationships 17.5 (CI 17.07 - 17.93), Environmental 17.6 (CI 17.25 - 17.95), Spiritual, Religious, Personal beliefs, 17.4 (CI 16.93 - 17.87). Scores for women on long-term ART (Group 3) are not different from the other 2 groups and the p-values were not statistically significant. Conclusion: Women on long-term ART fare extremely well compared to other groups with more than 93% showing good QOL and none showing poor Quality of Health in spite of being on ART for a longer period of time than the other two groups. Despite a multitude of impeding factors, women who continue ART faithfully and consistently enjoy a good quality of health and life. Adequate preparation and a supportive health system are essential for ensuring long-term adherence, but the attitude and commitment of women are also critical.

Short-Term and Long-Term Outcomes among COVID-19 Survivors: A Multi-Center Prospective Observational Study

Background: Since the outbreak of the COVID-19 pandemic caused massive case fatalities across the world, people have been left with significant physical and mental disabilities, which has had an adverse impact on their quality of life. The objective of this study is to measure the short-term and long-term outcomes among COVID-19 survivors. Methods: This is a six-month-long multicentre prospective observational study, carried out in four specialized hospitals in the capital city Dhaka, where six hundred participants were enrolled by non-probability convenience sampling. Data were collected through three structured interviews, and follow-ups were done during discharge, at 1st month, and 6th month. An analytical study was done on demographic variables, socio-economic conditions, physical findings and outcomes. Data were analysed using Statistical Package for Social Sciences (SPSS). Results: A total of 600 participants were enrolled. The mean age was 49.83. Many participants belong to the age range of 31 to 40 years. More than two-thirds (72.7%) of participants were male, whereas 27.30% were female. Most patients admitted had mild and moderate COVID-19 symptoms (40% and 58%, respectively). Among short-term COVID complications, it was found that 43.3% of the participants complained of fatigue, 32.6% of depression, 24.7% of sleep disturbance, 19% of anxiety and, 5% memory loss. In long-term COVID complications the number reduced significantly: 5% of the participants complained of fatigue, 10% of depression, 2.7% of sleep disturbance, 7.3% of anxiety and, 2.7% memory loss. The severity of lung parenchymal disease also reduced in long term COVID symptoms. The study found a statistically significant relationship between age groups and CT severity index (χ2 = 9.458, p = 0.032). Most patients (29.2%) in the under-30 age group had a CT Severity Index score of 2 & 3 (29.2%). The important CT Severity Index scores for individuals aged 30 to 60 years were 3 and 4, accounting for 37.7% and 33.3%, respectively. In the over-60 age group, 40.8% of patients showed a CT Severity Index score of 4, showing a range of 51% - 75%. Conclusion: This study found that fatigue, depression, and sleep disturbances are prevalent among COVID-19 survivors;however, these symptoms generally reduce over time. Lung problems improved;however, some patients suffered from persistent effects. Older patients, especially those with pre-existing conditions, suffer from more severe outcomes. These findings underscore the need for ongoing care for COVID-19 survivors.

云南瑞丽HIV-1感染长期存活者的病毒分离及其生物学特性的研究

目的 研究长期不进展者的病毒生物学特征及其与疾病发展的关系。方法 用感染者和正常人外周血单核细胞(PBMC)共培养的方法分离病毒,终点以共培养上清液中的p24抗原作为病毒生长的评价指标。结果 (1)从15例长期不进展者分离到4株病毒,占26.7％。同时取该地区HIV-1感染进展者血样20份,分离到14株病毒,阳性率为70.0％;(2)病毒分离率影响因素的试验结果表明,病毒的分离率与CD_4细胞数有明显关系,CD_4细胞数越高,分离率越低。反之,CD_4细胞数越低,病毒分离率越高。此外,去除CD_8细胞后可以显著提高病毒的分离率;(3)病毒生物学特性观察发现长期不进展者分离株均属生长缓慢、低滴度、非致细胞融合型(NSI型),在T细胞不能生长的病毒;(4)大部分进展者分离株与长期不进展者分离株在生物学特性方面没有显示区别。结论 长期不进展者与大部分进展者的病毒生物学特征没有明显区别,因此,推测病毒学因素可能不是决定病程进展的最主要因素。影响疾病进展的其它因素,如免疫因素等尚需进一步研究。

Long-term survival of more than 3 years among patients with advanced non-small cell lung cancer treated with chemotherapy

AIM: To evaluate the prognostic factors of long-term survival of more than 3 years in patients with advanced non-small cell lung cancer(NSCLC). METHODS: We retrospectively analyzed the records of 474 patients with advanced ⅢB/Ⅳ NSCLC who received chemotherapy as initial treatment between September 2002 and March 2007.RESULTS: The median survival time(MST) was 12.5 mo and the 3 year and 5 year survival rates were 14.6% and 5.3%, respectively. Long-term survival of more than 3 and 5 years was observed in 65 and 16 patients, respectively. The MST for the 65 patients was61.5 mo(range, 60.1-81.0 mo). In the 474 patients, a good performance status(PS), female sex, non-smoking status and adenocarcinoma histology were significantly associated with a favorable outcome. Furthermore, female sex, a good PS, non-smoking status and adenocarcinoma histology were significantly correlated with longterm survival of more than 3 years and most of these patients(89.2%, 58/65) received epidermal growth factor receptor-tyrosine kinase inhibitors as any line treatment. Survival analysis of long-term survivors showed that a PS of 0 was an independent prognostic factor for predicting favorable outcomes. CONCLUSION: Our results suggest that a good PS and adenocarcinoma histology play an important role in long-term survival of more than 3 years. A PS of 0 was an independent prognostic factor for predicting favorable outcomes in patients with advanced NSCLC who survived for more than 3 years.

Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis

Purpose： To evaluate the quality of life among survivors after sepsis in 2 years, comparing with critical patients without sepsis and the general people, analyze the changes and the predictors of quality of life among septic survivors. Methods： This prospective case-control study screened the intensive care unit （ICU） patients in Tianjin Third Central Hospital from January 2014 to October 2017, and the Chinese general population in the previous studies was also included. According to inclusion criteria and exclusion criteria, 306 patients with sepsis were enrolled as the observation group, and another 306 patients without sepsis in 1CU during the same period, whose ages, gender and Charlson Comorbidity Index matched with observation group, were enrolled as the control group. At 3 too, 12 mo, and 24 mo after discharge, the Mos 36-item Short Form Health Survey （SF-36）, the Euroqol-5 dimension （EQ-5D）, and the activities of daily living （ADL） were evaluated in face-to-face for the quality of life among survivors. Results： There were 210 （68.6%） septic patients and 236 （77.1%） non-septic critically ill patients surviving. At 3 months after discharge, the observation and control groups had the similar demographic characteristics （age： 58.8 ± 18.1years vs. 57.5 ±17.6 years, p = 0.542; male： 52.0% vs. 51.4%, p = 0.926）. However, the observation group had higher acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） scores, higher sequential organ failure assessment （SOFA） scores, longer hospital stay, and longer ICU stay than the control group did （p 〈 0.05）. There were no significant differences in the eight dimensions of the SF36 scale, the EQ-5D health utility scores, and the activities of daily life scores between septic survivors and non-septic survivors （p 〉 0.05）. In addition, compared with the quality of life of the Chinese general population （aged 55-64 years）, the quality of life of septic patients were significantly lower at 3 months after discharge （p 〈 0.05）. Comparing the quality of life of the ill patients who had been discharged at 3 mo and 24 mo, the general health improved statistically （p = 0.000） and clinically （score improvement 〉 5 points）. Older age （OR, 1.050; 95% CI, 1.022-1.078, p = 0.000）, female （OR, 3.375; 95% CI, 1.434 -7.941, p = 0.005） and longer mechanical ventilation time （OR, 3.412; 95% CI, 1.413, 8.244, p = 0.006） were the risk factors for the quality of life of septic survivors. Conclusion： The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill survivors. After discharge, the general health of sepsis improved overtime. Age, female and mechanical ventilation time （〉5 days） were the predictors of the quality of life after sepsis.

Measurement Error in Proportional Hazards Models for Survival Data with Long-term Survivors

This work studies a proportional hazards model for survival data with ＂long-term survivors＂, in which covariates are subject to linear measurement error. It is well known that the naive estimators from both partial and full likelihood methods are inconsistent under this measurement error model. For measurement error models, methods of unbiased estimating function and corrected likelihood have been proposed in the literature. In this paper, we apply the corrected partial and full likelihood approaches to estimate the model and obtain statistical inference from survival data with long-term survivors. The asymptotic properties of the estimators are established. Simulation results illustrate that the proposed approaches provide useful tools for the models considered.

Late recurrence after surgery for cholangiocarcinoma:implications for follow-up?

BACKGROUND:Biliary tract cancer is uncommon,but has a high rate of early recurrence and a poor prognosis. There is only limited information on patients surviving more than 5 years after resection. METHODS:We report a patient who developed recurrence 8 years after resection of cholangiocarcinoma.Descriptions of late recurrence after excision of cholangiocarcinoma are reviewed. RESULTS:Few long-term survivors with biliary tract cancer have been reported.The survivors tend to have well differentiated or papillary tumors.The present case had no recurrence for 8 years despite poor prognostic factors including poor differentiation,invasion through the muscle wall and perineural invasion.It has been suggested that tumor cells left after the first operation grow and present as late recurrence.There is a need to differentiate a new primary and field change from recurrence of the previous tumor. CONCLUSIONS:Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years occurs.The mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6%to 43%in different series.Early detection of local recurrence may give an opportunity for further surgical resection.

山东省1例HIV长期不进展感染者的确证过程及随访情况

目的描述山东省1例HIV长期不进展感染者的确证过程及随访期内实验结果的变化。方法研究对象为1例27岁男性HIV感染者,2013年8月7日首次ELISA检测HIV抗体阳性;密切接触者为研究对象确证感染前接触过的3个同性性伴,其中第一个性伴已无法取得联系。采用中国艾滋病综合防治信息系统首次流行病学调查问卷,由调查员对研究对象的一般人口学特征及行为学特征等内容进行面对面调查。在首次ELISA检测结果呈阳性后,对研究对象进行了4次随访(2013年8月14、21、30日和9月16日),每次随访均进行胶体硒法快速检测、ELISA、Westernblot、CD4^+T淋巴细胞和病毒载量检测;在确证感染后,对其进行长期随访检测CD4^+T淋巴细胞和病毒载量,观察研究对象的病程进展。结果研究对象与性伴一维持性行为时间为2011—2012年,其间连续多次HIV抗体ELISA检测结果均阴性;与性伴二维持性行时间为2013年1—4月,且在2013年4月发生最后1次无保护同性性行为,经溯源调查,性伴二为艾滋病综合防治信息系统抗病毒治疗模块中已进行抗病毒治疗的艾滋病患者;与性伴三维持性行为时间为2013年5—10月,性伴三的两次ELISA检测均阴性。2013年8月7日因需医院手术,研究对象进行了HIV抗体ELISA检测,结果呈阳性,而Westernblot检测确证结果为HIV-1抗体不确定(带型为gp160/gp120/p24)。随后4次随访,HIV抗体快速检测均为阳性,ELISA检测均为阳性,Westernblot确证结果均为HIV-1抗体阳性(带型均为gp160/gp120/gp41/p24/p17)。连续随访观察5年的结果显示,第1~4次CD4^+T淋巴细胞检测结果分别为520、613、834、879个/μl,后续随访22次CD4^+T检测结果持续维持在高水平,中位数为895个/μl;除有2次随访未检测病毒载量,共有5次随访检测病毒载量超过1000拷贝/ml,其余19次检测结果均低于1000拷贝/ml。同源性分析结果显示,研究对象与性伴二感染的HIV型别均为HIV-1CRF_01AE型,gag基因的相似度是97.5%,推断其为传染源,而研究对象约在2013年4月底与传染源最后1次无保护同性性行为时感染。结论该感染者被发现时为HIV早期感染者;持续随访检测结果提示,该感染者属于长期不进展者。

我国HIV-1 B’亚型感染长期存活者病毒分离及体外复制的研究

目的从HIV-1B’亚型感染的长期存活者分离HIV-1病毒,观察HIV-1病毒分离与CD4淋巴细胞水平和病毒载量的相关性。方法采用外周血单核细胞共培养法,从感染者外周血分离HIV-1毒株,测定其复制动力学,并比较HIV分离率与CD4细胞计数和病毒载量的关系。结果从190例HIV感染者中分离到101株HIV-1病毒,平均病毒分离率为53%;载量为<103、103～104、104～105和>105拷贝/ml时,病毒分离率分别为3.7%、36%、68%和73%;CD4细胞计数为<200、200～500和≥500个/μl时,病毒分离率分别为66%、59%和28%。结论HIV病毒培养阳性率与CD4细胞计数呈负相关,与病毒载量呈正相关;HIV体外复制力与病毒载量呈正相关关系。

HIV-1和GBV—C合并感染的研究进展

研究发现，持续的GBV-C病毒血症和HIV-1感染者长期存活有显著关系，目前对其保护性作用机制了解甚少，可能是GBV-C通过调节化学因子和细胞因子或其受体的表达来实现的。相反的是，有些研究则未观察到GBV—C感染对HIV-1疾病的进展产生有利影响。此文对HIV-1／GBV-C合并感染的流行特点、合并感染对病程进展的影响及GBV-C感染对艾滋病进展的作用机制进行了综述。

人免疫缺陷病毒Ⅰ型基因序列分析中的质量控制研究

目的 研究DNA序列分析中各种影响因素的作用,建立排除污染、进行序列质量控制的方法。方法 通过对 950份HIV 1样品DNA基因序列结果的分析,查找序列读取及序列分析中存在的各种影响因素,对各种可能导致污染的原因进行分析和解释。结果 在使用各种软件进行序列分析时,两样本之间的基因距离为 0;两样本所测区段的核苷酸或氨基酸序列完全一致或相差甚微;样本与实验室内所构建的克隆株之间的基因距离过近,同源性达到 99%以上;两个独立传播的群体之间个别样本的互混等指标均提示存在污染的可能。结论 构建基因进化树和将样本的核苷酸序列翻译成蛋白质的氨基酸序列后构建共享序列,是一种很好的发现序列质量问题、进行序列质量控制的方法。

杭州市2004至2014年艾滋病患者抗病毒治疗的生存分析

目的 分析国家＂四免一关怀＂政策执行以来,杭州市艾滋病患者抗病毒治疗的生存情况.方法 从国家艾滋病综合防治信息系统治疗库中收集2004年至2014年符合研究条件的杭州市艾滋病抗病毒治疗患者2370例,对患者的资料,包括基本信息、病毒载量、CD4＋T淋巴细胞计数、治疗开始时间、WHO临床分期,感染途径及随访情况等进行回顾性分析.采用Kaplan-Meier法和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 2370例研究对象中,总随访时间为3968.14人年,死亡57例,总病死率为1.44/100人年（57/3968.14）.Kaplan-Meier法结果显示,抗病毒治疗第1年、第3年和第5年的累计生存率分别是98.08%、96.20%和95.24%.总病死率从2006年的6.06/100人年下降到2014年的1.44/100人年.艾滋病相关疾病病死率从2009年的1.10/100人年下降到2014年的0.90/100人年.多因素Cox回归分析发现,CD4＋T淋巴细胞200~349个/μL组的死亡风险是CD4＋T淋巴细胞〈200个/μL组的0.466倍（95%CI 0.246~0.882）;年龄在≥50岁组、40~〈50岁组、30~〈40岁组治疗患者的死亡风险是〈30岁组患者的3.408倍（95%CI 1.365~8.506）、3.788倍（95%CI 1.645~8.718）和2.593倍（95%CI 1.139~5.905）;基线WHO为Ⅲ期/Ⅳ期是Ⅰ期/Ⅱ期患者死亡风险的1.960倍（95%CI 1.117~3.439）.结论 高龄、低CD4＋T淋巴细胞计数和基线WHO为Ⅲ期/Ⅳ期是影响艾滋病患者生存率的主要因素,尽早抗病毒治疗是提高患者生存率的关键.

长期不进展人类免疫缺陷病毒-1感染者准种膜蛋白V3环氨基酸特点分析

目的 了解长期不进展HIV-1感染者HIV-1准种膜蛋白V3环氨基酸序列特征及变异特点.方法 应用终点有限稀释套式PCR方法,对5例长期不进展HIV-1感染者不同时间点单个HIV-1前病毒env基因c2-v3-c3区域进行扩增和序列测定,用序列确证分析技术分析env基因区V3环氨基酸序列特征.结果 5例患者不同随访时间点获得的准种序列中,V3环35个氨基酸中出现多样性的位点分别有1～10个不等,同一患者不同随访时间点准种优势株序列完全一致或仅有1～2个位点不同;4例患者V3环顶端四肽为GPGR,1例患者为GPGK,同一患者不同随访时间点V3环顶端四肽一致;根据V3环11和25位氨基酸及V3环的电荷推测HIV-1辅助受体均为趋化因子受体（CCR）5.结论 长期不进展HIV-1感染者V3环序列存在不同程度变异,顶端四肽稳定性高,感染的HIV-1毒株可能为非合胞体诱导型毒株.

北京市1177例免费抗病毒治疗艾滋病病例生存情况及其影响因素分析

目的分析北京市1177例免费抗病毒治疗艾滋病病例的生存情况及其影响因素。方法采用回顾性队列研究方法，对艾滋病综合防治信息系统中2012年1月1日-12月31日期间开始治疗的病例进行随访观察。观察起点为研究对象开始进行抗病毒治疗时，观察终点为2015年12月31日。应用寿命表法计算生存率，应用乘积极限法计算平均生存时间，应用Cox比例风险模型分析生存时间的影响因素。结果共纳入研究对象1177例，平均生存时间47．45个月（95％CI47．18—47．72），总病死率为0．43／100人年（16／3728．42），治疗第1、2、3、4年的生存率分别为98．96％、98．69％、98．59％和98．59％。Cox比例风险模型分析结果显示：患者开始治疗时年龄≥50岁与15～29岁相比（HR=28．98，95％CI3．18～263．94）；传播途径为静脉注射吸毒与同性性传播相比（HR=22．60，95％CI5．07～100．78）；基线CD4＋T淋巴细胞计数0—50个／μL与〉200个／μL相比（HR=14．23，95％CI2．67—75．90），对研究对象生存时间的影响有统计学意义。结论北京市免费抗病毒治疗有效降低了艾滋病病例的病死率，延长了生存时间；开始治疗时年龄、传播途径、基线CD4＋T淋巴细胞计数是影响生存时间的危险因素。