中国三城市HIV阳性男男性行为人群接受随访与抗病毒治疗服务状况及其影响因素分析

  目的  分析四川省凉山州4个艾滋病防治重点县（4县）抗病毒治疗（ART）脱失情况及其影响因素。  方法  采用回顾性队列研究方法，以4县2005 — 2019年入组治疗的艾滋病病毒感染者/病人（HIV/AIDS）为研究对象，随访观察至2020年底；从国家艾滋病综合防治信息系统收集病例报告、治疗及随访相关信息；采用寿命表法计算年度脱失概率和累计维持率，采用Cox比例风险回归模型进行影响治疗脱失的多因素分析。  结果   4县治疗总脱失率为14.82/人年，在治疗后的0～1、2～3、4～5、9～10年的脱失概率分别为18 %、10 %、7 %和10 %；多因素Cox比例风险回归模型结果显示女性治疗脱失风险低于男性（AHR = 0.83），入组治疗时年龄 ≥ 40岁治疗脱失风险低于 < 30岁者（AHR = 0.93）；已婚或同居者脱失风险低于未婚者（AHR = 0.85）；与医疗机构来源相比，样本来源为重点人群者脱失风险较低（AHR = 0.83）；与治疗前合并感染HCV或HBV者相比，未合并感染者的脱失风险较低（AHR值分别为0.84、0.92）；诊断感染HIV后 ≥ 1个月入组者脱失风险均高于 < 1个月入组者（1月～、6月～、12月～入组者AHR值分别为1.13、1.18和1.34）；美姑县的脱失风险高于布拖县（AHR = 3.83）；相对2018年后入组者，2016、2017年间入组者脱失风险最低（AHR = 0.5）。  结论   凉山4县治疗脱失率较高，脱失速度随治疗时间延长而下降，但从2018年起新入组治疗的脱失率有增加趋势；男性，< 30岁，无配偶、经医疗机构检测发现、合并感染HCV或HBV、诊断后超过1个月启动治疗、现住址在美姑县是治疗脱失的危险因素。

Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies

  Objective  To analyze the situation and determinants of loss to follow-up among human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) patients under antireoviral treatment (ART) in four key counties of Liangshan prefecture, Sichuan province.   Methods  With retrospective cohort study design, we enrolled all HIV/AIDS patients (aged ≥ 15 years) receiving ART during the period from 2005 through 2019 in 4 counties of Liangshan prefecture and conducted follow-ups of the patients untill the end of 2020. The patients′ information on diagnosis and ART were extracted from National HIV/AIDS Comprehensive Information Management System. Life table method was used to calculate the annual rate of loss to follow-up and accummulated follow-up rate; Cox proportion hazard regression method was adopted to explore risk factors of loss to follow-up.   Results  The overall incidence rate of loss to follow-up was 14.82 per 100 person-years among all patients; the rate of loss to follow-up at the 1st, 3r, fifth, and the 10th year were 18%, 10%, 7%, and 10%, respectively. The multivariate Cox proportional hazard regression model showed that the patients with following characteristics were at a decreased risk of loss to follow-up: a) being female (versus male: adjusted hazard risk [aHR] = 0.83), b) aged ≥ 40 years (versus < 30 years: aHR = 0.93), c) being married or cohabitating (versus single: aHR = 0.85), d) being screened out from high risk populations (versus being diagnosed when attending medical services: aHR = 0.83), e) without co-infection of hepatitis C virus (HCV) or hepatitis B virus (HBV) (versus with HCV: aHR = 0.84 or with HBV: aHR = 0.92), and f) having the initiative ART during 2016 or 2017 (versus during 2018: aHR = 0.5) ; while, the patients having the initiative ART 1 – 5, 6 – 11, and ≥ 12 months after the confirmation of HIV infection were at an increased risk of loss to follow-up, with the aHR of 1.13, 1.18, and 1.34 compared to those having the initiative ART less than one month after the diagnosis. The patients′ risk of loss to follow-up differed by their living region and the patients in one of the four counties had the highest risk (aHR = 3.83) compared to the patients in the other counties.   Conclusion  The incidence rate of loss to follow-up was relatively high in four counties of Liangshan prefecture; the rate decreased with the extension of ART treatment and the rate increased after 2018. Male gender, aged less than 30 years, being single, being diagnosed when attending medical service, with the co-infection of HCV or HBV, having the initiative ART more than one month after confirmed diagnosis were risk factors of loss to follow-up in the patients.