Zhang N, Zhu X Y, Wang G Y, Tao X R, Wang N, Kang D M
Institute for AIDS Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, China.
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2019 Jan 10;40(1):74-78. doi: 10.3760/cma.j.issn.0254-6450.2019.01.015.
To understand the survival status and influencing factors for HIV/AIDS patients on highly active anti-retroviral therapy (HAART) in Shandong province. Both Kaplan-Meier (K-M) method and cumulative incidence function (CIF) were used to calculate the cumulative incidence of AIDS-related death respectively, and Fine-Gray model was used to identify the influencing factors related to survival time. Through K-M method, a higher AIDS-related cumulated death rate than the CIF, was estimated. Among all the HIV/AIDS patients who initiated HAART from 2003 to 2015 in Shandong, 5 593 of them met the inclusion criteria. The cumulative incidence rate for AIDS-related death was 3.08 in 1 year, 4.21 in 3 years, 5.37 in 5 years, and 7.59 in 10 years respectively by CIF. Results from the F-G analysis showed that HIV/AIDS patients who were on HAART, the ones who had college degree or above (=0.40, 95: 0.24-0.65) were less likely to die of AIDS-associated diseases. However, HIV/AIDS patients who were on HAART and living in the western areas of Shandong (=1.33, 95: 1.01-1.89), diagnosed by medical institutions (=1.39, 95: 1.06-1.80), started to receive care ≥1 year after diagnosis (=2.02, 95: 1.30-3.15), their CD(4) cell count less than 200 cells/μl (=3.41, 95: 2.59-4.59) at the time of diagnosis, with NVP in antiviral treatment (ART) regime (=1.36, 95: 1.03-1.88), at Ⅲ/Ⅳ clinical stages (=2.61, 95: 1.94-3.53) and CD(4) cell count less than 350 cells/μl (=5.48,95: 2.32-12.72) at initiation of HAART ., were more likely to die of AIDS-associated diseases. With the existence of competing risks, the cumulative incidence rate for AIDS-related death was overestimated by K-M, suggesting that competing risk models should be used in the survival analysis. Measures as early diagnoses followed by timely care and early HAART could end up with the reduction of AIDS-related death.
为了解山东省接受高效抗逆转录病毒治疗(HAART)的HIV/AIDS患者的生存状况及影响因素。分别采用Kaplan-Meier(K-M)法和累积发病率函数(CIF)计算艾滋病相关死亡的累积发病率,并采用Fine-Gray模型识别与生存时间相关的影响因素。通过K-M法估计的艾滋病相关累积死亡率高于CIF法。在2003年至2015年期间在山东开始接受HAART治疗的所有HIV/AIDS患者中,有5593例符合纳入标准。采用CIF法计算的艾滋病相关死亡累积发病率1年为3.08,3年为4.21,5年为5.37,10年为7.59。F-G分析结果显示,接受HAART治疗的HIV/AIDS患者中,具有大专及以上学历者(=0.40,95%CI:0.24-0.65)死于艾滋病相关疾病的可能性较小。然而,接受HAART治疗且居住在山东西部地区(=1.33,95%CI:1.01-1.89)、由医疗机构诊断(=1.39,95%CI:1.06-1.80)、诊断后≥1年开始接受治疗(=2.02,95%CI:1.30-3.15)、诊断时CD(4)细胞计数<200个/μl(=3.41,95%CI:2.59-4.59)、抗病毒治疗(ART)方案中使用奈韦拉平(NVP)(=1.36,95%CI:1.03-1.88)、处于Ⅲ/Ⅳ临床分期(=2.61,95%CI:1.94-3.53)以及开始HAART治疗时CD(4)细胞计数<350个/μl(=5.48,95%CI:2.32-12.72)的HIV/AIDS患者,死于艾滋病相关疾病的可能性更大。由于存在竞争风险,K-M法高估了艾滋病相关死亡的累积发病率,提示在生存分析中应使用竞争风险模型。早期诊断并及时治疗以及尽早开始HAART治疗等措施可降低艾滋病相关死亡。