早期抗病毒治疗对艾滋病患者生存状况的影响

杨文杰; 安伟锋; 马彦民; 李宁; 朱谦; 孙定勇; 黄学勇; 许汴利

Abstract

杨文杰,安伟锋,马彦民,李宁,朱谦,孙定勇,黄学勇,许汴利.早期抗病毒治疗对艾滋病患者生存状况的影响[J].Chinese journal of Epidemiology,2014,35(9):1065-1068

早期抗病毒治疗对艾滋病患者生存状况的影响

Survival effect regarding earlier initiation of antiretroviral treatment on AIDS patients

Received:March 11, 2014

DOI：10.3760/cma.j.issn.0254-6450.2014.09.022

KeyWord: 艾滋病早期抗病毒治疗生存影响

English Key Word: AIDS Earlier initiation of antiretroviral treatment Surviva effect

FundProject:国家科技重大专项（2012ZX10004905）

Author Name	Affiliation	E-mail
Yang Wenjie	The College of Public Health of Zhengzhou University, Zhengzhou 450001, China Henan Provincial Center for Disease Control and Prevention
An Weifeng	Henan Provincial Center for Disease Control and Prevention
Ma Yanmin	Henan Provincial Center for Disease Control and Prevention
Li Ning	Henan Provincial Center for Disease Control and Prevention
Zhu Qian	Henan Provincial Center for Disease Control and Prevention
Sun Dingyong	Henan Provincial Center for Disease Control and Prevention
Huang Xueyong	Henan Provincial Center for Disease Control and Prevention
Xu Bianli	Henan Provincial Center for Disease Control and Prevention	xubl@hncdc.com.cn

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Abstract:

目的比较不同时间开始抗病毒治疗对艾滋病患者生存状况的影响，并探讨抗病毒治疗最佳时机。方法利用国家艾滋病抗病毒治疗信息系统，收集2007－2012年河南省加入抗病毒治疗的艾滋病患者基本和随访信息，并按照基线免疫学水平，将所有研究对象分为早期治疗组（基线CD₄⁺T淋巴细胞计数350～500 cell/μl）和常规治疗组（基线CD₄⁺T淋巴细胞计数≤350 cell/μl），采用生存分析方法进行全死因回顾分析。结果共纳入16 282例艾滋病患者，常规治疗组病死率明显高于早期治疗组（5.78/100人年 vs. 1.64/100人年），中位生存期低于早期治疗组中位生存期（2.07年 vs. 3.15年）。常规治疗组6年累积生存率低于早期治疗组（77.39% vs. 92.10%，χ²=156.00，P<0.01）。多因素分析显示，开始治疗时年龄、性别、婚姻状况、感染途径、初始治疗方案和基线症状数为常规治疗组生存时间的影响因素（P<0.05），开始治疗时的性别、初始治疗方案和基线症状数为早期治疗组生存时间的影响因素（P<0.05）。结论早期抗病毒治疗可提高河南省接受抗病毒治疗的艾滋病患者生存率，延长其生存时间。

English Abstract:

Objective To compare the survival effect of initiation of antiretroviral treatment on AIDS patients at different stages so as to explore the best time of initiation with the treatment. Methods Information regarding the dates of AIDS patient initially receiving the anti-retroviral therapy during 2007-2012 was collected from the Chinese HIV/AIDS Integrated Control System. According to the level of baseline immunology,all the participants were divided into earlier treatment group (baseline CD₄⁺ T cell counts between 350/μl and 500/μl) and conventional treatment group (baseline CD₄⁺T cell counts ≤350/μl). Data was analyzed under Survival and Review methods. Results A total number of 16 282 cases were selected. The mortality of conventional treatment group was obviously higher than the earlier treatment group (5.78/100 person year vs. 1.64/100 person year),and the median survival time was lower than the earlier treatment group (2.07 year vs. 3.15 year). The cumulative survival rate of the 6-year conventional treatment group was lower than the earlier treatment group (77.39% vs. 92.10%,χ²=156.00,P<0.01). By means of multi-variable analysis,we found that factors as age,gender,marital status,route of transmission,schedule on initial therapy,number of symptoms at the baseline etc. in the conventional treatment group were associated with survival time of patients after the ART initiation (P<0.05),while gender,schedule for initial therapy,number of symptoms at baseline etc. in the earlier treatment group,were associated with survival time of patients after the initiation of ART (P<0.05). Conclusion Earlier initiation of antiretroviral treatment on AIDS patients could improve the survival rate and prolong the survival time.

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