Krentz Hartmut B, John Gill M
1 Southern Alberta Clinic, Calgary, Canada.
2 Department of Medicine, University of Calgary, Calgary, Canada.
Int J STD AIDS. 2018 Nov;29(11):1098-1105. doi: 10.1177/0956462418778705. Epub 2018 Jun 22.
Individuals diagnosed with HIV before 1996 had poor prognoses. Few HIV care centers can track patients continuously from the 1980s to present. We determined the sociodemographic, clinical, and health care utilization characteristics of patients diagnosed and followed for >20 years (i.e. long-term HIV/AIDS survivors) to understand what factors contributed to survival. All HIV-positive patients diagnosed before 1996 were categorized as active, moved/lost, or died as of 1 January 2016. Baseline sociodemographic, clinical characteristics, antiretroviral therapy (ART) usage, retention, HIV care costs, and health status were analyzed. Of 876 patients, 49.5% died, 30.3% moved or left, 20.3% remained active in care for a median of 23.4 years. At diagnosis, continuously-followed patients were younger with a higher CD4 cell count, attended regular clinic visits at higher frequencies, and had received more ART than patients who moved or died. As of 1 January 2016, their median age was 57 years (interquartile range 53-62), 15% were aged >65 years, median CD4 cell count was 591 cells/mm (475-863) with 68% >500 cells/mm. Sixty-two percent remained employed. The total cost of HIV care was $32,251,030 (Cdn$); median cost per patient per year $15,418 ($13,697-$18,392). Individuals diagnosed prior to 1996 benefited from early diagnosis and engagement to care, regular follow-ups, and timely initiation of ART, strongly supporting the modern guidelines of care.
1996年以前被诊断出感染艾滋病毒的患者预后较差。很少有艾滋病毒护理中心能够从20世纪80年代开始持续追踪患者至今。我们确定了被诊断并接受超过20年随访的患者（即长期艾滋病毒/艾滋病幸存者）的社会人口统计学、临床和医疗保健利用特征，以了解促成生存的因素。所有在1996年以前被诊断为艾滋病毒阳性的患者截至2016年1月1日被分类为仍在接受治疗、已迁移/失访或死亡。分析了基线社会人口统计学、临床特征、抗逆转录病毒疗法（ART）使用情况、留存率、艾滋病毒护理费用和健康状况。在876名患者中，49.5%死亡，30.3%迁移或离开，20.3%仍在接受治疗，中位治疗时间为23.4年。在诊断时，持续接受随访的患者更年轻，CD4细胞计数更高，更频繁地参加定期门诊就诊，并且比迁移或死亡的患者接受了更多的抗逆转录病毒疗法。截至2016年1月1日，他们的中位年龄为57岁（四分位间距53 - 62岁），15%的患者年龄超过65岁，中位CD4细胞计数为591个细胞/mm³（475 - 863个细胞/mm³），68%的患者CD4细胞计数>500个细胞/mm³。62%的患者仍在就业。艾滋病毒护理的总费用为32251030加元；每位患者每年的中位费用为15418加元（13697 - 18392加元）。1996年以前被诊断的个体受益于早期诊断、参与护理、定期随访以及及时开始抗逆转录病毒疗法治疗，这有力地支持了现代护理指南。
