文章摘要
豆智慧,张福杰,赵燕,晋灿瑞,赵德才,甘秀敏,马烨.2002-2014年中国免费艾滋病抗病毒治疗进展[J].中华流行病学杂志,2015,36(12):1345-1350
2002-2014年中国免费艾滋病抗病毒治疗进展
Progress on China's national free antiretroviral therapy strategy in 2002-2014
收稿日期:2015-10-15  出版日期:2015-12-15
DOI:10.3760/cma.j.issn.0254-6450.2015.12.005
中文关键词: 艾滋病病毒;高效抗反转录病毒治疗;药物;监测;生存率;病毒学失败率
英文关键词: HIV;Highly active autiretrovial therapy;Drug;Surveillance;Survival rate;Virological failure rate
基金项目:
作者单位E-mail
豆智慧 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
张福杰 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心
首都医科大学附属北京地坛医院 
 
赵燕 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
晋灿瑞 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
赵德才 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
甘秀敏 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心  
马烨 102206 北京, 中国疾病预防控制中心性病艾滋病预防控制中心 maye67@163.com 
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中文摘要:
      目的 分析艾滋病“四免一关怀”政策实施12年来中国免费艾滋病治疗进展特征。方法 采用回顾性队列研究和多次横断面调查分析,从全国艾滋病综合防治信息系统治疗库中收集2002-2014年所有免费艾滋病抗病毒治疗者368 449例,选取其治疗基线信息(开始治疗日期、CD4+T淋巴细胞计数、治疗药物方案)和随访信息[随访日期、CD4+T淋巴细胞(CD4)计数、病毒载量、随访状态],分析治疗进展和效果。结果 共368 449例艾滋病病毒感染者/艾滋病患者(HIV/AIDS)接受治疗。新治例数逐年增长,2010-2014年新治者占70.4%。治疗基线CD4计数<200 cells/μl者和临床诊断AIDS的构成比,从2006年的81.0%降至2014年39.7%。截至2014年底,拉米夫定替换去羟肌苷、依非韦仑替换奈韦拉平、替诺福韦替换司他夫定,这3种药物优化方案的使用率分别为99.5%、75.7%和60.6%。艾滋病治疗与管理由疾病预防控制中心主导平稳转交至医院,治疗县/区占全国县/区的75.4%。每年2次CD4检测比例,2010年以后为75.2%。每年1次病毒载量检测比例,从2010年70.8%增至2014年87.4%。病毒载量检测者病毒学失败率从2010年17.6%降至2014年11.8%。所有接受治疗者1、5、10年生存率分别为92.2%、80.5%和69.6%,其中基线CD4计数<50 cells/μl和>350 cells/μl者1、5、10年生存率分别为81.6%、69.9%、60.9%和97.9%、89.8%、81.0%。结论 我国免费艾滋病抗病毒治疗项目是一个人数规模巨大的动态治疗队列,药物与治疗标准跟进WHO推荐的药物和标准,所有接受治疗者10年生存率为65%。同时,随着治疗人数大幅增长而不断增加的经费、药品、人力需求等,艾滋病抗病毒治疗也面临着严峻的挑战。
英文摘要:
      Objective To analyze the progress and characteristics of China's “Free AIDS treatment strategy” since the implementation of the national “four free and one care” policy against AIDS 12 years ago. Methods Retrospective cohort study and cross-sectional analysis had been conducted in this study. 368 449 cases that had received the ‘free antiviral therapy’ from 2002 to 2014 were selected from the National Treatment Database. Data from the baseline (initial time of ART, CD4 cell count, and antiretroviral regimen) and from the follow-up program (dates and status of follow-up, CD4 cell counts) were gathered and analysed by SAS 9.3. Results The number of cases that having received new treatment was increasing year by year, accounting for 75.4% of all the cases identified from 2010 to 2014. Constituent ratios of patients with baseline CD4 cell count <200 cells/μl and clinical diagnosis of AIDS were decreasing from 81.0% in 2006 to 39.7 % in 2014. Status on drug optimization showed that: 3TC replaced DDI, EFV replaced NVP and TDF replaced D4T, making the utilization rates as 99.5%, 75.7%, and 60.6%, respectively, by 2014. Regions that were covered by the treatment accounted for 75.4% of all the counties/districts involved. The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model. Proportion on the twice-CD4-testing model had been 75.2% since 2010, with the rate of virological detection increased from 70.8% in 2010 to 87.4% in 2014 and the virological unsuccessful testing rate decreased from 17.6% in 2010 to 11.8% in 2014. Among all the patients, the 1, 5 and 10 year survival rates appeared as 92.2%, 80.5% and 69.6%, respectively. For patients with baseline CD4 cell counts as <50 cells/μl or >350 cells/μl, the corresponding survival rates showed as 81.6%, 69.9%, 60.9% and 97.9%, 89.8%, 81.0%, respectively. Conclusion China's HIV/AIDS free anti-retroviral therapy program appeared as a national treatment cohort which involved large number of participants, with new patients joining in, annually. Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO. Management program on treatment had gradually turned to hospital-based, with follow-up and laboratory testing programs guaranteed, ended up with satisfactory treatment effects.
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