广西钦州市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失分析

目的 了解初始抗病毒治疗HIV感染者死亡和脱失情况及其影响因素,为HIV感染者有效管理和治疗提供依据。方法 采用回顾性队列研究方法,从艾滋病综合防治信息系统下载广西钦州市2008—2018年初始抗病毒治疗（ART）HIV感染者数据,采用Cox比例风险回归模型分析其死亡和脱失情况。结果 共7 812例HIV感染者进入队列,总体病死率和脱失率分别为3.25/100人年和2.41/100人年。抗病毒治疗第1年内病死率和脱失率分别为5.70/100人年和 4.88/100人年。Cox回归分析显示,死亡影响因素是年龄≥50岁（HR=2.60,95%CI：2.27~2.98）、男性（HR=1.90,95%CI：1.62~2.23）、静脉吸毒（HR=1.84,95%CI：1.56~2.17）、治疗前WHO临床分期为Ⅲ/Ⅳ期（HR=1.33,95%CI：1.15~1.53）、治疗前CD4⁺T淋巴细胞计数<200 cells/μL（HR=1.58,95%CI：1.25~1.99）、治疗机构为县级（HR=2.74,95%CI：2.36~3.19）、HIV诊断到抗病毒治疗间隔天数30~< 90 d（HR=1.17,95%CI：1.01~1.36）、间隔天数90 ~<365 d（HR=1.21,95%CI：1.02~1.44）;脱失影响因素是年龄≥50岁（HR=1.60,95%CI：1.37~1.87）、男性（HR=1.56,95%CI：1.32~1.85）、静脉吸毒（HR=1.96,95%CI：1.62~2.36）、开始ART前CD4⁺T淋巴细胞计数≥ 350/μL（HR=1.43,95%CI：1.16~1.77）、抗病毒治疗初始方案含LPV/r（HR=1.80,95%CI：1.36~2.38）、抗病毒治疗开始时间在2013—2016年（HR=1.36,95%CI：1.12~1.65）、抗病毒治疗开始时间在2017—2018年（HR=1.66,95%CI：1.30~2.14）、HIV诊断到抗病毒治疗时间间隔天数>365 d（HR=1.21,95%CI：1.01~1.45）。结论 钦州市HIV感染者抗病毒治疗效果较好,但治疗第1年内病死率和脱失率较高。需针对死亡和脱失的影响因素,加强抗病毒治疗医疗卫生人员培训和治疗者宣传教育以提高抗病毒治疗效果。

Death and attrition among HIV-infected patients receiving initial antiretroviral therapy in Qinzhou,Guangxi, 2008-2018

Objective To understand the death and attrition of HIV-infected patients with initial antiretroviral therapy in Qinzhou City, Guangxi from 2008 to 2018 and their influencing factors. Methods A retrospective cohort study method was used to select HIV-infected people who started antiretroviral therapy (ART) in Qinzhou City from 2008 to 2018 from the Comprehensive AIDS Prevention and Control Information System, and the Cox proportional hazard regression model was used to analyze their death and attrition and their factors. Results A total of 7 812 HIV-infected patients entered the cohort. The overall mortality and attrition rate were 3.25/100 person-years and 2.41/100 person-years, respectively. The mortality rate and attrition rate within the first year of antiviral treatment were 5.70/100 person-years and 4.88/100 person-years, respectively. The results of Cox regression analysis showed that the influencing factors of death were age ≥50 years (HR=2.60, 95%CI2.27-2.98), male (HR=1.90, 95%CI1.62-2.23), intravenous drug use (HR=1.84, 95 %CI1.56-2.17), the WHO clinical stage before treatment was III/IV (HR=1.33, 95%CI1.15-1.53), the CD4⁺T lymphocyte count before treatment was less than 200/μL (HR=1.58, 95 %CI1.25-1.99), the treatment institution was at the county level (HR=2.74, 95%CI2.36-3.19), the interval between HIV diagnosis and antiviral treatment was> 30 days and <90 days (HR=1.17, 95%C1.01-1.36), the number of days between intervals was greater than 90 days and less than or equal to 365 days (HR=1.21, 95%CI1.02-1.44). Factors affecting attrition were age ≥50 years old (HR=1.60, 95%CI:1.37-1.87), male (HR=1.56, 95%CI1.32-1.85), intravenous drug use (HR=1.96, 95%CI1.62-2.36), CD4⁺T lymphocyte count before ART≥350/μL (HR=1.43, 95%CI:1.16-1.77), the initial antiviral treatment regimen contains LPV/r (HR=1.80, 95%CI1.36-2.38), antiviral treatment started in 2013-2016 (HR=1.36, 95%CI1.12-1.65), antiviral treatment started in 2017-2018 (HR=1.66, 95%CI1.30-2.14 ), the number of days between HIV diagnosis and antiviral treatment>365 days (HR=1.21, 95%CI:1.01-1.45). Conclusion sThe antiviral treatment effect of HIV-infected patients in Qinzhou City is more significant, but the mortality and attrition rate are higher within the first year of treatment. It is necessary to strengthen the training of antiretroviral treatment medical and health personnel and the publicity and education of therapists to improve the effect of antiretroviral treatment in response to the factors affecting death and attrition.