接受艾滋病病毒感染综合治疗的患者的治疗留存率和死亡率趋势：一项回顾性队列研究。
Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study.
作者信息
Ulloa Ana C, Puskas Cathy, Yip Benita, Zhang Wendy, Stanley Cole, Stone Sarah, Pedromingo Miguel, Lima Viviane Dias, Montaner Julio S G, Guillemi Silvia, Barrios Rolando
机构信息
BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC.
BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
出版信息
CMAJ Open. 2019 Apr 12;7(2):E236-E245. doi: 10.9778/cmajo.20180136. Print 2019 Apr-Jun.
BACKGROUND
Studies examining the relation between comprehensive care and health outcomes associated with comorbidities unrelated to HIV infection have focused mainly on the health outcomes of HIV-infected people and comorbid substance use disorders. We aimed to assess the impact of retention in comprehensive HIV infection care on overall, AIDS-related and non-AIDS-related mortality.
METHODS
Using a retrospective cohort design, we collected data for HIV-infected patients aged 19 years or more who first visited a comprehensive HIV infection clinic in Vancouver between Jan. 1, 2004, and Dec. 31, 2014. We defined retention in care as visit constancy (whether the patient attended the clinic at least once per given period) of 75% or greater. We used Poisson regression modelling to examine mortality trends. We performed Cox proportional hazards modelling to assess survival by retention during the first year of follow-up and identify factors associated with death.
RESULTS
A total of 2101 patients were included in the study. Of the 2101, 1340 (63.8%) were retained in the first year of care, and 271 (12.9%) died during the study period. Among the 264 cases in which the cause of death was known, although the primary underlying cause of death (74 [28.0%]) was AIDS-related, half of all AIDS-related deaths (37/74 [50%]) occurred early in the study (2004-2007). In later years, most deaths (147/184 [79.9%]) were non-AIDS-related. Overall mortality was significantly reduced among patients with higher retention in care during the first year of follow-up (per 20% increase in visit constancy; adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.79-0.96). Higher retention was also associated with reduced risk of AIDS-related death (adjusted HR 0.79, 95% CI 0.64-0.97).
INTERPRETATION
Although there was an overall trend toward decreased AIDS-related mortality over time, retention in care markedly decreased the likelihood of death. Maintaining patient engagement in comprehensive ancillary care is a patient-centred way of decreasing mortality rates among HIV-infected people.
背景
研究综合护理与未感染HIV的合并症相关健康结局之间关系的研究主要集中在HIV感染者的健康结局和合并物质使用障碍方面。我们旨在评估持续接受HIV综合感染护理对总体、艾滋病相关和非艾滋病相关死亡率的影响。
方法
采用回顾性队列设计，我们收集了2004年1月1日至2014年12月31日期间首次前往温哥华一家HIV综合感染诊所就诊的19岁及以上HIV感染者的数据。我们将持续接受护理定义为就诊稳定性（患者在给定时间段内是否至少就诊一次）达到75%或更高。我们使用泊松回归模型来研究死亡率趋势。我们进行了Cox比例风险模型分析，以评估随访第一年持续接受护理情况与生存情况，并确定与死亡相关的因素。
结果
共有2101名患者纳入研究。在这2101名患者中，1340名（63.8%）在护理的第一年持续接受护理，271名（12.9%）在研究期间死亡。在已知死因的264例病例中，尽管主要潜在死因（74例[28.0%]）与艾滋病相关，但所有艾滋病相关死亡病例的一半（37/74[50%]）发生在研究早期（2004 - 2007年）。在随后几年中，大多数死亡（147/184[79.9%]）与非艾滋病相关。在随访的第一年，持续接受护理程度较高的患者总体死亡率显著降低（就诊稳定性每增加20%；调整后的风险比[HR]为0.87，95%置信区间[CI]为0.79 - 0.96）。持续接受护理程度较高也与艾滋病相关死亡风险降低相关（调整后的HR为0.79，95%CI为0.64 - 0.97）。
解读
尽管随着时间推移艾滋病相关死亡率总体呈下降趋势，但持续接受护理显著降低了死亡可能性。保持患者参与综合辅助护理是以患者为中心降低HIV感染者死亡率的一种方式。
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