| 程文,张奥迪,杨柏林,陈积标,尹寒露,顾静,许祝平,孟晓军.基于社会组织的随访管理对HIV感染者抗病毒治疗和生存结局影响的回顾性队列研究[J].中华流行病学杂志,2026,47(2):307-314 |
| 基于社会组织的随访管理对HIV感染者抗病毒治疗和生存结局影响的回顾性队列研究 |
| A retrospective cohort study of impact of follow-up management based on social organization on antiretroviral therapy and survival outcomes of people infected with HIV |
| 收稿日期:2025-07-18 出版日期:2026-02-13 |
| DOI：10.3760/cma.j.cn112338-20250718-00505 |
| 中文关键词: 艾滋病病毒感染者 社会组织 随访管理 死亡率 回顾性队列 |
| 英文关键词: People infected with HIV Social organization Follow-up management Mortality Retrospective cohort |
| 基金项目:无锡市卫生健康委项目（BJ2023097， FZXK2021010） |
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| 中文摘要: |
| 目的 评估基于社会组织的随访管理对HIV感染者抗病毒治疗（ART）和生存结局的影响，为推广此模式提供依据。方法 选取江苏省无锡市2006年1月1日至2023年6月30日诊断的HIV感染者进行回顾性分析。将其中累计接受6个月及以上基于社会组织随访管理的感染者作为暴露组研究对象，通过倾向性评分匹配的方法按照1∶2的比例匹配对照组研究对象。采用Kaplan-Meier方法绘制生存曲线，通过log-rank检验比较两组研究对象之间的生存率差异。采用竞争风险模型分析艾滋病相关死亡和非艾滋病相关死亡的相关因素。结果 共有2 210例HIV感染者纳入分析，其中暴露组741例，对照组1 469例。从入组后的第2年起，暴露组的CD4+T淋巴细胞（CD4）计数均值高于对照组（均P<0.05），暴露组在入组后18个月内的病毒载量抑制率高于对照组（均P<0.05）。暴露组的艾滋病相关死亡率和非艾滋病相关死亡率分别为0.09/100人年和0.13/100人年，低于对照组的0.35/100人年和0.69/100人年（均P<0.05）。暴露组的1、5和10年的累积生存概率分别为99.7%、99.4%、97.4%，高于对照组的97.8%、95.0%、91.4%（χ2=23.67，P<0.001）。竞争风险模型分析结果显示，在HIV感染者中，艾滋病相关死亡风险的负相关因素包括接受基于社会组织的随访管理［亚分布风险比（SHR）=0.31，95%CI：0.10~0.98］、ART依从（SHR=0.02，95%CI：0.01~0.06）、基线CD4计数≥200个/μl（SHR=0.37，95%CI：0.18~0.79）；非艾滋病相关死亡风险的正相关因素为已婚（SHR=2.84，95%CI：1.28~6.31），负相关因素包括接受基于社会组织的随访管理（SHR=0.17，95%CI：0.07~0.41）、ART依从（SHR=0.02，95%CI：0.01~0.04）、检测依从（SHR=0.24，95%CI：0.12~0.46）、高中/中专文化程度（SHR=0.33，95%CI：0.16~0.67）。结论 基于社会组织的随访管理能够改善HIV感染者的ART和生存结局，应加大对该模式的支持和推广力度，让更多的HIV感染者获益。 |
| 英文摘要: |
| Objective To evaluate the impact of follow-up management-based on social organization on the antiretroviral therapy (ART) and survival outcomes of people infected with HIV, and provide evidence for the promotion of the application of this approach. Methods A retrospective analysis was conducted in people infected with HIV in Wuxi, Jiangsu Province, diagnosed between January 1, 2006 and June 30, 2023. Those who had received the social organization-based follow-up management for at least six months were selected as the study participants in exposure group. The study participants in the control group were matched at a ratio of 1∶2 through the propensity score matching method. Kaplan-Meier method was used to draw the survival curves and log-rank test was used to compare the differences in survival rates between the two groups. A competing risk model was used to analyze the associated factors with both AIDS-related and non-AIDS-related deaths. Results A total of 2 210 people infected with HIV were included in our analysis, in whom 741 were in the exposure group and 1 469 were in the control group. From the second year after enrollment, the average counts of CD4+T lymphocytes (CD4) counts were continuously higher in the exposure group than in the control group (all P<0.05). The rates of viral load suppression were significantly higher in the exposure group than in the control group within 18 months after enrollment (all P<0.05). The AIDS-related and non-AIDS-related mortality rates were 0.09/100 person-years (PY) and 0.13/100 PY, respectively, in the exposure group, lower than 0.35/100 PY and 0.69/100 PY in the control group (all P<0.05). The cumulative survival rates of 1, 5 and 10 years were 99.7%, 99.4%, and 97.4% in the exposed group, significantly higher than 97.8%, 95.0%, and 91.4% in the control group (χ²=23.67, P<0.001). Competing risk model analysis showed that negative associated factors for the risk of AIDS-related death in people infected with HIV included receiving social organization- based follow-up management [sub-distribution hazard ratio (SHR)=0.31, 95%CI: 0.10-0.98], ART adherence (SHR=0.02, 95%CI: 0.01-0.06), and baseline CD4 counts ≥200 cells/μl (SHR=0.37, 95%CI:0.18-0.79). For the risk of non-AIDS-related death, positive associated factors involved being married (SHR=2.84, 95%CI: 1.28-6.31), while negative associated factors included receiving social organization-based follow-up management (SHR=0.17, 95%CI: 0.07-0.41), ART adherence (SHR=0.02, 95%CI: 0.01-0.04), testing adherence (SHR=0.24, 95%CI: 0.12-0.46), and education level of high school or secondary vocational school (SHR=0.33, 95%CI: 0.16-0.67). Conclusions The social organization-based follow-up management could improve the ART and survival outcomes of people infected with HIV. More efforts should be made to support and promote the application of this approach to benefit more people infected with HIV. |
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