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[2010年至2014年中国新诊断的HIV/AIDS患者中与抗逆转录病毒治疗启动及时性相关因素的分析]

[An analysis of factors associated with timeliness of antiretroviral therapy initiation among newly diagnosed HIV/AIDS from 2010 to 2014 in China].

作者信息

Tang H L, Xu J, Han J, Li J, Mao Y R

机构信息

National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Aug 6;51(8):711-717. doi: 10.3760/cma.j.issn.0253-9624.2017.08.010.

Abstract

To analyze timeline of antiretroviral therapy (ART) initiation among newly diagnosed HIV/AIDS from 2010 to 2014, as well as influencing factors. Data from the Chinese HIV/AIDS Comprehensive Response Information Management System was used to collect newly diagnosed HIV/AIDS cases from January 1, 2010 to December 31, 2014. Inclusion criteria of HIV/AIDS were confirmed cases and clinically diagnosed HIV positive, Chinese mainland cases, 14 years old and above, the first CD4(+)T lymphocyte ≤350 cells/μl in the follow up period. A total of 177 971 HIV/AIDS cases were included in this study. The general demographic characteristics (gender, age, ethnicity, education, occupation, etc.), infection routes, sample sources, CD4(+)T lymphocyte level and other information were collected from the database. Chi square test was used to analyze univariate factor of the timeliness of ART initiation. Multivariate logistic regressions were used to analyze potential factors associated with timeliness of ART initiation. Out of the 17 7971 cases, 130 679 (73.4%) were males. The proportion of the timeliness of ART initiation was 55% (97 915). The proportion of timeline of ART within 15 d increased from 26.4% (4 319/16 388) in 2010 to 39.7% (20 212/50 889) in 2014. The highest proportion was in the group of patients infected by illegal blood (plasma) donation, which was 38% (945). The proportion of timeline of ART within 30 d increased from 43.2% (7 077/16 388) in 2010 to 63% (32 070/50 889) in 2014.The highest proportion was in the group of patients infected by heterosexual transmission, which was 58.3% (73 098). Multivariate logistic regression analysis on timeliness of ART showed that the factors of timeliness of ART initiation of HIV/AIDS as follow. The possibility of timeliness of ART among patients who were female, education of junior high school and above, ethnic group of Han, farmers, married were higher, with values at 1.08, 1.09, 1.13, 1.05 and 1.12. The possibilities of timeliness of ART in group of patients aging 25-34, 35-44, 45-54 and ≥55 years old were higher than that of the group of patients aging 15-24 years old, with values at 1.13, 1.31, 1.46 and 1.51, respectively. The possibilities of timeliness of ART among the homosexuals, injection drug use and sexual contact plus injection drug use cases were lower than that of the heterosexuals, with values at 0.86, 0.59 and 0.72, respectively. The possibilities of timeliness of ART among patients whose HIV diagnosis from hospitals and detention centers were lower than that of patients whose HIV diagnosis from volunteer testing and counseling, with values at separately 0.90 and 0.29. The possibilities of timeliness of ART among patients whose CD4(+)T lymphocyte at 50-99, 100-199, 200-350 cells/μl were lower than that of the patients whose CD4(+)T lymphocyte count at 0-49 cells/μl, with values at 0.84, 0.64 and 0.40, respectively. All the P values above was<0.05. The proportion of timeliness of ART increased annually from 2010 to 2014. Those who were men, unmarried or divorced, at younger age, injection drug use, diagnosis from hospitals and detention centers and high CD4(+)T lymphocyte levels were related to the timeliness of ART.

摘要

分析2010年至2014年新诊断的HIV/AIDS患者开始抗逆转录病毒治疗(ART)的时间线及其影响因素。利用中国HIV/AIDS综合防治信息管理系统的数据,收集2010年1月1日至2014年12月31日新诊断的HIV/AIDS病例。HIV/AIDS的纳入标准为确诊病例和临床诊断HIV阳性、中国大陆病例、14岁及以上、随访期首次CD4(+)T淋巴细胞≤350个/μl。本研究共纳入177971例HIV/AIDS病例。从数据库中收集一般人口学特征(性别、年龄、民族、教育程度、职业等)、感染途径、样本来源、CD4(+)T淋巴细胞水平等信息。采用卡方检验分析ART开始及时性的单因素。采用多因素logistic回归分析与ART开始及时性相关的潜在因素。在177971例病例中,男性130679例(73.4%)。ART开始及时性的比例为55%(97915例)。ART在15天内开始的比例从2010年的26.4%(4319/16388)升至2014年的39.7%(20212/50889)。比例最高的是非法采供血(浆)感染组,为38%(945例)。ART在30天内开始的比例从2010年的43.2%(7077/16388)升至2014年的63%(32070/50889)。比例最高的是异性传播感染组,为58.3%(73098例)。对ART及时性的多因素logistic回归分析显示,HIV/AIDS患者ART开始及时性的因素如下。女性、初中及以上文化程度、汉族、农民、已婚患者ART及时性的可能性较高,比值分别为1.08、1.09、1.13、1.05和1.12。25-34岁、35-44岁、45-54岁和≥55岁患者组ART及时性的可能性高于15-24岁患者组,比值分别为1.13、1.31、1.46和1.51。同性恋、注射吸毒以及性接触加注射吸毒病例组ART及时性的可能性低于异性传播病例组,比值分别为0.86、0.59和0.72。HIV诊断来自医院和看守所的患者ART及时性的可能性低于来自自愿咨询检测的患者,比值分别为0.90和0.29。CD4(+)T淋巴细胞为50-99、100-199、200-350个/μl的患者组ART及时性的可能性低于CD4(+)T淋巴细胞计数为0-49个/μl的患者组,比值分别为0.84、0.64和0.40。以上所有P值均<0.05。2010年至2014年ART开始及时性的比例逐年上升。男性、未婚或离异、年龄较小、注射吸毒、医院和看守所诊断以及CD4(+)T淋巴细胞水平较高与ART开始及时性有关。

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