1998-2015年湖北省武汉市HIV/AIDS患者死亡及生存时间分析

目的 探讨武汉市人类免疫缺陷病毒携带者/艾滋病（human immunodeficiency virus carriers/acquired immune deficiency syndrome，HIV/AIDS）患者死亡情况、生存时间及其影响因素。方法 收集武汉市1998年1月1日~2015年12月31日所管理HIV/AIDS患者的生存、死亡等信息。计算患者的全死因死亡率，应用单因素和多因素分析探讨患者生存时间的影响因素。结果 共有3 310例患者进入研究，死亡363例，全死因死亡率为4.22/100人年，平均死亡年龄为52岁。单因素分析显示，年龄、婚姻状况、文化程度、接触史、病程阶段、是否提供宣传咨询、是否提供抗机会性感染药物、是否提供关怀救助、是否患有结核、是否进行抗逆转录病毒治疗（antiretroviral therapy，ART）、基线CD4+细胞计数对HIV/AIDS患者生存时间有影响（均有P<0.05）；Cox比例风险模型分析显示，65~88岁年龄组、低文化、处于AIDS期、没有提供宣传咨询、患有结核、没有接受ART、基线CD4+细胞计数<200个/mm3者有较高的死亡风险（均有P<0.05）。结论 武汉市HIV/AIDS患者的死亡率逐年下降，ART是影响HIV/AIDS患者生存时间的重要因素，应针对性地进行干预，以进一步延长患者寿命。

Analysis of death and survival time of HIV/AIDS patients from 1998 to 2015 in Wuhan City,Hubei Province

Objective To discuss the death, survival and its influencing factors of human immunodeficiency virus (HIV) carriers/acquired immunodeficiency syndrome (AIDS) patients in Wuhan City.Methods HIV/AIDS patients in Wuhan were recruited into this cohort study between January 1st, 1998 and December 31st, 2015. Information related to survivals, deaths and others were collected and the total mortality was calculated. Univariate and multivariate analysis were used to analyze the factors influencing survival time.Results A total of 3 310 HIV/AIDS patients were recruited and 363 deaths were reported with the total mortality rate of 4.22 per 100 persons per year. The average age at death was 52. Univariate analysis presented a significant difference (all P<0.05) in survival time of HIV/AIDS patients based on age, marriage, education, exposure history, the course of disease, whether to provide publicity and education or not, whether to provide anti-opportunistic infection drugs or not, whether to provide social assistance or not, whether to suffer from tuberculosis or not, whether to be subject to antiretroviral therapy (ART), the baseline CD4+ cell counts. Analysis of Cox proportional hazard model indicated that age from 65 to 88 years, low education, being a AIDS patient, not providing publicity and education, suffering from tuberculosis, not receiving ART, and CD4+ cell count<200 (P<0.05) were risk factors of death.Conclusions The all-cause mortality rate of HIV/AIDS patients is decreasing in the recent years. The important influencing factor of the survival time among HIV/AIDS patients is ART. It is necessary to implement the effective interventions continuously based on the factors related to the mortality of HIV/AIDS patients to increase their life span.