广西接受抗病毒治疗的老年HIV/AIDS患者死亡和脱失情况及其影响因素分析
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摘要
目的调查分析广西老年HIV/AIDS病例抗病毒治疗后的死亡和脱失情况,并分析其影响因素。方法数据来源于"国家艾滋病抗病毒治疗信息系统",由广西105家抗病毒治疗机构收集后上报至该系统。分析截至2015年6月广西启动抗病毒治疗的老年HIV/AIDS病例死亡率和脱失率,采用COX回归模型分析死亡和脱失的影响因素。结果共调查研究对象20 467例,死亡率为4.69/100人年。女性的死亡风险较低(AHR=0.56, 95%CI:0.51-0.62)。以未婚为参照,已婚或同居的死亡风险较低(AHR=0.77, 95%CI:0.62-0.96)。启动治疗时CD4计数大于200/μL者的死亡风险较低(200～349/μL, AHR=0.74, 95%CI:0.67-0.82; 350～499/μL, AHR=0.46, 95%CI:0.35-0.60;≥500/μL,AHR=0.37, 95%CI:0.21-0.64)。2012—2015年启动抗病毒治疗者死亡风险较低(AHR=0.72, 95%CI:0.63-0.82)。WHO分期为3/4期者死亡风险较高(AHR=1.96, 95%CI:1.80-2.14)。研究对象脱失率为11.67/100人年。女性(AHR=0.79, 95%CI:0.75-0.84)、已婚或同居者(AHR=0.70, 95%CI:0.62-0.80)脱失风险较低;经静脉注射吸毒感染(AHR=1.73, 95%CI:1.32-2.27)、 WHO分期为3/4期(AHR=1.17, 95%CI:1.11-1.23)、 2009—2011年启动抗病毒治疗(AHR=1.35, 95%CI:1.22-1.49)、 2012—2015年启动抗病毒治疗(AHR=1.33, 95%CI:1.20-1.47)者脱失风险较高。结论老年HIV/AIDS病例应尽早启动抗病毒治疗,并制定针对性干预措施,提升抗病毒治疗服务质量,提高治疗依从性。
Objective To investigate the mortality rate and attrition rate of elderly HIV/AIDS patients(≥50)who initiated highly active antiretroviral therapy(HAART)and the risk factors.Methods Data was collected from 105 antiretroviral treatment sites in Guangxi and reported to the National AIDS Comprehensive Prevention and Control Information System.Analysis of mortality and attrition rate for elderly HIV/AIDS cases initiated by antiviral therapy in Guangxi was as of June 2015.COX regression model was conducted to analyze the risk factors that influenced the mortality rate and attrition rate after the initiation of HAART.Results A total of 20 467 elderly HIV/AIDS patients were enrolled in this study.The mortality rate was 4.69/100 person year.Female had lower risk(AHR =0.56,95% CI:0.51-0.62).Compared to the unmarried patients,married or cohabi tated patients had lower risk(AHR =0.77,95% CI :0.62-0.96).Patients initiated HAART with CD4 count>200/μL had lower risk of death( 200 ～ 349/μL,AHR=0.74,95%CI:0.67-0.82;350～499/μL,AHR =0.46,95% CI:0.35-0.60; ≥500/μL,AHR =0.37,95%CI:0.21-0.64).Patients who were initiated the treatments during 2012-2015(AHR=0.72,95%CI:0.63-0.82)were associated with lower risk of death.Patients initiated HAART with WHO clinic stage 3/4(AHR =1.96,95% CI:1.80-2.14)was associated with higher risk of death.The attrition rate was 11.67/100 person year.Female(AHR=0.79,95%CI:0.75-0.84),married or cohabitation(AHR =0.70,95% CI:0.62-0.80)were associated with lower attrition rate;in fection via intravenous drug use(AHR =1.73,95% CI:1.32-2.27),WHO clinic stage 3/4(AHR =1.17,95% CI:1.11-1.23),initiated the treatment during 2009-2011,2012-2015(AHR =1.35,95% CI:1.22-1.49;AHR =1.33,95% CI:1.20-1.47)were associated with higher attrition rate.Conclusion For better management of elderly HIV/AIDS patients,HAART treatment should be started as earlier as possible,develop the targeted interventions,improve the quality of HAART services and increase their adherence.
Objective To investigate the mortality rate and attrition rate of elderly HIV/AIDS patients(≥50)who initiated highly active antiretroviral therapy(HAART)and the risk factors.Methods Data was collected from 105 antiretroviral treatment sites in Guangxi and reported to the National AIDS Comprehensive Prevention and Control Information System.Analysis of mortality and attrition rate for elderly HIV/AIDS cases initiated by antiviral therapy in Guangxi was as of June 2015.COX regression model was conducted to analyze the risk factors that influenced the mortality rate and attrition rate after the initiation of HAART.Results A total of 20 467 elderly HIV/AIDS patients were enrolled in this study.The mortality rate was 4.69/100 person year.Female had lower risk(AHR =0.56,95% CI:0.51-0.62).Compared to the unmarried patients,married or cohabi tated patients had lower risk(AHR =0.77,95% CI :0.62-0.96).Patients initiated HAART with CD4 count>200/μL had lower risk of death( 200 ～ 349/μL,AHR=0.74,95%CI:0.67-0.82;350～499/μL,AHR =0.46,95% CI:0.35-0.60; ≥500/μL,AHR =0.37,95%CI:0.21-0.64).Patients who were initiated the treatments during 2012-2015(AHR=0.72,95%CI:0.63-0.82)were associated with lower risk of death.Patients initiated HAART with WHO clinic stage 3/4(AHR =1.96,95% CI:1.80-2.14)was associated with higher risk of death.The attrition rate was 11.67/100 person year.Female(AHR=0.79,95%CI:0.75-0.84),married or cohabitation(AHR =0.70,95% CI:0.62-0.80)were associated with lower attrition rate;in fection via intravenous drug use(AHR =1.73,95% CI:1.32-2.27),WHO clinic stage 3/4(AHR =1.17,95% CI:1.11-1.23),initiated the treatment during 2009-2011,2012-2015(AHR =1.35,95% CI:1.22-1.49;AHR =1.33,95% CI:1.20-1.47)were associated with higher attrition rate.Conclusion For better management of elderly HIV/AIDS patients,HAART treatment should be started as earlier as possible,develop the targeted interventions,improve the quality of HAART services and increase their adherence.
引文
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[9]郑武,笪琴,汤恒,等.湖北省接受艾滋病抗病毒治疗的老年患者生存情况分析[J].实用预防医学, 2018,25(2):176-180.
[10]郭小茜.不同年龄成人艾滋病病毒感染者的抗病毒治疗效果分析[D].北京:中国疾病预防控制中心, 2017.
[11] Stafford KA,Magder LS,Hungerford LL,et al.Immunologic response to antiretroviral therapy by age among treatment-naive patients in Sub-Saharan Africa[J].AIDS,2018,32(1):25-34.
[12] Lay P,An S,Soeung S,et al.Ten year experience with antiretroviral treatment in Cambodia:Trends in patient characteristics and treatment outcomes[J].PLoS One,2017,12(11):e0185348.
[13] Ssebutinde P,Kyamwanga IT,Turyakira E,et al.Effect of age at initiation of antiretroviral therapy on treatment outcomes;A retrospective cohort study at a large HIV clinic in southwestern Uganda[J].PLoS One,2018,13(8):e0201898.
[14] Ahn MY,Jiamsakul A,Khusuwan S,et al.The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV[J].J Int AIDS Soc,2019,22(2):e25228.
[15] Savasi V,Parisi F,Oneta M,et al.Effects of highly active antiretroviral therapy on semen parameters of a cohort of 770 HIV-1 infected men[J].PLoS One,2019,14(2):e0212194.
[2]王丽艳,秦倩倩,葛琳,等.我国50岁及以上艾滋病病毒感染者/艾滋病患者特征分析[J].中华流行病学杂志, 2016, 37(2):222-226.
[3]王丽艳,秦倩倩,丁正伟,等.中国艾滋病全国疫情数据分析[J].中国艾滋病性病, 2017, 23(4):330-333.
[4]孟琴,沈智勇,刘玄华,等.广西2008—2016年≥50岁HIV/AIDS病人的特征分析[J].中国艾滋病性病,2018, 24(4):341-344.
[5]罗雅凌,廖清华,杨晴,等.1994—2013年江西省艾滋病死亡报告病例分析[J].中国慢性病预防与控制, 2015, 23(2):155-156.
[6]曾小妹,陈言,莫少雄,等.海南省2011—2015年艾滋病病例报告情况分析[J].中国皮肤性病学杂志,2018, 32(10):1172-1176.
[7] Bernard C,Balestre E,Coffie PA,et al.Aging with HIV:what effect on mortality and loss to fol low-up in the course of antiretroviral therapy?The IeDEA West Africa Cohort Collaboration[J].HIV AIDS(Auckl),2018,10:239-252.
[8]欧松,邓晓军,蒋华宝,等.老年艾滋病抗病毒治疗临床疗效观察[J].现代医药卫生, 2017(8):1133-1135.
[9]郑武,笪琴,汤恒,等.湖北省接受艾滋病抗病毒治疗的老年患者生存情况分析[J].实用预防医学, 2018,25(2):176-180.
[10]郭小茜.不同年龄成人艾滋病病毒感染者的抗病毒治疗效果分析[D].北京:中国疾病预防控制中心, 2017.
[11] Stafford KA,Magder LS,Hungerford LL,et al.Immunologic response to antiretroviral therapy by age among treatment-naive patients in Sub-Saharan Africa[J].AIDS,2018,32(1):25-34.
[12] Lay P,An S,Soeung S,et al.Ten year experience with antiretroviral treatment in Cambodia:Trends in patient characteristics and treatment outcomes[J].PLoS One,2017,12(11):e0185348.
[13] Ssebutinde P,Kyamwanga IT,Turyakira E,et al.Effect of age at initiation of antiretroviral therapy on treatment outcomes;A retrospective cohort study at a large HIV clinic in southwestern Uganda[J].PLoS One,2018,13(8):e0201898.
[14] Ahn MY,Jiamsakul A,Khusuwan S,et al.The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV[J].J Int AIDS Soc,2019,22(2):e25228.
[15] Savasi V,Parisi F,Oneta M,et al.Effects of highly active antiretroviral therapy on semen parameters of a cohort of 770 HIV-1 infected men[J].PLoS One,2019,14(2):e0212194.