广西接受抗病毒治疗的老年HIV/AIDS患者死亡和脱失情况及其影响因素分析

目的调查分析广西老年HIV/AIDS病例抗病毒治疗后的死亡和脱失情况,并分析其影响因素。方法数据来源于"国家艾滋病抗病毒治疗信息系统",由广西105家抗病毒治疗机构收集后上报至该系统。分析截至2015年6月广西启动抗病毒治疗的老年HIV/AIDS病例死亡率和脱失率,采用COX回归模型分析死亡和脱失的影响因素。结果共调查研究对象20 467例,死亡率为4.69/100人年。女性的死亡风险较低(AHR=0.56, 95%CI:0.51-0.62)。以未婚为参照,已婚或同居的死亡风险较低(AHR=0.77, 95%CI:0.62-0.96)。启动治疗时CD4计数大于200/μL者的死亡风险较低(200～349/μL, AHR=0.74, 95%CI:0.67-0.82; 350～499/μL, AHR=0.46, 95%CI:0.35-0.60;≥500/μL,AHR=0.37, 95%CI:0.21-0.64)。2012—2015年启动抗病毒治疗者死亡风险较低(AHR=0.72, 95%CI:0.63-0.82)。WHO分期为3/4期者死亡风险较高(AHR=1.96, 95%CI:1.80-2.14)。研究对象脱失率为11.67/100人年。女性(AHR=0.79, 95%CI:0.75-0.84)、已婚或同居者(AHR=0.70, 95%CI:0.62-0.80)脱失风险较低;经静脉注射吸毒感染(AHR=1.73, 95%CI:1.32-2.27)、 WHO分期为3/4期(AHR=1.17, 95%CI:1.11-1.23)、 2009—2011年启动抗病毒治疗(AHR=1.35, 95%CI:1.22-1.49)、 2012—2015年启动抗病毒治疗(AHR=1.33, 95%CI:1.20-1.47)者脱失风险较高。结论老年HIV/AIDS病例应尽早启动抗病毒治疗,并制定针对性干预措施,提升抗病毒治疗服务质量,提高治疗依从性。     

2020年山东省≥15岁HIV/AIDS患者抗病毒治疗耐药影响因素分析

目的 分析山东省艾滋病病毒感染者/艾滋病（HIV/AIDS）患者抗病毒治疗耐药的影响因素。方法 对山东省2020年1—12月接受抗病毒治疗时间> 6个月、年龄≥15岁12 608例HIV/AIDS患者进行病毒载量检测,并在检测病毒载量（VL）> 1 000拷贝/mL的样本中进行耐药基因型检测。将病毒学应答失败且基因测序结果对≥1种抗病毒治疗药物存在低度及以上者认定为耐药患者。选择100例耐药患者（耐药组）和131例非耐药患者（非耐药组）进行抗病毒治疗耐药影响因素问卷调查。采用χ2检验和logistic回归模型分析耐药相关影响因素。结果 有效检测12 521例患者,抗病毒治疗耐药率为1.74%(218/12 521);获得有效问卷223份,其中耐药组97份,非耐药组126份,logistic多因素回归分析结果显示,治疗时间相差1～12个月的患者是及时治疗者发生耐药的2.74倍（95%CI=1.18～6.33）;更换过1、2、3次药物组合者是未换药的12.62倍（95%CI=5.44～29.23）、39.96倍（95%CI=10.10～158.15）、12.01倍（95%CI=...     

成都市HCV合并感染对HIV/AIDS抗病毒治疗效果的影响

  目的  了解艾滋病病毒(human immunodeficiency virus, HIV)-丙型肝炎病毒(hepatitis C virus, HCV)合并感染者和HIV感染者艾滋病(acquired immunedeficiency syndrome, AIDS)抗病毒治疗(Antiretroviral therapy, ART)的效果,并进一步分析HCV合并感染对艾滋病ART效果的影响。  方法  利用国家艾滋病综合防治信息系统选取成都市2010年1月1日至2018年12月31日确诊的HIV/AIDS病例信息,随访时间截至2019年12月31日。采用Cox比例风险模型分析HCV感染对艾滋病ART病毒学失败的影响。  结果  符合纳入标准的HIV-HCV合并感染者共555例,另匹配HIV感染者555例。在接受艾滋病抗病毒治疗4年内,HIV感染组和HIV-HCV合并感染组CD4+T淋巴细胞计数(简称CD4)的中位数年均分别升高45.9个/mm3、37.1个/mm3。两组病例累计随访2 393.1人年,病毒学失败率为7.15/100人年(171/2 393.1)。多因素Cox分析结果显示,HIV-HCV合并感染组发生病毒学失败的风险是HIV感染组的1.512(1.042~2.195)倍(P=0.030)。  结论  合并HCV感染可能是影响HIV/AIDS艾滋病抗病毒治疗效果的危险因素。     

泸州市50岁以上艾滋病病毒学失败患者耐药性分析

目的 分析泸州市50岁以上接受艾滋病抗病毒治疗患者中发生病毒学失败的耐药影响因素和耐药特征,为抗病毒治疗提供参考,提高治疗成功率。方法 对2021年泸州市50岁以上接受艾滋病抗病毒治疗且病毒学失败的患者进行HIV-1基因型耐药检测,采用统计学Logistic回归分析病毒学失败患者耐药发生的影响因素,以P<0.05为差异有统计学意义。结果 共招募575研究对象,成功获得序列550例(95.65%),其中281例(51.09%)耐药。多因素Logistic回归分析发现,病程为艾滋病患者是HIV感染者的1.49倍(95%CI:1.04～2.61);治疗前CD4+T淋巴细胞计数为>200个/μl组是≤200个/μl组的0.68倍(95%CI:0.47～0.97);治疗时间≥36个月是治疗时间<12个月的1.96倍(95%CI:1.06～3.64);感染CRF08＿BC亚型毒株是CRF07＿BC亚型毒株的1.71倍(95%CI:1.11～2.65)。耐药突变位点核苷类逆转录酶抑制剂(NRTIs)中的M184V/I和非核苷类逆转录酶抑制剂(NNRTIs)中的K103N、V179D...     

南昌市1994—2018年HIV/AIDS生存时间及其影响因素分析

目的了解江西省南昌市艾滋病病毒感染者/艾滋病(HIV/AIDS)患者生存时间及其影响因素。方法运用回顾性队列研究方法,以寿命表法计算生存率,采用Kaplan-Meier绘制累积生存率曲线,Cox回归模型分析南昌市1994—2018年5月纳入的2 996例HIV/AIDS患者生存时间的影响因素。结果 2 996例HIV/AIDS患者中,914例因艾滋病及相关疾病死亡,平均死亡率为2.4/100人年;截至观察终点时,中位数生存时间为2.3年,抗病毒治疗组1、2、5、7、10年累积生存率分别为95.0%、92.0%、86.0%、82.0%、74.0%;多因素Cox回归模型分析结果显示,≥60岁年龄组死亡风险是20岁年龄组的1.27倍(95%CI=1.03～1.63),男性患者死亡风险是女性的1.27倍(95%CI=1.03～1.56),基线CD4+T淋巴细胞计数(CD4)缺失组死亡风险是200个/mm3组的1.24倍(95%CI=1.02～1.50),未治疗患者死亡风险是抗病毒治疗患者10.44倍(95%CI=8.71～12.50)。结论确诊时年龄、性别、本地出生、初诊CD4值水平、是否接受抗病毒治疗、可能感染途径等是HIV/AIDS生存时间的主要影响因素,应及早进行艾滋病检测、接受抗病毒治疗,以延长HIV/AIDS生存时间。     

陕西省HIV/AIDS患者接受抗病毒治疗后病毒载量结果及其影响因素分析

目的 分析陕西省艾滋病病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immune deficiency syndrome,AIDS)患者(以下简称为HIV/AIDS患者)接受抗病毒治疗后病毒载量结果及相关影响因素。 方法 对接受抗病毒治疗六个月以上的1 046例HIV/AIDS患者进行病毒载量检测,结合病例流行病学资料分析病毒载量结果及其影响因素。 结果 1 046例HIV/AIDS患者中,≥1 000 copies/ml占9.6%(100/1 046),50~999 copies/ml占9.1%(95/1 046),＜50 copies/ml占25.4%(266/1 046),TND(未检出病毒)占55.9%(585/1 046)。单因素分析显示病毒载量结果＜1 000 copies/ml与≥1 000 copies/ml HIV/AIDS患者在民族(P＜0.05)、教育程度(χ²=10.901,P＜0.05)、感染途径(χ²=14.286, P＜0.05)变量上差异有统计学意义。多因素分析显示教育程度大专及以上是病毒载量≥1 000 copies/ml的保护因素(OR=0.344,95%CI:0.121~0.979),HIV感染途径中注射吸毒是病毒载量≥1 000 copies/ml的危险因素(OR=5.237,95%CI:1.272~21.556)。 结论 陕西省HIV/AIDS患者抗病毒治疗效果较好,但需要提高患者治疗依从性,减少病毒抑制失败。     

2004—2022年河南省新乡市15岁以上接受艾滋病抗病毒治疗患者生存状况及影响因素分析

目的 了解河南省新乡市15岁以上接受艾滋病抗病毒治疗患者的生存状况及影响因素。方法 从中国疾病预防控制信息系统免费艾滋病抗病毒治疗（ART）数据库中选取2004—2022年新乡市15岁以上HIV/AIDS患者，采用回顾性队列研究方法，分析患者生存状况，采用Cox比例风险模型探讨接受ART患者死亡风险的相关影响因素。结果共纳入研究对象2 274例，中位生存时间为18.0年，接受ART治疗满1年的患者累计生存率为93%。多因素Cox比例风险模型分析显示，接受治疗时的年龄30～<50岁组（AHR=2.316,95%CI:1.283～4.180）及≥50岁（AHR=4.227,95%CI:2.296～7.782）,WHO临床分期为Ⅲ期（AHR=1.771,95%CI:1.306～2.401）及Ⅳ期（AHR=1.837,95%CI:1.285～2.626），初始治疗方案为齐多夫定+去羟肌苷+奈韦拉平（AHR=1.901,95%CI:1.169～3.092）、奈韦拉平+拉米夫定+司他夫定及其他（AHR=2.368,95%CI:1.404～3.992）者死亡风险较高；已婚有配偶者（AHR=0....     

苏州市2005—2015年艾滋病抗病毒治疗患者生存分析

目的了解苏州市2005—2015年艾滋病抗病毒治疗患者生存率及其影响因素。方法自国家艾滋病综合防治信息系统中收集苏州市2015年12月31日前首次接受抗病毒治疗者数据,分析其治疗后生存率及其影响因素。结果共1 885例接受治疗者纳入分析,58例(占3.1%)死于艾滋病相关疾病,第1、5、10年累计生存率分别为96.08%、94.55%、94.55%。Cox比例风险模型分析结果显示,感染途径、基线CD4+T淋巴细胞计数是生存率的影响因素。经同性性行为感染HIV者病死风险是经异性性行为感染HIV者的30%(HR=0.309,95%CI:0.13~0.71);纳入治疗时CD4+T淋巴细胞计数<50/mm3、50~199/mm3的患者病死风险分别是≥200/mm3的20.01倍(HR=20.01,95%CI:6.84~58.53)、5.28倍(HR=5.28,95%CI:1.69~16.49)。结论苏州市艾滋病患者抗病毒治疗效果良好,早治疗可以有效提高患者的生存率。     

艾滋病抗病毒治疗失败人群服药依从性及影响因素

目的 了解艾滋病抗病毒治疗失败人群的服药依从性及其影响因素。方法 以苏州市2019—2020年抗病毒治疗满6个月后,治疗失败的HIV感染者(病毒载量>1 000 copies/mL)为研究对象,分析人口学特征、对抗病毒药物的认知、社会支持程度等对服药依从性的影响。结果 共纳入治疗失败HIV感染者212人,过去1个月全部按时吃药145人,占68.4%。多因素logistic回归分析显示,住所方便服用艾滋病抗病毒治疗药物(OR=4.59,95%CI:1.05～19.96)和自我报告健康状况好(OR=3.58,95%CI:1.36～9.39)的患者服药依从性较高。结论 苏州市抗病毒治疗失败人员服药依从性较低,服药依从性跟住所服药方便程度和患者自我健康状况等相关。     

2019—2021年新疆阿克苏地区HIV/AIDS患者治疗效果及影响因素分析

目的分析新疆阿克苏地区HIV/AIDS抗病毒治疗患者病毒载量和影响治疗效果的相关因素。方法回顾性分析2019—2021年阿克苏地区5个区(县)接受抗病毒治疗HIV/AIDS患者的临床资料,根据病毒载量判断治疗成功或失败,采用Logistic回归分析抗病毒治疗失败的影响因素。结果2019—2021年共检测3 912例HIV/AIDS患者,其中813例病毒载量≥1 000拷贝/ml,3 099例病毒载量<1 000拷贝/ml,抗病毒治疗有效率为79.2%。单因素分析显示,年龄(χ²=12.548)、性别(χ²=10.913)、受教育程度(χ²=15.731)及治疗方案(χ²=89.441)是病毒载量的影响因素(P<0.05)。二分类Logistic回归分析显示,性别女(OR=0.807,95%CI:0.687～0.948)和初中教育程度(OR=0.760,95%CI:0.614～0.941)治疗有效率较高;21～30岁(OR=1.950,95%CI:1.071～3.551)、3TC+TDF+...     

Incidence of tuberculosis and early mortality in a large cohort of HIV infected patients receiving antiretroviral therapy in a tertiary hospital in Addis Ababa, Ethiopia

Preceding studies on morbidities and mortalities associated with TB in a cohort of HIV care indicate high incidence of TB development and premature death among patients on highly active antiretroviral treatment (HAART). This study aims to measure the rate of TB, TB mortality, and associated risk factors following commencement of HAART in a cohort of patients attending HIV care in Ethiopia. Patient information was gathered from the hospital register and analysed. TB incidence peaked within six months of HAART initiation, and dropped from 3.3/100 person-years in the first year to 0.4/100 person-years in the fifth year. At baseline, risk factors associated with TB included WHO clinical stage 3 HIV infection (adjusted hazard ratio (AHR) 2.53; 95% CI 1.70-3.70), WHO clinical stage 4 HIV infection (AHR, 3.86; 95% CI 2.54-5.86), and patients who were bed ridden >50% a day (AHR, 1.52; 95% CI 1.13-2.05). The rate of mortality was 6.9% (incidence 2.8 per 100 person-years) and 57% of deaths occurred in the first six months of HAART initiation. Multivariate Cox model indicated WHO clinical stage 4 HIV infection, CD4+ cell count <50 cells/μl, bed ridden >50% a day, and TB after HAART initiation as baseline independent predictors of mortality. Additional evidence shows that regular CD4+monitoring of patients before HAART initiation as well as earlier HAART initiation decreases death, and regular clinical staging decreases TB incidence.     

Incidence and predictors of loss to follow-up among human immunodeficiency virus-infected adult patients on anti-retroviral therapy at Hadiya zone public hospitals,southern Ethiopia: a retrospective cohort study

Background

Loss to follow-up from anti-retroviral therapy (ART) is common and can have adverse health impacts. This study aimed to assess the incidence and predictors of loss to follow-up among adult patients on ART treatment at Hadiya zone public hospitals.

Methods

An institution-based retrospective cohort study was conducted in public hospitals in Hadiya zone, Ethiopia, from 2014 to 2018. Kaplan-Meier failure curves were used to estimate the probability of loss to follow-up after ART initiation. The Cox proportional hazard model was used to assess predictors associated with loss to follow-up after ART initiation.

Results

The incidence rate of loss to follow-up among advanced and not advanced disease of adult HIV-infected patients was 11.9/100 person-years (95% CI 9.47–14.99) and 8.6/100 person-years (95% CI 6.37–11.67), respectively. Baseline CD4 cell count < 200 cells/mm³ (AHR?=?3.4, 95% CI: 1.87, 6.18), advanced disease at ART initiation (AHR?=?0.33, 95% CI: 0.18, 0.58), not receiving isoniazid preventive therapy (AHR?=?2.5, 95% CI: 1.64, 3.94), fair or poor adherence to medication (AHR?=?2.8, 95% CI: 1.87, 4.34) and ambulatory or bedridden functional status (AHR?=?2.4, 95% CI: 1.33, 4.18) were significantly associated.

Conclusions

The overall incidence rate of loss to follow-up was high. Loss to follow-up was associated with low CD4 cell count, advanced disease stage, not receiving IPT, fair or poor adherence and ambulatory or bedridden functional status. Therefore, interventions should be strengthened to reduce loss to follow-up by addressing the identified risk factors.

     

伊宁市成人HIV/AIDS患者抗病毒治疗效果及影响因素分析

目的 了解伊宁市成人艾滋病病毒感染者/艾滋病患者（human immunodeficiency virus infection and acquired immune deficiency syndrome,HIV/AIDS）抗病毒治疗效果并分析其影响因素。方法 在国家艾滋病抗病毒治疗数据库中收集2005-2015年抗病毒治疗者的治疗信息;采用回顾性研究和Logistic回归方法进行分析。结果 共3 740例艾滋病抗病毒治疗者纳入研究,异性感染和吸毒感染分别占46.3%和32.0%,基线CD4+T淋巴细胞计数为278（170,395）个/μl。治疗满6、12、24、36、60个月时病毒抑制率分别为70.4%（1 568/2 228）、64.4%（1 695/2 631）、66.3%（1 590/2 400）、70.1%（1 345/1 919）和73.6%（550/747）,治疗满12个月的病毒抑制率低于其他时间（均有P<0.05）。多因素分析显示药物漏服在治疗满12、36和60个月均为病毒抑制失败的危险因素,调整比值比（AOR）（95%CI）分别为3.581（2.943～4.357）、2.496（1.957～3.182）和3.137（1.969～4.998）;在治疗满12个月时,吸毒感染（AOR=1.544,95%CI:1.164～2.048）和基线CD4+T淋巴细胞计数（个/μL）<200（AOR=1.371,95%CI:1.086～1.731）是病毒抑制失败的危险因素。结论 伊宁市抗病毒治疗病毒抑制失败率较高,药物漏服是病毒抑制失败的主要危险因素,需加强吸毒感染及晚期治疗患者的依从性教育和服药指导,提高乡镇级卫生院的诊疗水平,进一步提高治疗效果。     

Risk of Tuberculosis Among HAART Receiving HIV Patients Attending an ART Centre of West Bengal,India: A Prospective Cohort Study

This prospective study was conducted to find out the incidence density rate and to identify the attributed risk factors of Tuberculosis development among ART receivers. All patients who were registered in a nodal ART centre of India within 1st January 2008–31st December 2008 and had been initiated ART in the year of 2008 were considered as a cohort and were followed up till 31st December 2012. This study was started with 169 ART receivers and ended with 129 patients. During total 631.1 person-years observation, 39 TB cases (31 pulmonary and 8 extra pulmonary) were diagnosed. TB incidence density rate reduced from 12.08/100 to 1.12/100 person-years during the follow up periods. Cox regression model revealed that patients having past history of Tuberculosis were at 5 times higher risk (Hazard ratio = 5.205; 95 % CI 2.439–11.106; p = 0.000). Patients with WHO clinical stage 3 or 4 at the time of enrolment had 2 times more risk of development of TB (Hazard ratio = 2.081; 95 % CI 1.502–2.884; p = 0.000). This study highlighted that special attention should be paid on earliest identification of TB among the HIV patients who had past history of TB or suffering from WHO clinical stage 3 or 4 to prevent the silent transmission and multidrug resistance development of Tuberculosis in the community.     

2004 - 2016年贵州省艾滋病抗病毒治疗病毒抑制失败及耐药影响因素分析

目的 了解贵州省2004 - 2016年艾滋病抗病毒治疗病毒抑制失败及耐药病例情况。方法 选择艾滋病综合防治信息系统中2004 - 2016年6月在贵州省接受抗病毒治疗且做过病毒载量检测的4 349例艾滋病病毒感染者及病人进行横断面分析。结果 4 349例研究对象中,男性占68.5%(2 977/4 349),平均年龄为（45.0±13.7）岁,未婚者居多,占76.2%（3 316/4 349）,传播途径以异性传播为主,占67.2%（2 924/4 349）。4 349例病毒抑制失败占20.7%（899/4 349）,多因素logistic回归分析结果显示,年龄小于45岁(OR = 0.809,95%CI:0.694～0.9420),婚姻状况为未婚(OR = 0.500,95%CI:0.382～0.653)、已婚或同居(OR = 0.722,95%CI:0.539～0.967),感染途径为同性性行为(OR = 0.282,95%CI:0.205～0.388)和异性性行为(OR = 0.735,95%CI:0.608～0.889),治疗时长为6～47个月组(OR = 0.782,95%CI:0.634～0.964)与其他组比较,病毒抑制失败率差异有统计学意义（P＜0.05）;247例送检病例中耐药占59.5%（147/247）,多因素logistic回归分析结果显示,治疗时长为6～34个月的病人对耐药产生的差异有统计学意义（OR = 0.459,95%CI:0.211～0.998,P＜0.05）。结论 抗病毒治疗人群中病毒抑制失败率较高,耐药突变加重。     

The Cedar Project: high incidence of HCV infections in a longitudinal study of young Aboriginal people who use drugs in two Canadian cities

ABSTRACT: BACKGROUND: Factors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities. METHODS: The Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants' venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion. RESULTS: In total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing. CONCLUSIONS: This study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.     

The interruption of outpatient clinical care of HIV-infected patients

OBJECTIVE: To determine factors associated with the interruption of outpatient care of HIV-positive patients. METHODS: Non-concurrent prospective study carried out in a public AIDS referral center in Belo Horizonte, Brazil. Medical records were reviewed in order to assess factors associated with the interruption of clinical care of HIV patients admitted between 1993 and 1995. Patients should have attended at least one follow-up visit within a period of 7 months. Statistical analysis was carried out using Chi-square and relative hazard (RH) with 95% confidence interval (CI) estimated by Cox Regression Model. RESULTS: Cumulative incidence of interruption was 54% among 517 patients included in the study (mean follow-up=24.6 months; 26.5/100 person-years). Multivariate analysis indicated that those individuals who had fewer (<2) CD4+ T lymphocyte cell counts (RH=1.94; 95% CI=1.32-2.84) did not have viral load measured (RH=14.94; IC 95%=5.44-41.04), attended <7 medical follow-up visits (RH =2.80; IC 95%=1.89-4.14), did not change clinical category (RH =1.40; IC 95% =1.00-1.93) and did not undergo any anti-retroviral therapy (RH =1.43; IC 95% =1.06-1.93) had independently an increased risk of interrupting clinical care. CONCLUSIONS: The rate of clinical interruption in this center is high. The results suggest that interruption may be a function of better clinical outcome, i.e. the service may give priority to those patients with more severe clinical condition, and interruption of clinical care may be a marker for future antiretroviral compliance.     

云南省德宏州3103例艾滋病患者抗病毒治疗后生存分析

目的 了解云南省德宏州艾滋病患者接受国家免费抗病毒治疗后的生存情况.方法 采用回顾性研究,对德宏州2004年7月1日至2009年12月31日接受国家免费抗病毒治疗、入组抗病毒治疗时CD4+T淋巴细胞计数＜350个/μl、且年满16周岁的所有艾滋病患者进行分析.结果 共计3103例艾滋病患者开展了抗病毒治疗,平均年龄(36.0±9.9)岁,62.4%是男性,感染途径以经异性性传播为主(66.2%).病例平均随访治疗时间为21.7个月,绝大部分病例依从性＞90%,即平均每月漏服次数不足1～5次.抗病毒治疗后,第1、2、3、4、5年的累计生存率分别为0.95、0.94、0.93、0.92和0.92.Cox比例风险回归模型分析发现:在控制了年龄、性别、婚姻状况等因素的潜在混杂作用影响后,基线CD4+T淋巴细胞计数水平以及传播途径与其生存时间之间存在统计学关联.基线CD4+T淋巴细胞计数在200～350个/mm3之间死于艾滋病相关疾病的风险较基线CD4+T淋巴细胞计数＜200个/mm3的艾滋病患者低(HR=0.16,95%Cl:0.09～0.28)、经母婴传播等途径(不包括经异性性传播途径)感染HIV的患者死于艾滋病相关疾病的风险较经静脉注射毒品途径感染HIV者低(HR=0.35,95%Cl:0.13～1.00).结论 免费抗病毒治疗显著提高了艾滋病患者的生存率,较早启动抗病毒治疗有望取得更好的生存效果.     

Payment for antiretroviral drugs is associated with a higher rate of patients lost to follow-up than those offered free-of-charge therapy in Nairobi, Kenya

This retrospective analysis of routine programme data from Mbagathi District Hospital, Nairobi, Kenya shows the difference in rates of loss to follow-up between a cohort that paid 500 shillings/month (approximately US$7) for antiretroviral drugs (ART) and one that received medication free of charge. A total of 435 individuals (mean age 31.5 years, 65% female) was followed-up for 146 person-years: 265 were in the 'payment' cohort and 170 in the 'free' cohort. The incidence rate for loss to follow-up per 100 person-years was 47.2 and 20.5, respectively (adjusted hazard ratio 2.27, 95% CI 1.21-4.24, P=0.01). Overall risk reduction attributed to offering ART free of charge was 56.6% (95% CI 20.0-76.5). Five patients diluted their ART regimen to one tablet (instead of two tablets) twice daily in order to reduce the monthly cost of medication by half. All these patients were from the payment cohort. Payment for ART is associated with a significantly higher rate of loss to follow-up, as some patients might be unable to sustain payment over time. In resource-limited settings, ART should be offered free of charge in order to promote treatment compliance and prevent the emergence of drug resistance.     

云南省德宏州HIV感染者的阴性配偶中新发感染率研究

目的 了解德宏州HIV感染者的阴性配偶中HIV新发感染率.方法 2005年11月始在HIV感染者的阴性配偶中建立前瞻性队列,每6个月随访,进行问卷调查和HIV检测.结果 至2008年6月底共纳入研究对象790人,随访观察702人,2006-2008年随访期间发病密度为2.58/100人年,各年度发病密度分别为2.22/100人年、2.95/100人年、2.74/100人年.Cox回归模型结果显示,与发病风险有关的因素有:居住于盈江县[风险比(HR)=4.37,95%CI:1.48～12.90,P=0.008 ]、有吸毒史(HR=3.49,95%CI:1.09～11.18,P=0.035)以及配偶(指感染者)未接受过抗病毒治疗(HR=3.60,95%CI:1.41～9.16,P=0.007).结论 德宏州HIV感染者的阴性配偶中HIV新发感染率较高,针对某些地区以及本人有吸毒史、或其HIV阳性配偶未接受抗病毒治疗的感染者配偶仍需加强HIV预防干预.