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[2002年至2017年河南省接受抗逆转录病毒治疗的既往血浆捐献者感染艾滋病毒/艾滋病后的生存分析]

[Survival analysis on Former Plasma Donors living with HIV/AIDS after initiation of antiretroviral therapy in Henan province, 2002-2017].

作者信息

Liang Y, Yang W J, Sun D Y, Li N, Wang Z

机构信息

Institute for AIDS/STD Prevention and Cure, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.

出版信息

Zhonghua Liu Xing Bing Xue Za Zhi. 2019 Jun 10;40(6):638-642. doi: 10.3760/cma.j.issn.0254-6450.2019.06.007.

Abstract

To explore the survival status and influencing factors on former plasma donors (FPD) living with HIV/AIDS after initiation of antiretroviral therapy (ART) during 2002-2017 in Henan province. A retrospective study was conducted, using data from the ART database of national comprehensive HIV/AIDS information system. The inclusion criteria on patients would include HIV/AIDS cases with current residence in Henan province, route of infection being blood-borne (plasma collection), initiation of ART between 2002 and 2017, and 15 year-olds or above. According to the time of initation on antiviral treatment, observation was carried on between January 1, 2002 and December 31, 2017. Outcome of observation was defined as death caused by AIDS or related diseases. Life Table was used to estimate the survival rate and Kaplan-Meier method was used to draw the survival curve. Log-rank test was used to compare the univariate intergroup survival rates while Cox proportional hazards regression model was used to analyze the influencing factors on survival status among deaths due to AIDS or related diseases. Excel 2010 software and SPSS 23.0 software was used for data cleaning and statistical analysis. A total of 25 825 HIV/AIDS patients were enrolled in this study. During the follow-up period, the overall mortality was 3.9/100 person year (8 354/214 796.3), among all the patients. The accumulate survival rates of 1 year, 4 years, 8 years, 12 years and 16 years after the initiation of ART were 91.2%, 80.1%, 71.2%, 65.7% and 61.5%, respectively. The results from the multivariate Cox proportional hazards regression model analysis showed that male . female (a=1.46, 95: 1.39-1.53); aged 45-49 years group and aged 60 and older years group of initiating ART . aged 15-44 years group of initiating ART respectively (a=1.47, 95: 1.40-1.54; a=2.50, 95: 2.22-2.81); other marital status . being married or under cohabitation (a=1.29, 95: 1.21-1.36); baseline CD(4)(+)T cells counts (CD(4))<50, 50-199 and 200-349 cells/μl respectively . baseline CD(4)≥350 cells/μl (a=4.50, 95: 4.14- 4.89; a=2.49, 95: 2.31-2.69; a=1.44, 95: 1.33-1.56); number of opportunistic infections at baseline were one case, 2-3 cases and 4-5 cases respectively . non opportunistic infections cases at baseline (a=1.17, 95: 1.06-1.29; a=1.47, 95: 1.35-1.59; a=1.74, 95: 1.60-1.89); taking TMP-SMZ . not taking TMP-SMZ (a=0.69, 95: 0.65- 0.73). The 16-year accumulate survival rate was 61.5% among FPD living with HIV/AIDS after initiation of ART, during 2002 to 2017 in Henan province. The risk factors for FPD death case would include: being males, aged 45 and older years at the initiation of ART, baseline CD(4)<350 cells/μl and the number of baseline opportunistic infections cases ≥1. The protective factors on FPD death appeared as: being married or cohabited as wel as on TMP-SMZ.

摘要

为探究2002年至2017年期间河南省接受抗逆转录病毒治疗(ART)的既往血浆捐献者(FPD)感染艾滋病毒/艾滋病后的生存状况及影响因素。进行了一项回顾性研究,使用国家综合艾滋病毒/艾滋病信息系统的ART数据库中的数据。纳入患者的标准包括现居住在河南省的艾滋病毒/艾滋病病例、血液传播(血浆采集)感染途径、2002年至2017年开始接受ART治疗且年龄在15岁及以上。根据开始抗病毒治疗的时间,观察时间为2002年1月1日至2017年12月31日。观察结局定义为艾滋病或相关疾病导致的死亡。采用生命表估计生存率,采用Kaplan-Meier方法绘制生存曲线。采用对数秩检验比较单因素组间生存率,采用Cox比例风险回归模型分析艾滋病或相关疾病死亡患者生存状况的影响因素。使用Excel 2010软件和SPSS 23.0软件进行数据清理和统计分析。本研究共纳入25825例艾滋病毒/艾滋病患者。在随访期间,所有患者的总死亡率为3.9/100人年(8354/214796.3)。ART开始后1年、4年、8年、12年和16年的累积生存率分别为91.2%、80.1%、71.2%、65.7%和61.5%。多因素Cox比例风险回归模型分析结果显示,男性.女性(α=1.46,95%:1.39-1.53);开始ART时年龄在45-49岁组和60岁及以上组.开始ART时年龄在15-44岁组(α=1.47,95%:1.40-1.54;α=2.50,95%:2.22-2.81);其他婚姻状况.已婚或同居(α=1.29,95%:1.21-1.36);基线CD4(+)T细胞计数(CD4)分别<50、50-199和200-349个细胞/μl.基线CD4≥350个细胞/μl(α=4.50,95%:4.14-4.89;α=2.49,95%:2.31-2.69;α=1.44,95%:1.33-1.56);基线机会性感染病例数分别为1例、2-3例和4-5例.基线无机会性感染病例(α=1.17,95%:1.06-1.29;α=1.47,95%:1.35-1.59;α=1.74,95%:1.60-1.89);服用复方磺胺甲恶唑.未服用复方磺胺甲恶唑(α=0.69,95%:0.65-0.73)。2002年至2017年期间河南省接受ART治疗的FPD感染艾滋病毒/艾滋病后的16年累积生存率为61.5%。FPD死亡病例的危险因素包括:男性、开始ART时年龄在45岁及以上、基线CD4<350个细胞/μl以及基线机会性感染病例数≥1。FPD死亡的保护因素包括:已婚或同居以及服用复方磺胺甲恶唑。

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