| 陈方方,王岚,金杉杉,徐芳,王璐.河南省驻马店市2008-2014年艾滋病单阳家庭抗病毒治疗原阳者死亡率及影响因素分析[J].中华流行病学杂志,2016,37(7):955-959 |
| 河南省驻马店市2008-2014年艾滋病单阳家庭抗病毒治疗原阳者死亡率及影响因素分析 |
| Mortality rate and influencing factors among index partners of HIV discordant couples in the context of antiretroviral therapy, Zhumadian, Henan province, 2008-2014 |
| 收稿日期:2016-04-20 出版日期:2016-07-15 |
| DOI：10.3760/cma.j.issn.0254-6450.2016.07.010 |
| 中文关键词: 艾滋病 单阳家庭 原阳者 抗病毒治疗 死亡率 生存分析 |
| 英文关键词: AIDS HIV discordant couple Index partner Antiretroviral therapy Mortality rate Survival analysis |
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| 中文摘要: |
| 目的 了解河南省驻马店市单阳家庭中接受抗病毒治疗原阳者的生存状况及其影响因素。方法 采用2008-2014年开展的开放式、前瞻性队列研究，每年随访一次，收集当地单阳家庭治疗原阳者的人口学特征、CD4+T淋巴细胞（CD4）、病毒载量、艾滋病相关症状、治疗启动日期、治疗机构级别、治疗方案等信息，以及随访期间的死亡结局，用寿命表法计算生存率，Cox比例风险模型分析死亡率的影响因素。结果 2008-2014年间接受过抗病毒治疗的4 196例原阳者中，350例发生死亡，死亡率为1.88/100人年（95%CI：1.86/100人年～1.90/100人年）。随访第1～7年的生存率依次为99.64%、97.70%、95.62%、93.54%、91.25%、86.86%和82.36%。年龄在≥50岁（HR=3.48，95%CI：2.67～4.55）、初中及以上文化程度（HR=0.75，95%CI：0.56～1.00）、基线CD4水平在350个/μl以上（HR=0.55，95%CI：0.42～0.72）、基线病毒载量水平在400拷贝/ml以上者（HR=1.71，95%CI：1.32～2.22）和既往启动治疗者（HR=0.65，95%CI：0.41～1.05）是单阳家庭治疗原阳者生存状况的影响因素。结论 驻马店市单阳家庭治疗原阳者的死亡率较低，整体治疗效果较好；在治疗条件下，需进一步识别并控制影响治疗者生存的关键因素，提高治疗的及时性和依从性，使治疗者维持在较高的免疫水平，尤其要关注早期治疗、长期治疗者可能发生的耐药、治疗失败等不良事件。 |
| 英文摘要: |
| Objective To analyze the mortality rate in index partners of HIV discordant couples in the context of antiretroviral therapy and related factors in Zhumadian, Henan province. Methods An open and prospective cohort survey was conducted annually during 2008-2014. Information about the index partners'demographic characteristics, CD4+T (CD4) cell counts, viral load, AIDS-related syndromes, date of therapy initiation, level of treatment institution, and outcome of death were collected. Life table was used to calculate survival rate, and Cox proportional hazards model was used to analyze the mortality related factors. Results Among 4 196 index partners receiving antiretroviral therapy between 2008 and 2014, 350 were fatal, with the mortality rate of 1.88 per 100 person years (95%CI:1.86-1.90). The survival rates of these patients with the duration of follow-up from 1 to 7 years were 99.64%, 97.70%, 95.62%, 93.54%, 91.25%, 86.86% and 82.36% respectively. Factors related to the survival of the index partners of HIV discordant couples were age≥50 years (HR=3.48, 95%CI:2.67-4.55), junior high school or above education level (HR=0.75, 95%CI:0.56-1.00), baseline CD4 cell counts>350 cells per μl (HR=0.55, 95%CI:0.42-0.72), baseline viral load>400 copies/ml (HR=1.71, 95%CI:1.32-2.22) and initiating treatment prior to cohort entry (HR=0.65, 95%CI:0.41-1.05). Conclusions The mortality rate of index partners receiving antiretroviral therapy was relatively low, indicating a better effect of long-term treatment on patients'survival. It is necessary to further identify and control the key factors influencing the survival of patients receiving therapy, improve the timeliness and adherence of the treatment, keeping patients' immunity level. Meanwhile, much attention should be paid to the drug resistance due to long term treatment and treatment failure. |
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