Chen Lin, Yang Jiezhe, Zhang Renjie, Xu Yun, Zheng Jinlei, Jiang Jianmin, Jiang Jun, He Lin, Wang Ning, Yeung Philip Chun, Pan Xiaohong
Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China.
AIDS Res Ther. 2015 Sep 25;12:32. doi: 10.1186/s12981-015-0074-7. eCollection 2015.
The objective of this study was to determine the rate of acquired immune deficiency syndrome (AIDS) in Zhejiang province and to identify specific factors associated with progression of this disease.
This study utilized a retrospective cohort to identify the specific factors involved in the progression of human immunodeficiency virus (HIV) to AIDS. We collected data of patients existing in care between 2008 and 2012 from the national surveillance system databases. We performed our analyses using a multivariate Cox proportional hazards model.
This study included 9216 HIV-positive patients (75.6 % male), which yielded 12,452 person-years (py) of follow-up-data. The AIDS progression rates were 33.9 % (2008), 33.6 % (2009), 38.1 % (2010), 30.6 % (2011) and 25.9 % (2012). We observed a significant reduction in the rate of progression Of HIV to AIDS post-2010 (Pearson χ(2) = 4341.9, P < 0.001). The cumulative AIDS progression incidence rates were 33.4, 35.4, 36.4, 37.0 and 37.04 per 100 py in 1 each of the 5 years of follow-up. This study found that age was an independent risk factor for the progression of HIV to AIDS. Compared with patients infected with HIV by homosexual transmission, patients infected with HIV by heterosexuals transmission or blood transfusion had a reduced hazard ratio (HR) for progression to AIDS (heterosexual transmission: HR = 0.695, 0.524, P = 0.007; blood transfusion: HR = 0.524, P = 0.015). Diagnosed with HIV from 2011 to 2012 and having a higher CD4+ cell count (350-500 cells/mm(3); or >500 cells/mm(3)) at baseline were independently associated with lower rates of HIV progression to AIDS [HR = 0.382, 0.380, 0.187, P < 0.001]. Patients with a CD+ T-cell count of 200-350 cells/mm(3) or greater than 350 cells/mm(3) were less likely to develop AIDS following HIV diagnosis than were those patients without HAART treatment.
This study found a high progression rate from HIV to AIDS in HIV patients residing within Zhejiang province from 2008 to 2010. This rate decreased after 2010, which coincided with the new criteria for HAART treatment, which likely contributed to the observed reduction in the rate of progression. Initiation of HAART with higher CD4+ T-cell count may reduce rate of AIDS progression. Based on our results, we conclude that efficient strategies for HIV screening, as well as early diagnosis and treatment are necessary to reduce the progression of HIV to AIDS.
本研究的目的是确定浙江省获得性免疫缺陷综合征（艾滋病）的发病率，并确定与该疾病进展相关的具体因素。
本研究采用回顾性队列研究来确定人类免疫缺陷病毒（HIV）进展为艾滋病所涉及的具体因素。我们从国家监测系统数据库中收集了2008年至2012年期间接受治疗的患者数据。我们使用多变量Cox比例风险模型进行分析。
本研究纳入了9216名HIV阳性患者（75.6%为男性），产生了12452人年的随访数据。艾滋病进展率分别为2008年33.9%、2009年33.6%、2010年38.1%、2011年30.6%和2012年25.9%。我们观察到2010年后HIV进展为艾滋病的速率显著降低（Pearson χ(2)=4341.9，P<0.001）。在随访的5年中，每年每100人年的累积艾滋病进展发病率分别为33.4、35.4、36.4、37.0和37.04。本研究发现年龄是HIV进展为艾滋病的独立危险因素。与通过同性传播感染HIV的患者相比，通过异性传播或输血感染HIV的患者进展为艾滋病的风险比（HR）降低（异性传播：HR=0.695，0.524，P=0.007；输血：HR=0.524，P=0.015）。2011年至2012年诊断为HIV且基线时CD4+细胞计数较高（350 - 500个细胞/mm(3)；或>500个细胞/mm(3)）与HIV进展为艾滋病的较低速率独立相关[HR=0.382，0.380，0.187，P<0.001]。CD+T细胞计数为200 - 350个细胞/mm(3)或大于350个细胞/mm(3)的患者在HIV诊断后比未接受高效抗逆转录病毒治疗（HAART）的患者更不容易发展为艾滋病。
本研究发现2008年至2010年期间居住在浙江省的HIV患者中，HIV进展为艾滋病的速率较高。2010年后该速率下降，这与HAART治疗的新标准一致，这可能是观察到的进展速率降低的原因。在较高的CD4+T细胞计数时开始HAART可能会降低艾滋病进展速率。基于我们的结果，我们得出结论，有效的HIV筛查策略以及早期诊断和治疗对于减少HIV进展为艾滋病是必要的。
