Hu X S, Zhao Y, Huang L L, Luo Y X, Wu Z Y
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China (Present address: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China).
Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Nov 6;51(11):982-987. doi: 10.3760/cma.j.issn.0253-9624.2017.11.006.
To understand the antiretroviral treatment (ART) discontinuation rate and its influencing factors among HIV infected patients who initiated ART between 2012 and 2015 in Wenshan prefecture, Yunnan province. Demographic characteristics, baseline informations of ART, initial treatment regimens and follow-up status of a total of 4 354 patients who initiated ART from 2012 to 2015 in Wenshan prefecture were collected. A historical cohort study was used to describe the discontinuation incidence rate of ART. Life table was used to estimate cumulative retention rate and Cox proportional hazard model was used to determine the influencing factors of ART discontinuation. The percentage and incidence rate of discontinuation were 25.1% (1 092/4 354) and 14.53 per 100 person-years among patients who initiated ART from 2012 to 2015 in Wenshan prefecture. ART retention rates were 88%, 83%, 78%, 74% at 6(th) month, 12(th) month, 18(th) month, 24(th) month, respectively. The multivariate Cox proportional hazard regression model showed that male patients were at a higher risk of discontinuation (=1.24, 95% 1.09-1.41) than female patients, patients aged ≥50 years were at a higher risk of discontinuation (=1.27, 95% 1.06-1.53) than patients aged<30 years, discontinuation hazard among patients who were unmarried or divorced or widowed was 1.30 times (:1.30, 95% 1.14-1.48) as patients who were married or cohabitation, discontinuation hazard among patients infected with HIV through injection drug use (IDU) was 1.49 times (:1.49, 95% 1.23-1.82) as those infected through heterosexual transmission, patients with a baseline CD4 cell count350/μl (=1.34, 95% 1.13-1.58) or ≥500/μl (=1.36, 95% 1.09-1.71) were at a higher risk of discontinuation than those with a baseline CD4 cell count from 350/μl to 500/μl, patients initiating ART in 2014 (=1.25, 95% 1.04-1.50) or in 2015 (=1.26, 95% 1.02-1.55) were at a higher risk of discontinuation than those initiating ART in 2012. There is an uptrend for ART discontinuation rate in Wenshan prefecture. Male, 50 years or older, unmarried or divorced or widowed, transmission route as IDU, baseline CD4 count 350/μl or ≥500/μl are risk factors of ART discontinuation.
为了解云南省文山州2012年至2015年开始接受抗逆转录病毒治疗（ART）的HIV感染患者中ART停药率及其影响因素。收集了文山州2012年至2015年开始接受ART的4354例患者的人口学特征、ART基线信息、初始治疗方案及随访情况。采用历史性队列研究描述ART停药发生率，用寿命表估计累积保留率，用Cox比例风险模型确定ART停药的影响因素。文山州2012年至2015年开始接受ART的患者中，停药百分比和发生率分别为25.1%（1092/4354）和每100人年14.53例。第6个月、12个月、18个月、24个月的ART保留率分别为88%、83%、78%、74%。多因素Cox比例风险回归模型显示，男性患者停药风险高于女性患者（=1.24，95%可信区间1.09 - 1.41），年龄≥50岁患者停药风险高于年龄<30岁患者（=1.27，95%可信区间1.06 - 1.53），未婚、离异或丧偶患者停药风险是已婚或同居患者的1.30倍（=1.30，95%可信区间1.14 - 1.48），通过注射吸毒感染HIV（IDU）患者的停药风险是通过异性传播感染患者的1.49倍（=1.49，95%可信区间1.23 - 1.82），基线CD4细胞计数<350/μl（=1.34，95%可信区间1.13 - 1.58）或≥500/μl（=1.36，95%可信区间1.09 - 1.71）的患者停药风险高于基线CD4细胞计数在350/μl至500/μl之间的患者，2014年（=1.25，95%可信区间1.04 - 1.50）或2015年开始接受ART的患者停药风险高于2012年开始接受ART的患者。文山州ART停药率呈上升趋势。男性、50岁及以上、未婚或离异或丧偶、传播途径为IDU、基线CD4计数<350/μl或≥500/μl是ART停药的危险因素。
