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。     

我国艾滋病抗病毒治疗标准调整前后治疗病人生存情况研究

目的比较中国艾滋病抗病毒治疗标准调整前后,接受抗病毒治疗的成年艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的生存状况,以及探讨死亡相关的影响因素。方法通过国家艾滋病抗病毒治疗综合防治信息系统,收集病人的基线情况和随访信息,计算病死率以及建立COX比例风险回归模型进行分析。结果共收集到开展抗病毒治疗的HIV/AIDS病人270 313例,其中2008年及以前入组的病人5年累计生存率为0.79;2009-2011年入组的病人5年累计生存率为0.85;2012-2013年入组的病人3年累计生存率大于0.90。多因素COX回归结果显示,治疗标准调整年份≤2008年开始抗病毒治疗者,其死亡风险是2012-2013年开始抗病毒治疗者的1.28倍。除此之外,性别、年龄、婚姻状况、感染途径、药物治疗方案均影响病人死亡。结论艾滋病抗病毒治疗标准调整后,使得更多的HIV/AIDS病人在免疫水平较高时开始接受抗病毒治疗,对降低病死率、延长生存时间具有重要意义。     

抗病毒治疗的HIV/AIDS病人生存状况的影响因素

随着艾滋病(AIDS)高效抗反转录病毒治疗(HAART)时间的积累,艾滋病病毒(HIV)感染者/AIDS病人(简称HIV/AIDS病人)生存状况及影响因素分析,成为近年来国内外艾滋病研究领域关注的热点和重点。研究常用回顾性队列研究方法,采用寿命表法计算生存率,并绘制相关影响因子的Kaplan-Meier生存曲线。Cox比例风险回归模型单因素和多因素分析显示,年龄、性别、婚姻状况、BMI指数、感染途径、世界卫生组织的临床分期、基线CD4+T淋巴细胞水平等,是影响艾滋病抗病毒治疗生存时间的危险因素。针对重点人群加大艾滋病抗病毒治疗的宣传力度,早发现早诊断早治疗,提高治疗覆盖率,可以有效保障治疗效果,延长病人生存时间。     

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。     

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。     

影响AIDS患者生存时间的因素研究

为了了解艾滋病病毒(HIV)感染及其自然史,评价艾滋病(AIDS)患者的预后,需要对影响AIDS患者生存时间的因素进行研究。研究一般采用生存分析的方法,通过拟合生存分析模型,筛选影响生存时间的保护因素和危险因素。AIDS患者的生存时间受许多因素影响,包括抗病毒治疗水平、诊断时间、传播途径、AIDS定义诊断的疾病、个体因素(如年龄、性别、民族等)以及实验室指标等,其中,以抗病毒治疗水平的提高对AIDS患者生存时间的延长影响最为显著。     

四川省凉山州1995-2012年HIV/AIDS病人死亡情况分析

目的了解凉山州1995-2012年艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的死亡情况及主要影响因素。方法利用中国艾滋病综合防治信息管理系统,对1995-2012年凉山州报告的28394例HIV/AIDS病人的数据资料进行描述性分析,应用寿命表法计算生存率、死亡率,采用Kaplan-Meier法分析HIV/AIDS病人生存时间的影响因素。结果累计死亡4075人(14.4%),其中因艾滋病及相关疾病死亡1494人(36.7%),吸毒过量死亡1001人(24.6%),其他原因死亡1457人(35.8%)。因艾滋病死亡的1494例HIV/AIDS病人中,诊断时平均年龄为(31.0±9.7)岁,男性1199人(80.3%),已婚有配偶970人(64.9%),彝族1398人(93.6%),经注射吸毒感染915人(61.2%),未接受抗病毒治疗1311人(87.8%),诊断到死亡平均时间为(28.9±24.1)个月。研究对象平均生存时间为166.97个月[95%可信区间(CI)=159.58~174.36]。1年生存率为98.42%,5年生存率为89.43%,10年生存率为76.39%,15年生存率为65.59%。总病死率为2.11/100人年。单因素分析结果显示,诊断时的年龄、民族、婚姻状况、职业、感染途径、病程阶段、是否接受抗病毒治疗,是HIV/AIDS病人生存时间的影响因素。结论凉山州HIV/AIDS病人因艾滋病死亡主要集中在农村,青年彝族男性为多;早期发现,及时接受抗病毒治疗可减少死亡。     

贵州省男男性行为者中的HIV/AIDS病人接受抗病毒治疗后的生存分析

目的了解贵州省男男性行为者(MSM)中的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人),在接受抗艾滋病病毒治疗(ART)后的生存时间及其影响因素。方法回顾性分析贵州省2006年至2015年接受抗病毒治疗的MSM HIV/AIDS病人的生存时间,计算累计生存概率,运用COX回归分析其影响因素。结果共收集MSM HIV/AIDS病人1 671例,开始治疗时的年龄为14~72(30.6±9.5)岁,未婚占73.3%(1225/1 671)。治疗后病人的随访时间M=16.0(QR:6.0~33.0)个月。在发生死亡的49例中,有63.3%(31/49)的病人在开始治疗后的6个月内死亡;第1、3、5年的累计生存率分别为0.98、0.96和0.95。多因素COX回归结果显示:病人开始治疗时年龄越小死亡风险越大;开始治疗时的CD4+T淋巴细胞计数越低死亡风险越大;治疗前患有肺结核、有疾病症状体征的病人死亡风险更高。结论抗病毒治疗延长了MSM AIDS病人的生存时间。建议针对年龄小、CD4+T淋巴细胞计数低、治疗前患有肺结核或已有疾病症状体征的病人,加强临床诊疗和医学随访。     

郑州市HIV/AIDS病人抗病毒治疗不同时期生存情况比较分析

目的分析郑州市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗(ART)不同时期生存情况的变化。方法采用回顾性队列研究。共3 014例符合标准的病例,依据不同抗病毒治疗时间分成国家艾滋病防治规划"十五"(2004-2005)、"十一五"(2006-2010年)、"十二五"(2011-2015年)3个治疗时期。这3个时期新增治疗病例分别为71例、954例和1 989例,由此组成3个组,比较分析3组病例的基本情况和生存状况,SPSS 23.0软件统计分析。结果不同抗病毒治疗时期,入组治疗患者的性别、年龄、职业、HIV感染途径、基线CD4+T淋巴细胞数及首治抗病毒治疗方案差异均有统计学意义(P0.05)。十二五期间ART病人五年生存率(0.91)高于十一五期间ART病人(0.80),而十一五期间ART病人两年生存率(0.87)高于十五期间ART病人(0.67)。十五、十一五、十二五期间艾滋病病死率分别是28.89/100人年、5.61/100人年和2.66/100人年,不同治疗时期ART病人生存时间的差异有统计学意义(χ2=72.08,P0.01);相对于十五期间,十一五、十二五期间艾滋病死亡风险分别下降了0.377倍和0.162倍。结论随着对艾滋病防治工作力度的加大,HIV/AIDS病人生存率显著提高,病死率及死亡风险明显下降,艾滋病抗病毒治疗工作取得显著成效。     

安岳县42例HIV/AIDS病人免费抗病毒治疗情况分析

目的探讨四川省安岳县艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(HIV/AIDS病人)抗病毒治疗的效果及相关状况,为艾滋病的综合防治提供基础资料和科学依据。方法采用前瞻性随访研究方法,对HIV/AIDS病人的实验室检查相关结果、治疗方案及随访情况做描述性分析、重复测量方差分析、Logistic回归分析。结果 42例病人治疗前、治疗半年后及治疗1年后,CD+4T淋巴细胞(简称CD4细胞)计数的变化差异有统计学意义(F=307.93,P0.001);当基线CD4细胞计数200个/μL时,其出现治疗效果较差的危险性是基线CD4细胞计数≥200个/μL的5.675倍;基线CD4细胞计数200个/μL,发生艾滋病相关死亡的风险较大。按医嘱定期检查肝功、血常规等的次数,随着治疗时间的延长而逐渐减少。结论抗病毒治疗后,病人身体素质有所提高;基线CD4细胞计数越低,治疗效果就越差;抗病毒治疗病人随着治疗时间的增加,依从性逐渐降低。     

Outcome of HIV-infected patients with invasive squamous-cell carcinoma of the anal canal in the era of highly active antiretroviral therapy

PURPOSE: Before the development of highly active antiretroviral therapy for the treatment of HIV infection, HIV patients diagnosed with invasive squamous-cell carcinoma of the anal canal carried a very poor prognosis. This study was designed to determine the outcome in a similar group of patients in the era of highly active antiretroviral therapy.METHODS: HIV-positive patients treated for invasive squamous-cell carcinoma of the anal canal at the University of Texas Medical Center affiliated hospitals from 1980 to 2001 were identified from operative data and cancer registries. We reviewed these records and collected data regarding age, CD4 count, highly active antiretroviral therapy, cancer treatment, complications, and survival. The patients were divided into two groups based on the presence or absence of highly active antiretroviral therapy and compared using a Kaplan-Meier approach.RESULTS: Fourteen patients with HIV and invasive squamous-cell carcinoma of the anal canal were identified. Six were in the prehighly active antiretroviral therapy group and eight in the highly active antiretroviral therapy group. All were considered for treatment with chemotherapy and radiation. In the prehighly active antiretroviral therapy group, one patient refused therapy and three were unable to complete the squamous-cell carcinoma therapy as planned because of complications. Four of eight highly active antiretroviral therapy patients were unable to complete the squamous-cell carcinoma therapy as planned. The prehighly active antiretroviral therapy patients had a mean age of 40 years and a mean CD4 count of 190 at the time of diagnosis. The highly active antiretroviral therapy patients had a mean age of 44 years and a mean CD4 count of 255 at the time of diagnosis. The 24-month survival was 17 percent in the prehighly active antiretroviral therapy group and 67 percent in the highly active antiretroviral therapy group (P = 0.0524). All six patients in the prehighly active antiretroviral therapy group died with active squamous-cell carcinoma vs. two in the highly active antiretroviral therapy group. Four of the remaining six patients had no evidence of active squamous-cell carcinoma at the last follow-up visit.CONCLUSIONS: A review of patients with HIV and invasive squamous-cell carcinoma of the anal canal suggests a trend toward a higher CD4 count at the time of diagnosis and improved survival in patients receiving highly active antiretroviral therapy. In this new era, HIV-positive patients should be on highly active antiretroviral therapy. If not, highly active antiretroviral therapy should be initiated, and standard multimodality therapies for invasive squamous-cell carcinoma of the anal canal are recommended.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

河南省2007-2012年首次接受抗病毒治疗的AIDS病人入组时的流行病学特征

目的了解河南省2007-2012年首次加入国家免费抗病毒治疗项目的艾滋病（AIDS）病人,入组时的流行病学特征。方法收集河南省2007-2012年开始接受抗病毒治疗的艾滋病病人的基本信息,分析其流行病学特征和变化趋势。数据采用Excel 2010进行了整理,使用SPSS 17.0软件进行统计学分析。结果 19 909例AIDS病人平均年龄为（43.96±10.95）岁,56.73%为男性,已婚或者同居者占73.98%。经血液途径感染13 393例（67.27%）,经异性性途径感染4645例（23.33%）,经同性性途径感染419例（2.10%）。基线CD＋4T淋巴细胞计数的平均值是（198.72±168.38）个/μL,HIV确认阳性时间与开始治疗时间的间隔天数的中位数为280（P25=29,P75=1418）天。64.46%的病人首次接受抗病毒治时,采用D4T/AZT/TDF＋3TC＋NVP方案。结论河南省艾滋病抗病毒治疗时机的选择较之以前有所提前,应进一步采取措施早发现和积极治疗艾滋病病人,同时重视复方新诺明预防治疗工作。     

Prevalence and correlates of untreated human immunodeficiency virus type 1 infection among persons who have died in the era of modern antiretroviral therapy

We evaluated all human immunodeficiency virus (HIV)-related deaths over the period 1 January 1995-31 December 2001 in a Canadian province in which all HIV care and antiretroviral therapy are provided free of charge. Persons who had received antiretroviral drugs before death were compared with those who had died without ever receiving HIV treatment, by fitting a logistic model. Overall, 1239 deaths were attributed to HIV infection during the study period. Of these, 406 (32.8%) occurred among persons who had never received any HIV treatment. In adjusted analyses, aboriginal ethnicity, female sex, and lower median income were negatively associated with receiving HIV treatment before death. Furthermore, among the 833 individuals who received treatment before death, only 379 (45.5%) received antiretroviral medication >or=75% of the time during their first year receiving therapy. The data demonstrate the need for novel interventions to expand HIV care to specific populations.     

Antiretroviral treatment change among HIV, hepatitis B virus and hepatitis C virus co-infected patients in the Australian HIV Observational Database

OBJECTIVES: To assess the impact of highly active antiretroviral therapy (HAART) on rates of change of antiretroviral treatment among patients co-infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in the Australian HIV Observational Database (AHOD). METHODS: Analysis was based on 805 of the 2218 patients recruited to the AHOD by March 2003, who had commenced HAART after 1 January 1997, who had recorded test results for HBV surface antigen and anti-HCV antibody, and who had follow-up of more than 3 months. The effect of hepatitis co-infection on the rate of antiretroviral treatment change after commencing HAART was assessed using a random-effect Poisson regression model. RESULTS: Among those included in the analyses, the prevalences of HBV and HCV were 4.8% and 12.8%, respectively. The overall rate of combination antiretroviral treatment change was 0.74 combinations per year. Factors independently associated with an increased rate of change of combination antiretroviral treatment were: prior AIDS-defining illness; prior exposure to double combination antiretroviral therapy; and antiretroviral treatment class. Co-infection with HBV and/or HCV was not found to be significantly associated with the rate of combination antiretroviral treatment change. CONCLUSIONS: While both HBV and HCV co-infections are relatively common in the AHOD, they do not appear to be serious impediments to the treatment of HIV-infected patients.     

Incidence rate of modifying or discontinuing first combined antiretroviral therapy regimen due to toxicity during the first year of treatment stratified by age

Toxicity is the most frequently reported reason for modifying or discontinuing the first combined antiretroviral therapy regimens, and it can cause significant morbidity, poor quality of life and also can be an important barrier to adherence, ultimately resulting in treatment failure and viral resistance. Elderly patients with HIV/AIDS (≥50 years) may have a different profile in terms of treatment modification due to higher incidence of comorbidities and polypharmacy. The aim of this study was to describe the incidence of modifying or discontinuing first combined antiretroviral therapy regimen due to toxicity (TOX-MOD) during the first year of treatment at the IPEC – FIOCRUZ HIV/AIDS cohort, Rio de Janeiro, Brazil, stratified by age. Demographic, clinical and treatment characteristics from antiretroviral-naïve patients who first received combined antiretroviral therapy between Jan/1996 and Dec/2010 were collected. Incidence rate and confidence interval of each event were estimated using quasipoisson model. To estimate hazard ratio (HR) of TOX-MOD during the first year of combined antiretroviral therapy Cox's proportional hazards regression was applied. Overall, 1558 patients were included; 957 (61.4%), 420 (27.0%) and 181 (11.6%) were aged <40, 40–49, and ≥50 years, respectively. 239 (15.3%) events that led to any modifying or discontinuing within the first year of treatment were observed; 228 (95.4%) of these were TOX-MOD, corresponding to an incidence rate of 16.6/100 PY (95% CI: 14.6–18.9). The most frequent TOX-MOD during first combined antiretroviral therapy regimen were hematologic (59; 26.3%), central nervous system (47; 20.9%), rash (42; 19.1%) and gastrointestinal (GI) (38; 16.7%). In multivariate analysis, incidence ratio of TOX-MOD during the first year of combined antiretroviral therapy progressively increases with age, albeit not reaching statistical significance. This profile was maintained after adjusting the model for sex, combined antiretroviral therapy regimen and year of combined antiretroviral therapy initiation. These results are important because not only patients are living longer and aging with HIV, but also new diagnoses are being made among the elderly. Prospective studies are needed to evaluate the safety profile of first line combined antiretroviral therapy on elderly individuals, especially in resource-limited countries, where initial regimens are mostly NNRTI-based.     

Influence of antiretroviral treatment on quality of life in seropositive inmates

The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).     

Tuberculosis in HIV-infected persons in the context of wide availability of highly active antiretroviral therapy.

Highly active antiretroviral therapy (HAART) greatly reduces the risk of developing tuberculosis for HIV-infected persons. Nonetheless, HIV-associated tuberculosis continues to occur in countries where HAART is widely used. To identify the characteristics of HIV-infected persons who develop tuberculosis in the context of the availability of HAART, the current authors analysed data taken from 271 patients diagnosed, in Italy, during 1999-2000. These patients represent 0.7% of the 40,413 HIV-infected patients cared for in the clinical units participating in this current study. From the data it was observed that 20 patients (7.4%) had a previous episode of tuberculosis whose treatment was not completed. Eighty-one patients (29.9%) were diagnosed with HIV at tuberculosis diagnosis, 108 (39.8%) were aware of their HIV status but were not on antiretroviral treatment and 82 (30.3%) were on antiretroviral treatment. Patients on antiretroviral treatment were significantly less immunosuppressed than patients with HIV diagnosed concurrently with tuberculosis, or other patients not on antiretrovirals (median CD4 lymphocytes count: 220 cells x mm(-3) versus 100 cells x mm(-3), and 109 cells x mm(-3), respectively). No significant differences in clinical presentation of tuberculosis according to antiretroviral therapy status were recorded. Failure of tuberculosis control interventions (e.g. noncompletion of treatment) and of HIV care (delayed diagnosis of HIV infection and suboptimal uptake of therapy) may contribute to continuing occurrence of HIV-associated tuberculosis in a country where highly active antiretroviral therapy is largely available. However, a significant proportion of cases occur in patients who are on antiretroviral treatment.     

Knowledge of structured treatment interruption and adherence to antiretroviral therapy

We conducted a survey of 106 HIV-infected patients on antiretroviral therapy at a community hospital in Lancaster, Pennsylvania, to determine the extent of patient knowledge and attitudes about structured treatment interruption (STI) and whether these were factors in adherence to antiretroviral regimens. Thirty-six percent of patients possessed knowledge of STI as a treatment option and four patients reported that they had stopped taking antiretroviral therapy without specific recommendation from their physician based on information they had heard or read about STI. There was no difference in median adherence based on whether a patient was aware of STI, however, in the group who had heard of STI, attitude that STI is very beneficial was correlated with greater adherence to medication. More than one third of HIV-infected patients on antiretroviral therapy possessed knowledge of STI, and this knowledge affected adherence to antiretroviral regimens. Providers caring for HIV-infected patients should routinely inquire about patient knowledge of STI as another factor in assessing adherence to antiretroviral therapy.     

Adherence to antiretroviral therapy among HIV-infected methadone patients: effect of ongoing illicit drug use

Methadone maintenance patients infected with human immunodeficiency virus (HIV) currently receiving antiretroviral therapy had HIV RNA testing and were surveyed regarding their adherence to their treatment regimens. Adherence was measured using self-report on four questions relating to medication use in the last day and last month and whether the patient took "drug holidays." Of the patients (N = 42), 52% were receiving two-drug antiretroviral therapy and 48% were receiving triple therapy that included a protease inhibitor. Persons on triple therapy reported higher rates of adherence on all measures and were more likely to have undetectable HIV RNA levels than persons on dual therapy (60% vs. 50%). Ongoing illicit drug injection was the only factor significantly associated (p < .05) with multiple measure nonadherence; however, it was not associated with undetectable HIV RNA level. Levels of nonadherence were comparable to estimates from other chronic diseases, but this finding has important implications for patients receiving highly active antiretroviral therapy.