Deng Ling, Liu Zhongfu, Zhang Shize, Dou Zhihui, Wang Qixing, Ma Ye, Gong Yuhan, Yu Gang, Wang Ju, Yu Hailiang, Miao Fengyu
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Email:
Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Jun;36(6):569-75.
To investigate the survival time and affecting factors among AIDS patients under antiretroviral treatment, between 2008 and 2013 in Liangshan, Sichuan province.
Observational retrospective cohort study method was applied. AIDS patients were chosen from China's national comprehensive prevention and control management system of AIDS in Liangshan, during 2008-2013. Related information on demographics, source of infection, pathogenesis, treatment and death was collected. Cox proportional hazards model was applied to analyze the factors that might affect the survival on patients.
Among the 8 321 cases, ranging from 18 to 87.5 years old (mean age as 34.2 ± 9.8), 3 021 died and 3 721 patients had received HAART treatment. The total mortality rate dropped from 43.9/100 person-years to 20.7/100 person-years from 2008 to 2013. In the treatment group, mortality rate dropped from 27.3/100 person-years to 5.1/100 person-years, while in the untreated group it remained high-between 45.0/100-50.8/100 person-years. Proportion for the treatment coverage increased gradually, from 5.8% in 2008 to 54.5% in 2013. Median survival time of all the AIDS patients was 35.1 months, but 18.4 months in the untreated group. Survival of all the AIDS patients was associated with factors as: treatment, age when AIDS diagnosis was made and route of HIV infection (P < 0.05). The risk of death among untreated patients was 5.78 times to the treated ones, but did not seem to relate to gender or nationality (P > 0.05). Survival of the treated group was associated with factors as gender, age when AIDS diagnosis was made, nationality, route of HIV infection, CD4(+) T cell count when AIDS diagnosis was made, CD4(+) T cell count at treatment baseline, anemia at the treatment baseline (P < 0.05). Survival of the untreated group was mainly associated with age when AIDS was diagnosed (P < 0.05) while other factors did not seem to be significantly related (P > 0.05).
Antiretroviral therapy appeared an important factor that affecting the survival of AIDS patients, timely treatment and CD4(+) T cell count provided at the baseline for treatment, were two key factors that affecting the outcome of treatment. Our findings pointed out that tactic factors as: strengthening the detection, monitoring on CD4(+) T cell count, early diagnose and treatment, expanding the coverage of antiretroviral therapy, and appropriate timing for treatment etc., were important ways to enhance the effects of treatment, so as to reduce the mortality rate and prolong the time of survival.
调查2008年至2013年四川省凉山州接受抗逆转录病毒治疗的艾滋病患者的生存时间及影响因素。
采用观察性回顾性队列研究方法。选取2008 - 2013年凉山州中国国家艾滋病综合防治管理系统中的艾滋病患者。收集人口统计学、感染源、发病机制、治疗及死亡等相关信息。应用Cox比例风险模型分析可能影响患者生存的因素。
8321例患者年龄在18至87.5岁之间（平均年龄34.2±9.8岁），3021例死亡，3721例患者接受了高效抗逆转录病毒治疗（HAART）。2008年至2013年总死亡率从43.9/100人年降至20.7/100人年。治疗组死亡率从27.3/100人年降至5.1/100人年，而未治疗组死亡率仍维持在较高水平——45.0/100 - 50.8/100人年之间。治疗覆盖率逐渐上升，从2008年的5.8%升至2013年的54.5%。所有艾滋病患者的中位生存时间为35.1个月，但未治疗组为18.4个月。所有艾滋病患者的生存与以下因素相关：治疗、艾滋病诊断时的年龄及HIV感染途径（P<0.05）。未治疗患者的死亡风险是治疗患者的5.78倍，但似乎与性别或民族无关（P>0.05）。治疗组的生存与以下因素相关：性别、艾滋病诊断时的年龄、民族、HIV感染途径、艾滋病诊断时的CD4(+)T细胞计数、治疗基线时的CD4(+)T细胞计数、治疗基线时的贫血情况（P<0.05）。未治疗组的生存主要与艾滋病诊断时的年龄相关（P<0.05），而其他因素似乎无显著关联（P>0.05）。
抗逆转录病毒疗法是影响艾滋病患者生存的重要因素，及时治疗以及治疗基线时提供的CD4(+)T细胞计数是影响治疗效果的两个关键因素。我们的研究结果指出，加强检测、监测CD4(+)T细胞计数、早期诊断和治疗、扩大抗逆转录病毒疗法的覆盖范围以及合适的治疗时机等策略性因素是提高治疗效果、降低死亡率和延长生存时间的重要途径。
