| HIV确诊后尽早启动治疗可能减少患者脱失 |
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| 引用本文： | 安靓,楼金成,杨根,劳云飞.HIV确诊后尽早启动治疗可能减少患者脱失[J].中华疾病控制杂志,2020,24(12):1412-1417. |
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| 作者姓名： | 安靓 楼金成 杨根 劳云飞 |
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| 作者单位： | 1.650301 昆明，云南省传染病医院/艾滋病关爱中心艾滋病临床管理办公室 |
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| 基金项目： | 昆明医科大学应用基础研究联合专项 |
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| 摘 要： | 目的 分析从人类免疫缺陷病毒(human immunodeficiency virus, HIV)确诊到启动治疗时间间隔对艾滋病抗病毒治疗中患者脱失的影响，为指导动员治疗咨询提供参考。 方法 对云南省15年艾滋病抗病毒治疗(antiretroviral therapy, ART)数据回顾性分析，用COX回归评估不同时间间隔组患者首次发生脱失的风险。 结果 2004年-2018年在云南省接受ART的110 373例HIV感染者纳入分析，从HIV确诊到启动ART时间中位数47(11，550) d，中位随访2.63(0.88，5.28)年。其中47 974例(43.5%)患者在确诊HIV后30 d内启动ART，15 811例(14.3%)间隔时间在31~90 d，14 253(12.9%)例间隔时间在91~365 d，32 335例(29.3%)间隔时间超过365 d。总脱失率为6.77/100人年(95% CI:6.69~6.85)。以 < 30 d组为参照，30~ d组、91~ d组、>365 d组发生脱失的风险分别提高了10%、22%和14%。 < 30 d组、30~ d组、91~ d组、>365 d组患者治疗1年累计脱失率分别为11.4%、12.7%、15.0%和15.7%。 结论 通过真实世界数据证实:缩短从HIV确诊到启动ART时间间隔(30 d内)可以减少治疗中脱失。研究结果支持“艾滋病检测与治疗一站式服务”作为防治措施实施，并为云南省指导动员治疗咨询提供建议。
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| 关 键 词： | HIV/AIDS 抗病毒治疗 脱失 |
| 收稿时间： | 2020-01-15 |
Early treatment initiation post- HIV diagnosis may reduce care dropout |
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| Affiliation: | 1.Yunnan Provincial Infectious Disease Hospital, Yunnan AIDS Care Center, AIDS Clinical Management Office, Kunming 650301, China2.Kunming Medical University, School of Public Health, Kunming 650500, China |
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| Abstract: | Objective To analyze the effect of time interval from diagnosis of human immunodeficiency virus (HIV) to initiation of antiretroviral therapy (ART) on the dropout during treatment, and to provide reference for counseling on mobilization of ART. Methods COX regression was used to assess the risk of first dropout in patients with different time intervals. The data of 15- years ART in Yunnan Province were analyzed retrospectively. Results 110 373 cases of ART among people living with HIV in Yunnan from 2004 to 2018 were included in the analysis. the median time from the diagnosis of HIV to the start of ART was 47 (11 550) days, and the median follow-up was 2.63 (0.88, 5.28) years. Out of the total cases, 47 974 (43.5%) patients started ART within 30 days post-HIV-diagnosis, 15 811 (14.3%) patients had an interval of 31-90 days, 14 253 (12.9%) patients had an interval of 91-365 days, and 32 335 (29.3%) patients had an interval above 365 days. The total dropout rate was 6.77/100 person-years (95% CI:6.69-6.85). With the < 30 day group as the reference, the dropout risk in the 30-90 day group, the 91-365 day group and the >365 day group increased by 10%, 22% and 14%, respectively. In the groups of < 30- day, the 30-90 day, the 91-365 day and the >365 day, the cumulative dropout rates were respectively 11.4%, 12.7%, 15.0% and 15.7%. Conclusions Real-world data confirmed that shortening the time interval from HIV diagnosis to ART initiation (preferably within 30 days) can reduce treatment dropout. The results support the implementation of "one-stop AIDS testing and treatment service" as a prevention and treatment measure. This study provides powerful suggestions for Yunnan Province to guide the mobilization of treatment counseling. |
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