[2002 - 2014年中国国家免费抗逆转录病毒治疗策略进展]

[Progress on China' s national free antiretroviral therapy strategy in 2002-2014].

作者信息

Dou Zhihui, Zhang Fujie, Zhao Yan, Jin Canrui, Zhao Decai, Gan Xiumin, Ma Ye

机构信息

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; Beijing Ditan Hospital, Capital Medical University.

出版信息

Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Dec;36(12):1345-50.

PMID:26850386

Abstract

OBJECTIVE

To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago.

METHODS

Retrospective cohort study and cross-sectional analysis had been conducted in this study. 368 449 cases that had received the ' free antiviral therapy' from 2002 to 2014 were selected from the National Treatment Database. Data from the baseline (initial time of ART, CD(4) cell count, and antiretroviral regimen) and from the follow-up program (dates and status of follow-up, CD(4) cell counts) were gathered and analysed by SAS 9.3.

RESULTS

The number of cases that having received new treatment was increasing year by year, accounting for 75.4% of all the cases identified from 2010 to 2014. Constituent ratios of patients with baseline CD(4) cell count <200 cells/µl and clinical diagnosis of AIDS were decreasing from 81.0% in 2006 to 39.7 % in 2014. Status on drug optimization showed that: 3TC replaced DDI, EFV replaced NVP and TDF replaced D4T, making the utilization rates as 99.5%, 75.7%, and 60.6%, respectively, by 2014. Regions that were covered by the treatment accounted for 75.4% of all the counties/districts involved. The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model. Proportion on the twice-CD(4)-testing model had been 75.2% since 2010, with the rate of virological detection increased from 70.8% in 2010 to 87.4% in 2014 and the virological unsuccessful testing rate decreased from 17.6% in 2010 to 11.8% in 2014. Among all the patients, the 1, 5 and 10 year survival rates appeared as 92.2%, 80.5% and 69.6%, respectively. For patients with baseline CD(4) cell counts as <50 cells/µl or >350 cells/µl, the corresponding survival rates showed as 81.6% , 69.9% , 60.9% and 97.9%, 89.8% , 81.0%, respectively.

CONCLUSION

China' s HIV/AIDS free antiretroviral therapy program appeared as a national treatment cohort which involved large number of participants, with new patients joining in, annually. Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO. Management program on treatment had gradually turned to hospital-based, with follow-up and laboratory testing programs guaranteed, ended up with satisfactory treatment effects.

摘要

目的

分析自12年前国家实施艾滋病“四免一关怀”政策以来中国“免费艾滋病治疗策略”的进展及特点。

方法

本研究采用回顾性队列研究和横断面分析。从国家治疗数据库中选取2002年至2014年接受“免费抗病毒治疗”的368449例患者。收集基线（抗病毒治疗初始时间、CD4细胞计数和抗逆转录病毒治疗方案）和随访项目（随访日期和状态、CD4细胞计数）的数据，并通过SAS 9.3进行分析。

结果

接受新治疗的病例数逐年增加，占2010年至2014年所有确诊病例的75.4%。基线CD4细胞计数<200个/微升且临床诊断为艾滋病的患者构成比从2006年的81.0%降至2014年的39.7%。药物优化情况显示：3TC取代了DDI，EFV取代了NVP，TDF取代了D4T，到2014年使用率分别为99.5%、75.7%和60.6%。治疗覆盖的地区占所有涉及县/区的75.4%。以前由疾控中心主导的艾滋病治疗项目和管理模式已转变为以医院为基础的模式。自2010年以来，两次CD4检测模式的比例为75.2%，病毒学检测率从2010年的70.8%提高到2014年的87.4%，病毒学检测未成功的比例从2010年的17.6%降至2014年的11.8%。在所有患者中，1年、5年和10年生存率分别为92.2%、80.5%和69.6%。对于基线CD4细胞计数<50个/微升或>350个/微升的患者，相应的生存率分别为81.6%、69.9%、60.9%和97.9%、89.8%、81.0%。