云南省德宏州成年艾滋病患者抗病毒治疗脱失情况及其原因分析

姚仕堂; 时允; 李品银; 许元武; 杨文芹; 张银娣; 尹春英; 寸柳青; 翟志坚; 何纳; 段松

Abstract

姚仕堂,时允,李品银,许元武,杨文芹,张银娣,尹春英,寸柳青,翟志坚,何纳,段松.云南省德宏州成年艾滋病患者抗病毒治疗脱失情况及其原因分析[J].中华流行病学杂志,2015,36(7):667-671

云南省德宏州成年艾滋病患者抗病毒治疗脱失情况及其原因分析

Study on drop-out from antiretroviral therapy among adult HIV-infected individuals in Dehong prefecture, Yunnan province

投稿时间：2014-11-18

DOI：10.3760/cma.j.issn.0254-6450.2015.07.001

KeyWord: 艾滋病抗病毒治疗脱失

English Key Word: AIDS Antiretroviral therapy Drop-out

FundProject:国家科技重大专项(2011ZX10004-903,2012ZX10001001-004); 国家自然科学基金(81373062); 国家重点地区艾滋病防治项目

作者	单位	E-mail
姚仕堂	678400 芒市, 云南省德宏州疾病预防控制中心
时允	芒市人民医院
李品银	瑞丽市人民医院
许元武	陇川县人民医院
杨文芹	盈江县人民医院
张银娣	德宏州人民医院
尹春英	梁河县人民医院
寸柳青	盈江县中医院
翟志坚	畹町医院
何纳	复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室	nhe@shmu.edu.cn
段松	678400 芒市, 云南省德宏州疾病预防控制中心	dhduansong@sina.com.cn

ClickNum: 19470

PDFClickNum: 11039

Abstract:

目的了解云南省德宏州成年艾滋病患者抗病毒治疗(ART)脱失比例及其原因。方法对德宏州截至2014年9月30日的参加ART的8 367名成年艾滋病患者脱失情况进行调查。结果德宏州累计接受ART的成年艾滋病患者中脱失比例为14.4%(1 202/8 367)。单因素logistic回归分析,ART脱失与患者所在县(市)、性别、年龄、婚姻状况、感染途径、基线CD₄⁺T淋巴细胞计数和初始治疗方案有关。多因素logistic回归分析,ART脱失与患者所在县(市)、婚姻状况、感染途径、基线CD₄T淋巴细胞计数和初始治疗方案有关。芒市、梁河县、盈江县、已婚或同居、性传播、基线CD₄T淋巴细胞计数≤200 cells/mm³、初始治疗方案含齐多夫定(AZT)者脱失比例低;瑞丽市、未婚、注射吸毒、基线CD₄T淋巴细胞计数>200 cells/mm³、初始治疗方案不含AZT者脱失比例高。ART患者随着治疗时间的延长,其脱失比例下降。调查发现1 202例脱失治疗的患者中,失访704例(58.6%)、依从性困难303例(25.2%)、外出74例(6.2%)、缅甸籍回国64例(5.3%)、医嘱停药29例(2.4%)、羁押18例(1.5%)、其他原因10例(0.8%)。不同特征患者其脱失原因不同。结论德宏州不同特征的艾滋病患者ART脱失比例不同,需采取针对性的措施以减少脱失,重点是减少失访和提高治疗依从性。

English Abstract:

Objective To examine the proportion and reasons of drop-out from antiretroviral therapy (ART) among 8 367 adult HIV-infected individuals in Dehong prefecture, Yunnan province. Methods All adult HIV-infected patients receiving ART before September 30 of 2014 were examined for the situation of drop-out from ART. Results The proportion of drop-out from ART among adult HIV-infected patients in Dehong prefecture was 14.4% (1 202/8 367). Results from the univariate logistic regression analyses indicated that drop-out from ART was significantly correlated with factors as:living area, gender, age, marital status, HIV transmission route, baseline CD₄⁺T cell counts and initial treatment regimen of the patients. After adjusted for potential confounding variables by multiple logistic regression model, drop-out from ART was significantly correlated with residential area, marital status, HIV transmission route, baseline CD₄T cell count and initial treatment regimen of the patients. HIV-infected patients who were living in Mangshi city, Lianghe county or Yingjiang county, being married or living with partner, HIV infection through sexual contact, with baseline CD₄ T cell counts ≤200 cells/mm³, and ART included in the initial treatment regimen etc., were less likely to drop out from ART. The proportion of drop out from ART was significantly decreasing along with the increasing time of ART. Data from specific investigation revealed that among the 1 202 patients who dropped out from ART, 704(58.6%) were lost to follow-up, 303(25.2%) did not adhere to treatment, 74(6.2%) moved out the region, 64(5.3%) were Burmese that had returned to Burma, 29(2.4%) stopped the treatment according to doctors' advice, 18(1.5%) were incarcerated and 10(0.8%) were under other reasons. Reasons for the drop-out varied, according to the situation of patients. Conclusion The proportion of drop-out from ART varied significantly according to the characteristics of HIV-infected patients in Dehong prefecture that underscoring the needs for tailored responses to reduce drop-out of ART. Focus should be targeted on reducing the loss to follow-up and improving the treatment adherence.

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