嘉兴市HIV/AIDS病人生存时间及影响因素分析

目的了解嘉兴市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的生存时间和影响因素。方法采用回顾性队列研究的方法,对2007—2017年报告现住址为嘉兴市的HIV/AIDS病人的相关资料进行分析,通过寿命表法计算生存率,运用Kaplan-Meier法和COX比例风险模型分析生存时间的影响因素。结果 1 455例HIV/AIDS病人的平均生存时间为10.02年[95%可信区间(CI):9.838～10.210],1、5、10年生存率分别为95.63%、91.93%和88.24%。多因素分析显示,≥50岁年龄组死亡风险较50岁年龄组高[P0.001,风险比(HR)=3.979,95%CI=2.551～6.207)];异性性传播和其他途径感染的病人死亡风险(P=0.008,HR=2.325,95%CI:1.242～4.350;P=0.002,HR=5.154,95%CI:1.787～14.867)较同性性传播者高;确诊时首次检测CD4+T淋巴细胞数≥350个/mm3和接受抗病毒治疗(ART)的病人死亡风险(P0.001,HR=0.074,95%CI:0.034～1.161;P0.001,HR=0.103,95%CI:0.067～0.157)均较低。结论应采取扩大检测的防治策略,早期发现HIV/AIDS病人,并及时开展抗病毒治疗,从而降低病人死亡的风险,延长生存时间。     

广东省某市871例HIV/AIDS病人生存影响因素的回顾性队列研究

目的利用艾滋病综合防治信息系统了解艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）生存的影响因素。方法采用回顾性队列研究方法,了解HIV/AIDS病人被确证感染后的转归及相关情况。结果 HIV/AIDS病人被确证时的年龄是影响生存时间的重要因素[风险值（HR）=1.04,95%可信区间（CI）：1.01-1.06,P〈0.01]。是否接受抗病毒治疗（HR=0.10,95%CI：0.03-0.33,P〈0.01）及初次CD^＋_4T淋巴细胞计数分级则是影响HIV/AIDS病人生存的保护性因素（HR=0.69,95%CI：0.58-0.82,P〈0.01）,接受抗病毒治疗、初次CD＋4T淋巴细胞计数分级高的生存时间长,差异具有统计学意义。结论早发现、早治疗有利于提高HIV/AIDS病人的生存时间。     

北京市昌平区HIV/AIDS病人生存时间及影响因素分析

目的了解北京市昌平区艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)生存时间及其影响因素。方法采用回顾性队列研究方法,在中国艾滋病综合防治信息系统中收集2003—2017年北京市昌平区HIV/AIDS病人信息,使用寿命表法分析生存率,利用Kaplan-Meier法(K-M法)计算平均生存时间,利用COX比例风险模型分析研究对象生存时间的影响因素。结果1 174例HIV/AIDS病人平均生存时间为165.18个月,确诊后1、5和10年生存率分别为98.17%、96.53%、90.52%。COX比例风险模型多因素分析结果表明,确诊时疾病状态[风险比(HR)=4.263,P=0.006]、是否抗病毒治疗(HR=0.029,P=0.000)是HIV/AIDS病人生存时间的影响因素。结论早发现、早诊断、早治疗可延长HIV/AIDS病人的生存时间,减少HIV传播。     

济南市2000-2012年HIV/AIDS死亡病例的流行病学分析

目的分析济南市艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（HIV/AIDS病人）的死亡情况,探索减少死亡的办法。方法收集2000-2012年国家AIDS综合防治信息系统中,济南市HIV/AIDS死亡病例相关信息进行回顾性分析。结果截至2012年12月31日,济南市累计报告HIV/AIDS病人876例,累计死亡152例,累计死亡率17.35%;其中67.11%在确认1年内死亡,32.89%在确认1年后死亡,存活≥3年的占9.88%。死亡前检测过CD4＋T淋巴细胞的占37.5%;CD4＋T淋巴细胞水平在≤50个/μL、50～200个/μL、≥201个/μL各组间生存时间差异有统计学意义。死亡前进行高效抗反转录病毒治疗（HAART）的占11.84%;平均服药时间为1.01年;平均生存时间年2.53年。结论济南市AIDS病例发现晚,CD4＋T检测覆盖面、抗病毒治疗覆盖面不够。建议进一步加大AIDS知识宣传力度,消除歧视,扩大自愿咨询、主动检测的力度,扩大抗病毒治疗覆盖面,有效降低死亡率。     

成都市新都区431例≥50岁HIV/AIDS病人生存时间及其影响因素分析

目的了解成都市新都区≥50岁艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的生存时间,并探讨相关影响因素。方法通过中国艾滋病综合防治信息系统下载2008-2017年报告现住址为新都区且年龄≥50岁的HIV/AIDS病例资料,计算病死率和累计生存概率,采用COX比例风险回归模型分析死亡的相关影响因素。结果新都区2008-2017年累计报告HIV/AIDS病人431例,死亡115例,占26.68%。病死率从2008年0升至2011年57.14%,后降至2017年14.75%。死亡者均为汉族,以60～69岁为主,占38.26%,男性占83.48%,未婚/离异/丧偶者占63.48%,61.74%为农民/工人,小学及以下占65.22%,94.78%为异性性传播,8.70%有性病史。≥50岁HIV阳性人群的平均生存时间为5.08年[95%可信区间(CI):4.55～5.61年],1、3、5年累计生存概率分别为78.18%、66.00%、53.09%。COX回归分析显示,年龄和首次CD4+T淋巴细胞计数是≥50岁HIV/AIDS病人死亡的影响因素。结论成都市新都区≥50岁HIV/AIDS死亡病例以男性为主,未婚/离异/丧偶比例高且文化程度偏低,≥50岁HIV/AIDS病例死亡风险高,与其年龄和首次CD4+T淋巴细胞计数有关。     

有偿供血AIDS病人生存时间及其影响因素研究

目的探讨有偿供血艾滋病(AIDS)病人的病情特征、生存时间分布特征及其影响因素。方法采用历史性队列研究的方法,收集随州市经有偿供血感染的141例AIDS病人的病情、生存时间及其影响因素信息。用K-M法描述其生存时间,用Cox比例风险模型分析影响因素。结果病人的全身状况较差。主要死亡原因为严重感染、卡氏肺孢子虫肺炎和艾滋病病毒(HIV)脑病。141例病人总死亡率为78.04/1 000人月,AIDS相关死亡率为71.43/1 000人月。中位生存时间为6.00个月,95%可信区间为5.54-6.46个月。就诊或检出时状态、发病年代、抗病毒治疗(HAART)对生存时间有影响。结论随州市AIDS病人的病情较严重,生存时间较短。HAART能够延长生存时间。     

德州市2005-2015年艾滋病免费抗病毒治疗效果及影响因素评价北大核心

目的评价德州市艾滋病抗病毒治疗的效果,为制定有针对性的艾滋病防治策略提供科学依据。方法以德州市2005-2015年所有接受艾滋病抗病毒治疗的艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）为研究对象,以CD4^＋T淋巴细胞（简称CD4细胞）及病毒载量为客观指标,结合患者转归,综合分析抗病毒治疗的疗效。结果243例接受高效抗反转录病毒疗法（HAART）的HIV/AIDS病人,平均年龄（38.40±10.16）岁,基线CD4细胞计数均值为（239.96±161.10）个/μL,治疗后CD4细胞平均增长211.01个/μL（t=-11.604,P=0.000）。在开始治疗的36个月内,不同基线CD4细胞组计数增长存在统计学差异（F=5.701,P=0.001）。接受HAART平均时长（30.71±23.82）个月,治疗12个月病毒抑制率为88.69%（149/168）,累计死亡率为7.82%（19/243）。多因素Cox比例风险回归模型分析显示,随着确证时年龄的增长,HIV/AIDS病人的死亡率增加;基线CD4细胞计数≤200个/μL的HIV/AIDS病人的死亡风险,是基线CD4细胞计数〉200个/μL病人的12.683倍[95%可信区间（CI）：2.769-58.079]。结论抗病毒治疗可以有效促进免疫重建。提高早期发现能力,及早采取规范的治疗措施,加强依从性教育,对于提高艾滋病抗病毒治疗效果具有重要意义。     

宁波市接受抗病毒治疗的≥60岁HIV/AIDS病人生存情况分析北大核心

目的了解宁波市接受抗病毒治疗的≥60岁的艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）的流行病学特征及生存情况。方法采用回顾性队列研究方法,对≥60岁HIV/AIDS病人的主要流行病学特征和生存状况进行描述性分析,Kaplan-Meier法绘制生存曲线,寿命表法计算生存率,COX比例风险回归模型分析影响死亡的危险因素。结果 157例≥60岁的研究对象中,接受抗病毒初始治疗的年龄中位数为65[四分数位间距（IQR）：62.0~69.5]岁,以男性、本地、已婚或同居、异性性传播、基线CD4^＋T淋巴细胞（简称CD4细胞）〈200个/μL、世界卫生组织（WHO）分期Ⅰ期为主。第1、2、5、7年的累计生存率分别为86%、79%、72%和72%。≥60岁组的病死率高于〈60岁组,不同年龄组的KLM曲线,经Log-rank检验差异有统计学意义。多因素COX比例风险回归模型分析显示,≥60岁组,基线WHO临床分期Ⅳ期的死亡危险,是Ⅰ期病人的4.308倍[风险比（HR）=4.308,95%可信区间（CI）：1.661~11.173];〈60岁组、WHO临床分期Ⅰ期是研究对象死亡的保护因素。在〈60岁研究对象中,基线CD4细胞为200~350个/μL组的死亡风险,低于CD4细胞〈200个/μL组（HR=0.225,95%CI：0.110~0.460）;但不同的基线CD4细胞水平对≥60岁组死亡率影响无统计学意义。在60岁及以上病人中,异性性传播病例的死亡风险低于经同性性行为感染的病例（HR=0.018,95%CI：0.002~0.189）,但〈60岁组死亡率在不同传播途径间无差异。结论宁波市接受抗病毒治疗的60岁以上HIV/AIDS病人的生存率不高,应根据老年人群的流行特征和死亡危险因素采取针对性的治疗干预策略,早诊断早治疗仍然是提高老年病人生存率的关键。     

湖州市HIV/AIDS病人ART后生存状况及相关影响因素分析

目的了解浙江省湖州市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗(ART)后的生存状况及相关影响因素,为科学防控艾滋病提供措施和依据。方法采用回顾性队列研究和现况调查等方法,查阅中国疾病预防控制信息系统的艾滋病防治基本信息系统中,有关HIV/AIDS病人ART后进行的随访记录以及现场流行病学问卷调查,资料录入数据库后进行相应的统计学分析。结果共调查≥16周岁接受ART的HIV/AIDS病人670例,其中男性574例(85.7%),已婚/同居345例(51.5%),平均年龄(39.90±13.42)岁。经多因素COX回归分析结果表明,在控制了患者的性别、年龄以及婚姻状况等相关潜在混杂因素之后,基线CD4+T淋巴细胞(简称CD4细胞)计数≥200个/μL组的死亡风险较基线CD4细胞计数200个/μL组低[风险比(HR)=0.112,95%可信区间(CI):0.028～0.455],最近一个月漏服药物(次数≥2次/月)组的死亡风险较未漏服组高(HR=8.991,95%CI:2.531～31.938),具有轻度以上焦虑组的死亡风险较无焦虑组高(HR=3.673,95%CI:1.244～10.849)。结论湖州市HIV/AIDS病人免费ART后能够提高其生存率,基线CD4细胞计数高、无焦虑症及未漏服抗病毒药物会降低死亡风险,建议针对HIV/AIDS病人早期加入ART、增强其服药后的心理干预和卫生服务、以及加强服药依从性的宣教,以提高其生活质量。     

贵港市HIV/AIDS病人生存时间及艾滋病相关死亡影响因素分析

目的探讨影响贵港市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)生存时间及艾滋病相关死亡的因素,为制定适合该市的艾滋病防治策略和措施提供依据。方法在艾滋病综合防治信息系统中收集1996—2017年贵港市HIV/AIDS病人的相关信息。采用回顾性队列研究的方法,运用寿命表法计算生存率,通过Log-Rank检验比较各因素不同水平生存时间的差异,用Kaplan-meier法进行单因素分析并绘制生存曲线,多因素分析采用COX比例风险回归模型。结果 13 948例HIV/AIDS病人中,发生艾滋病相关死亡1 663例(11.9%),艾滋病无关死亡2 528例(18.1%)。累计观察59 635.5人年,艾滋病相关死亡率为2.79/100人年。自2010年病死率呈逐年下降的趋势。平均生存时间为219.82个月[95%可信区间(CI):218.107～221.533]。确诊后1、5、10、15年的累计生存率分别为89%、86%、85%、85%。COX回归多因素分析显示,少数民族及来源于主动筛查的病人死亡风险较低,而男性、老年人(≥70岁)、疾病状态为AIDS、文化程度低、 CD4~+T淋巴细胞计数低(200个/μL)、未接受抗病毒治疗的病人死亡风险较高。结论近几年来,贵港市HIV/AIDS病人的艾滋病相关死亡率逐年降低,应继续加强大众的宣传教育工作,尤其是强化重点人群对艾滋病的认识,不断提高检测的可及性及扩大抗病毒治疗的覆盖面。     

河南省既往有偿采供血感染HIV人群生存时间分析

目的了解河南省既往有偿采供血感染艾滋病 病毒（HIV）人群的生存时间及影响因素。方法采用回顾性队列研究方法,对河南省两乡镇1998-2007年既往有偿采供血感染HIV者529例进行调查,采用Cox风险比例模型分析影响感染HIV者生存时间的因素。结果感染HIV人群平均生存时间为9.98年（95%CI：9.83-10.13）,1998年及以前、1999-2000年、2001-2003年、2004年及以后,发展为AIDS病人平均生存时间和95%可信区间分别为4.00年（95%CI：3.33-4.67）、6.73年（95%CI：6.21-7.25）、9.63年（95%CI：9.39-9.86）、10.86年（95%CI：10.80-10.92）;相对于接受高效抗逆转录病毒治疗（HAART）者,未接受HAART治疗者的生存概率仅为0.22（RR95%CI：0.15-0.33）。结论AIDS发病时间和是否接受HAART治疗,是影响河南省既往有偿采供血地区感染HIV人群生存时间的主要因素。     

Prognostic factors for the survival of patients with AIDS cholangiopathy

OBJECTIVES: AIDS cholangiopathy, once considered to have extremely poor prognosis, is now rarely fatal. This study was designed to assess the survival of patients with AIDS cholangiopathy and investigate prognostic variables, especially in the era of highly active antiretroviral therapy (HAART). METHODS: Ninety-four patients with AIDS cholangiopathy were diagnosed at the San Francisco General Hospital from 1983 to 2001. The mortality status, demographic and clinical variables, and ERCP results were collected through death certificates, chart review, and endoscopic reports. RESULTS: The median survival time from the diagnosis of AIDS and AIDS cholangiopathy was 23 and 9 months, respectively. HAART significantly improved the mortality of patients with AIDS cholangiopathy (hazard ratio [HR] = 0.08, 95% confidence interval [CI] = 0.02-0.35). The presence or history of any opportunistic infection involving the digestive tract, lung, eye, nervous system, skin, or systemic involvement at the time when AIDS cholangiopathy was diagnosed was an indicator of poor prognosis (HR = 3.24, 95% CI = 1.45-7.26); this was especially true for cryptosporidial infection (HR = 2.05, 95% CI = 1.24-3.38). Patients with high serum ALP levels, especially greater than 1000 IU/L or eight times the normal value (HR = 2.69, 95% CI = 1.10-6.60), tended to have a shorter life expectancy than those with normal or slightly elevated serum ALP levels. CD4 lymphocyte counts, type of cholangiopathy, and the performance of sphincterotomy were not correlated with the survival of patients with AIDS cholangiopathy. CONCLUSIONS: HAART administration most likely accounts for the recent dramatic improvement in survival of patients with AIDS cholangiopathy. Underlying immunosuppressive status, reflected by the presence or history of any opportunistic infections, is associated with a worse outcome. Serum ALP levels might be a good clinical indicator for the prognosis of patients with AIDS cholangiopathy.     

广西HIV/AIDS病人死亡影响因素的回顾性调查

目的了解广西壮族自治区（广西）艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（HIV/AIDS病人）中,与AIDS相关死亡病例和非AIDS相关死亡病例的分布情况,以及接受AIDS抗病毒治疗病例死亡的主要影响因素。方法采用AIDS综合防治数据信息系统中的HIV/AIDS死亡病例信息数据进行分析。结果对2010年1月-2011年7月死亡的5 265例有效个案进行分析,临床诊断为AIDS相关疾病死亡2 647例（50.3%）,意外伤害410例（7.8%）,其他疾病或难以确定与AIDS相关疾病的死亡1 973例（37.5%）,不详235例（4.5%）。4 382例（83.2%）未接受抗病毒治疗的主要原因是,发现较晚（46.4%）和家庭经济困难（13.7%）。2004-2011年7月底,累计治疗AIDS病人21 761例,死亡1 718例。在有完整资料的1 694例死亡病例中,825例（48.7%）在治疗后3个月内死亡;1 065例（62.9%）治疗前最近1次检测CD4T淋巴细胞≤50个/μL。结论未能及时就医或诊断时间较晚,免疫功能低下,是HIV/AIDS病人死亡的主要影响因素。要进一步建立健全监测检测和治疗体系,提高覆盖面和可及性,争取HIV/AIDS病人早发现、早诊断,及时开展抗病毒治疗,降低病死率。     

Concurrent HIV/AIDS diagnosis increases the risk of short-term HIV-related death among persons newly diagnosed with AIDS, 2002-2005

Despite the overall effectiveness and availability of highly active antiretroviral therapy (HAART), 1500 HIV-related deaths still occur annually in New York City. In considering ways to further reduce deaths, we assessed the contribution of concurrent HIV/AIDS diagnosis to HIV-related mortality in New York City among persons newly diagnosed with AIDS. We used Cox regression to conduct a retrospective cohort analysis of HIV-related mortality among 15,211 residents age 13+ reported with AIDS to the population-based HIV/AIDS registry between January 2002 and June 2005. Concurrent HIV/AIDS diagnosis was defined as a diagnosis of AIDS occurring within 1 month of initial diagnosis of HIV. HIV-related mortality was 20.2% among persons diagnosed concurrently and 12.2% among those diagnosed nonconcurrently (p < 0.0001). Concurrent HIV/AIDS was associated with more than twice the risk of HIV-related death within the 4 months after diagnosis (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.94-2.65) but no increased risk thereafter (HR 1.12, 95% CI 0.77-1.61). Other significant predictors of death included injection drug use and birth in the Caribbean or Latin America. After 4 years 11.9% of all HIV-related deaths were attributable to a concurrent HIV/AIDS diagnosis. Public health initiatives that facilitate early diagnosis of HIV may reduce HIV-related mortality by giving people the opportunity to initiate care and begin treatment with HAART before immunosuppression places them at risk for opportunistic illness and death.     

Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease

OBJECTIVE: To find the survival and the predictors of death of HIV-infected patients with hepatitis C virus (HCV)-related end-stage liver disease (ESLD). DESIGN AND METHODS: A prospective cohort study set in the infectious diseases units of four tertiary care public hospitals in Andalucía, Spain. From a multicentric cohort of 2664 HIV/HCV-co-infected patients, all consecutive patients with HCV-related cirrhosis who presented with the first hepatic decompensation from January 1997 to June 2004 were followed-up and 153 patients were included. The survival and the demographic, HIV-related and liver-related factors associated with death were evaluated. RESULTS: Ninety-five (62%) patients died during the follow-up. In 79 (85%) individuals, the cause of death was liver related. The median survival time was 13 months. Independent predictors of survival were Child score [hazard ratio (HR), 1.2; 95% confidence interval (CI), 1.08-1.37; P = 0.001], CD4+ cell count at decompensation lower than 100 cells/microl (HR, 2.48; 95% CI, 1.52-4.06; P < 0.001) and hepatic encephalopathy as the first hepatic decompensation (HR, 2.45; 95% CI, 1.41-4.27; P = 0.001). HAART was prescribed to 101 (66%) patients. The cumulative probability of survival in patients under HAART was 60% at 1 year and 40% at 3 years, versus 38 and 18%, respectively, in patients not treated with HAART (P < 0.0001). The HR (95% CI) of death in patients on HAART was 0.5 (0.3-0.9), (P = 0.03). CONCLUSIONS The survival of HIV/HCV-co-infected patients with ESLD is extremely poor. Immunosuppression and markers of severe liver disease predict liver-related mortality in these patients. HAART seems to be associated with a reduced liver-related mortality.     

Establishing CD4 thresholds for highly active antiretroviral therapy initiation in a cohort of HIV-infected adult Chinese in Hong Kong

Studies on the use and outcome of highly active antiretroviral therapy (HAART) in HIV-infected Chinese have been scarce. We evaluated risk of progression to (1) nonaccidental death and (2) new AIDS-defining illness (ADI) or death in 223, 89.9% of 248 HIV-1-infected adult Chinese patients who were first initiated on HAART between 1997 and 2002, and followed through 2003. The study subjects were mostly male (88.3%), aged between 30-49 years (43.9%), and acquired HIV via sexual contact (95.7%). After a median follow-up of 38.6 months, 13 nonaccidental deaths were observed. Overall, 25 patients developed new ADI or died. Using Kaplan-Meier analyses, there was no survival difference of starting HAART at various CD4 strata but a higher risk of progression to new ADI/death in patients with pretreatment CD4 count less than 100 cells per microliter (p = 0.01). On Cox proportional hazards multivariate regression analyses, pretreatment CD4 counts of less than 100 cells per microliter and less than 150 cells per microliter but not higher levels were the cutoffs for increased progression to death (adjusted hazard ratio [HR] = 4.90, 95% confidence interval [CI]: 1.08-22.22) and new ADI/death (adjusted HR = 14.44, 95% CI: 1.95-106.89), respectively. Age 50 years or greater was the only other independent predictor of mortality and new ADI/death after HAART. Further studies are indicated to validate and discern implications of these preliminary findings of a lower CD4 threshold for antiretroviral therapy in a small Chinese HIV cohort.     

云南省艾滋病综合管理对相关服务可及性的影响分析

目的了解艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（HIV/AIDS病人）告知随访管理,对相关服务可及性的影响,为艾滋病防治策略提供依据。方法选择4个县,每县将50例自2008年进入管理并一直随访的〉15岁的HIV/AIDS病人作为管理组,以50例2011年检测发现并至少接受过一次随访的〉15岁HIV/AIDS病人作为对照组。通过＂艾滋病综合防治信息系统＂网路直报数据,对2006-2010年云南省接受相关服务的HIV/AIDS病人的数据进行分析,以P〈0.05为差异有统计学意义。结果共调查403人,其中对照组203人,管理组200人。对照组过去6个月获得AIDS咨询70.0%（142人）、免费安全套42.4%（86人）、民政救助5.4%（11人）、结核病筛查50.7%（103人）、抗病毒治疗12.8%（26人）、美沙酮维持治疗0.5%（1人）。与对照组相比,管理组过去6个月获得AIDS咨询100%（200人）（P〈0.05）、免费安全套69.5%（139人）[比值比（OR）=3.1,95%可信区间（CI）：2.0527～4.671,P〈0.05]、民政救助65.0%（130人）（OR=32.416,95%CI：16.529～63.573,P〈0.05）、结核病筛查81.5%（163人）（OR=4.277,95%CI：2.725～6.712,P〈0.05）、抗病毒治疗60.0%（120人）（OR=10.212,95%CI：6.197～16.827,P〈0.05）、美沙酮维持治疗44.0%（88人）（OR=158.714,95%CI：21.814～1154.766,P〈0.05）,均高于对照组,差异有统计学意义。2006-2010年,云南省获得CD4T淋巴细胞计数检测、配偶HIV抗体检测、抗病毒治疗和转介、母婴阻断转介和治疗、美沙酮维持治疗服务的HIV/AIDS病人均呈逐年大幅上升。结论综合管理工作促进HIV/AIDS病人获得相关服务,符合HIV/AIDS病人需求,对艾滋病防控起了重要作用     

Delay in the initiation of HAART, poorer virological response, and higher mortality among HIV-infected injecting drug users in Spain

Differences in the uptake and time to initiation of highly active antiretroviral therapy (HAART), the virological response to HAART, and survival from AIDS by transmission category were analyzed. A multicenter hospital-based cohort of HIV-infected patients attending 10 hospitals in Spain from January 1997 to December 2003 was used. Cross-checks with the National AIDS Registry were performed. Cox proportional hazard models were used to assess the impact of transmission category on time to HAART initiation, viral suppression (defined by first HIV-1 RNA viral load measurement <500 copies/ml after HAART), and survival from AIDS. Of 4643 patients, 73% were men and 56% were injecting drug users (IDUs). A statistically significant interaction was found between transmission category and previous non-HAART antiretroviral treatment (ART) (p < 0.05). Among ART naive patients, IDUs had a 33% lower risk of initiating HAART compared to men who have sex with men (MSM) [HR 0.67 (95% CI 0.57-0.79)]. No differences by transmission categories were seen among patients with prior non-HAART ART. IDUs had poorer viral load (VL) suppression than MSM [HR 0.86 (95% CI 0.74-0.99)] adjusting by baseline VL, AIDS diagnosis, and prior ART. Mortality from AIDS was two and a half times higher in IDUs than MSM [HR 2.51 (95% CI 1.03-6.1)]. Among patients who access the hospital network, IDUs have a lower uptake of HAART, have worse virological suppression, and have higher mortality after AIDS diagnosis. There is a need to extend the programs in order to enhance access and adherence of IDUs to HAART and consider the treatment of drug addiction as an integral part of the treatment for HIV infection.