河南省2002－2017年既往采供血人群艾滋病抗病毒治疗生存分析

梁妍; 杨文杰; 孙定勇; 李宁; 王哲

Abstract

梁妍,杨文杰,孙定勇,李宁,王哲.河南省2002－2017年既往采供血人群艾滋病抗病毒治疗生存分析[J].Chinese journal of Epidemiology,2019,40(6):638-642

河南省2002－2017年既往采供血人群艾滋病抗病毒治疗生存分析

Survival analysis on Former Plasma Donors living with HIV/AIDS after initiation of antiretroviral therapy in Henan province, 2002-2017

Received:December 06, 2018

DOI：10.3760/cma.j.issn.0254-6450.2019.06.007

KeyWord: 既往采供血艾滋病抗病毒治疗生存分析

English Key Word: Former plasma donation HIV/AIDS Antiretroviral therapy Survival analysis

FundProject:国家科技重大专项（2018ZX10715009）；河南省科技攻关计划（182102310188）

Author Name	Affiliation	E-mail
Liang Yan	Institute for AIDS/STD Prevention and Cure, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Yang Wenjie	Institute for AIDS/STD Prevention and Cure, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Sun Dingyong	Institute for AIDS/STD Prevention and Cure, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Li Ning	Institute for AIDS/STD Prevention and Cure, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Wang Zhe	Institute for AIDS/STD Prevention and Cure, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China	wangzhe@hncdc.com.cn

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Abstract:

目的分析河南省既往采供血人群（FPD）2002－2017年接受艾滋病抗病毒治疗的生存状况及其影响因素。方法采用回顾性队列方法，利用我国艾滋病防治基本信息系统河南省抗病毒治疗数据库，选取现住址为河南省、感染途径为采血（浆）、2002－2017年接受抗病毒治疗、年龄≥15岁的HIV/AIDS作为研究对象，根据抗病毒治疗开始时间，观察起点时间为2002年1月1日，观察截止时间为2017年12月31日，观察结局为艾滋病及相关疾病死亡。采用寿命表法估算生存率、Kaplan-Meier法绘制生存率曲线和log-rank检验，采用Cox比例风险回归模型分析影响死亡病例生存的相关因素。运用Excel 2010和SPSS 23.0软件进行数据整理和统计学分析。结果纳入25 825例研究对象，观察期的病死率为3.9/100人年（8 354/214 796.3），抗病毒治疗1、4、8、12和16年的累积生存率分别为91.2%、80.1%、71.2%、65.7%和61.5%。Cox比例风险回归模型分析结果显示，与女性相比，男性的aHR值（95% CI）为1.46（1.39～1.53）；与开始抗病毒治疗时年龄15～岁组相比，45～和60～岁组的aHR值（95% CI）分别为1.47（1.40～1.54）和2.50（2.22～2.81）；与已婚/同居相比，其他婚姻状况的aHR值（95% CI）为1.29（1.21～1.36）；与基线CD₄⁺T淋巴细胞计数（CD₄）≥350个/μl组相比，<50、50～和200～个/μl组的aHR值（95% CI）分别为4.50（4.14～4.89）、2.49（2.31～2.69）和1.44（1.33～1.56）；与基线无机会性感染症状者相比，有1、2～和4～5个机会性感染症状数的aHR值（95% CI）分别为1.17（1.06～1.29）、1.47（1.35～1.59）、1.74（1.60～1.89）；与无复方新诺明（TMP-SMZ）服用史相比，有TMP-SMZ服用史的aHR值（95% CI）为0.69（0.65～0.73）。结论 2002－2017年河南省FPD艾滋病抗病毒治疗16年的累积生存率达到61.5%。男性、开始抗病毒治疗时年龄≥45岁、基线CD₄<350个/μl、基线机会性感染症状数≥1个是影响死亡病例生存的危险因素，已婚/同居、TMP-SMZ服用史是影响死亡病例生存的保护因素。

English Abstract:

Objective To explore the survival status and influencing factors on former plasma donors (FPD) living with HIV/AIDS after initiation of antiretroviral therapy (ART) during 2002-2017 in Henan province. Methods A retrospective study was conducted, using data from the ART database of national comprehensive HIV/AIDS information system. The inclusion criteria on patients would include HIV/AIDS cases with current residence in Henan province, route of infection being blood-borne (plasma collection), initiation of ART between 2002 and 2017, and 15 year-olds or above. According to the time of initation on antiviral treatment, observation was carried on between January 1, 2002 and December 31, 2017. Outcome of observation was defined as death caused by AIDS or related diseases. Life Table was used to estimate the survival rate and Kaplan-Meier method was used to draw the survival curve. Log-rank test was used to compare the univariate intergroup survival rates while Cox proportional hazards regression model was used to analyze the influencing factors on survival status among deaths due to AIDS or related diseases. Excel 2010 software and SPSS 23.0 software was used for data cleaning and statistical analysis. Results A total of 25 825 HIV/AIDS patients were enrolled in this study. During the follow-up period, the overall mortality was 3.9/100 person year (8 354/214 796.3), among all the patients. The accumulate survival rates of 1 year, 4 years, 8 years, 12 years and 16 years after the initiation of ART were 91.2%, 80.1%, 71.2%, 65.7% and 61.5%, respectively. The results from the multivariate Cox proportional hazards regression model analysis showed that male vs. female (aHR=1.46, 95%CI:1.39-1.53); aged 45-49 years group and aged 60 and older years group of initiating ART vs. aged 15-44 years group of initiating ART respectively (aHR=1.47, 95%CI:1.40-1.54; aHR=2.50, 95%CI:2.22-2.81); other marital status vs. being married or under cohabitation (aHR=1.29, 95%CI:1.21-1.36); baseline CD₄⁺T cells counts (CD₄)<50, 50-199 and 200-349 cells/μl respectively vs. baseline CD₄ ≥ 350 cells/μl (aHR=4.50, 95%CI:4.14-4.89; aHR=2.49, 95%CI:2.31-2.69; aHR=1.44, 95%CI:1.33-1.56); number of opportunistic infections at baseline were one case, 2-3 cases and 4-5 cases respectively vs. non opportunistic infections cases at baseline (aHR=1.17, 95%CI:1.06-1.29; aHR=1.47, 95%CI:1.35-1.59; aHR=1.74, 95%CI:1.60-1.89); taking TMP-SMZ vs. not taking TMP-SMZ (aHR=0.69, 95%CI:0.65-0.73). Conclusions The 16-year accumulate survival rate was 61.5% among FPD living with HIV/AIDS after initiation of ART, during 2002 to 2017 in Henan province. The risk factors for FPD death case would include:being males, aged 45 and older years at the initiation of ART, baseline CD₄<350 cells/μl and the number of baseline opportunistic infections cases ≥ 1. The protective factors on FPD death appeared as:being married or cohabited as wel as on TMP-SMZ.

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