四川省西昌市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失情况

目的 了解四川省西昌市2008–2018年初始抗病毒治疗HIV感染者死亡和脱失的情况及其影响因素。方法 采用回顾性队列研究的方法,从艾滋病基本防治信息系统选取2008–2018年在西昌市首次开始抗病毒治疗（ART）的HIV感染者,分析抗病毒治疗者的死亡和脱失情况。采用Cox比例风险回归模型对影响抗病毒治疗HIV感染者病死率和脱失率的相关因素进行分析。结果 共计2 723例HIV感染者进入队列,总体病死率为1.92/100人年,总体脱失率为2.49/100人年。在开始抗病毒治疗的第1年内病死率和脱失率分别为10.83/100人年、13.89/100人年。Cox回归分析结果显示接受抗病毒治疗患者主要的死亡风险是年龄≥40岁（HR=2.30,95%CI：1.53~3.48）、男性（HR=1.94,95%CI：1.14~3.30）、ART前一年内结核感染（HR=1.92,95%CI：1.01~3.65）、ART前三个月出现艾滋病相关疾病/症状（HR=2.44,95%CI：1.50~3.99）、ART前乙肝感染（HR=2.50,95%CI：1.32~4.71）、CD4⁺T淋巴细胞计数< 200 cells/ul（HR=1.79,95%CI：1.12~2.86）。接受抗病毒治疗患者主要的脱失风险是年龄≥40岁（HR=1.53,95%CI：1.07~2.18）、男性（HR=5.60,95%CI：2.60~12.08）、静脉吸毒（HR=2.18,95%CI：1.46~3.27）、初始抗病毒治疗方案为EFV+3TC+TDF（HR=2.57,95%CI：1.32~5.01）。结论 西昌市HIV感染者的抗病毒治疗效果显著,但在开始治疗的第1年内病死率和脱失率较高。抗病毒治疗工作需采取针对性的措施,重点要减少静脉吸毒人群刑满释放后的脱失,从而提高抗病毒治疗效果。

Death and attrition among HIV-infected persons receiving initial antiretroviral treatment in Xichang,Sichuan, 2008-2018

Objective To understand the death and attrition and influencing factors among HIV-infected persons receiving initial antiretroviral therapy(ART) in Xichang City, Sichuan Province during 2008-2018. MethodsRetrospective cohort research was adopted to analyze the death and attrition among HIV-infected persons receiving initial ART in Xichang City, Sichuan Province, 2008-2018. Data were collected through national AIDS comprehensive treatment and prevention system. Cox proportional hazard regression model was employed to analyze related factors of death and attrition.Results A total of 2 723 eligible HIV-infected persons were enrolled. The mortality and ART attrition rates among all patients were 1.92 deaths and 2.49 attritions per 100 person-years, respectively. The mortality and attrition rates were 10.83 and 13.89 per 100 person-years in the first year of ART. Cox regression analysis showed that the main risk factors of mortality were aged ≥ forty years (HR=2.30, 95%CI: 1.53-3.48), males (HR=1.94, 95%CI: 1.14-3.30), tuberculosis infection one year before ART (HR=1.92, 95%CI: 1.01-3.65), AIDS-related disease/symptom three months before ART (HR=2.44, 95%CI: 1.50-3.99), hepatitis B infection before ART (HR=2.50, 95%CI: 1.32-4.71) and less than 200 cells/uL of CD4⁺T lymphocyte counts (HR=1.79, 95%CI: 1.12-2.86) at the initiation of ART. And the main risk factors of attrition were aged ≥ forty years (HR=1.53, 95%CI: 1.07-2.18), males (HR=5.60, 95%CI: 2.60 -12.08), injection drug users (HR=2.18, 95%CI: 1.46-3.27) and initial ART regimen EFV+3TC+TDF (HR=2.57, 95%CI: 1.32-5.01). Conclusion The effect of antiretroviral treatment was remarkable among HIV-infected persons in Xichang City. But the mortality and ART attrition rate in the first year were high. Targeted measures should be taken and focus on reducing the attrition among injection drug users after releasing from prison, so as to improve the effect of antiretroviral treatment.