PLWHA 接受联合抗逆转录病毒治疗的生存分析：探索长期预后和影响因素。
Survival analysis of PLWHA undergoing combined antiretroviral therapy: exploring long-term prognosis and influencing factors.
机构信息
Department of Infectious Disease, The People's Hospital of Dazu District, Chongqing, China.
The First Clinical College, Chongqing Medical University, Chongqing, China.
出版信息
Front Public Health. 2024 Feb 22;12:1327264. doi: 10.3389/fpubh.2024.1327264. eCollection 2024.
INTRODUCTION
The survival time of human immunodeficiency virus (HIV)-infected individuals or patients with acquired immunodeficiency syndrome (AIDS) is influenced by multiple factors. Studying survival and influential factors after antiretroviral therapy (ART) contributes to improving treatment protocols, management strategies, and prognosis for people living with HIV/AIDS (PLWHA).
METHODS
This retrospective cohort study collected case data and follow-up records of PLWHA who received ART in Dazu District, Chongqing City, between 2007 and 2022. Cumulative survival rates were calculated using life tables. Survival curves were plotted using the Kaplan-Meier method. Uni-variable and multivariable Cox proportional hazards models analyzed factors influencing survival.
RESULTS
The study included 5,237 PLWHA receiving ART. Within the first year of ART initiation, 146 AIDS-related deaths occurred, accounting for 29.49% (146/495) of total deaths. Cumulative survival rates at 1, 5, 10, and 15 years were 0.97, 0.90, 0.85, and 0.79, respectively. During the observation period, male patients who received ART had a 1.89 times higher risk of death compared to females (aHR, 1.89; 95%; CI, 1.50-2.37). Patients aged ≥60 years had a 3.44-fold higher risk of death than those aged <30 years (aHR, 3.44; 95% CI, 1.22-9.67). Injection drug users (aHR, 4.95; 95% CI, 2.00-12.24) had a higher risk of death than those with heterosexual (aHR, 1.60; 95% CI, 0.69-3.72) and homosexual transmission. Patients with a baseline CD4+ T lymphocyte count <200 cells/μL (aHR, 8.02; 95% CI, 4.74-13.57) and between 200 and 349 cells/μL (aHR, 2.14; 95% CI, 1.26-3.64) had a higher risk of death than those with ≥350 cells/μL. Patients with ART initiation at WHO clinical stage IV had a 2.48-fold higher risk of death than those at stage I (aHR, 2.48; 95% CI, 1.17-5.23).
CONCLUSION
The first year following ART initiation is critical in HIV/AIDS treatment, emphasizing the need for intensified follow-up and monitoring to facilitate successful immune system reconstruction. Older age, male sex, injection drug use, baseline CD4+ T lymphocyte count <200 cells/μL, and WHO clinical stage IV are associated with an increased risk of death. Tailored treatment and management strategies should be implemented for patient populations at higher risk of mortality and with a poorer prognosis.
简介
人类免疫缺陷病毒（HIV）感染者或获得性免疫缺陷综合征（AIDS）患者的生存时间受多种因素影响。研究抗逆转录病毒治疗（ART）后的生存和影响因素有助于改善 HIV/AIDS 患者（PLWHA）的治疗方案、管理策略和预后。
方法
本回顾性队列研究收集了 2007 年至 2022 年在重庆市大足区接受 ART 的 PLWHA 的病例数据和随访记录。使用生命表计算累积生存率。使用 Kaplan-Meier 方法绘制生存曲线。单变量和多变量 Cox 比例风险模型分析了影响生存的因素。
结果
本研究纳入了 5237 名接受 ART 的 PLWHA。在 ART 启动后的第一年，有 146 例 AIDS 相关死亡，占总死亡人数的 29.49%（146/495）。1、5、10 和 15 年的累积生存率分别为 0.97、0.90、0.85 和 0.79。在观察期间，与女性相比，男性接受 ART 的患者死亡风险高 1.89 倍（aHR，1.89；95%CI，1.50-2.37）。年龄≥60 岁的患者死亡风险比年龄<30 岁的患者高 3.44 倍（aHR，3.44；95%CI，1.22-9.67）。与异性恋（aHR，1.60；95%CI，0.69-3.72）和同性恋传播相比，注射吸毒者（aHR，4.95；95%CI，2.00-12.24）的死亡风险更高。基线 CD4+T 淋巴细胞计数<200 个/μL（aHR，8.02；95%CI，4.74-13.57）和 200-349 个/μL（aHR，2.14；95%CI，1.26-3.64）的患者死亡风险高于基线 CD4+T 淋巴细胞计数≥350 个/μL 的患者。与 I 期相比，WHO 临床分期 IV 期开始 ART 的患者死亡风险高 2.48 倍（aHR，2.48；95%CI，1.17-5.23）。
结论
ART 启动后的第一年是 HIV/AIDS 治疗的关键时期，强调需要加强随访和监测，以促进成功的免疫系统重建。年龄较大、男性、注射吸毒、基线 CD4+T 淋巴细胞计数<200 个/μL 和 WHO 临床分期 IV 与死亡风险增加相关。应针对死亡率较高和预后较差的患者人群实施有针对性的治疗和管理策略。
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