南京和运城市HIV感染者及艾滋病患者终止抗病毒治疗情况及其影响因素  

Drop out of antiretroviral therapy in people living with AIDS/HIV and related factors in Nanjing and Yuncheng

作　　者：李萌[1] 魏洪霞[2] 步凯[1] 刘晓燕[3] 冯一冰[1] 史灵恩[3] 张夏燕[1] 陈禹衡[3] 陈方方[1] 李效民[4] 傅更锋[3] 还锡萍[3] 王璐[1] 

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206 [2] 南京市第二医院 [3] 江苏省疾病预防控制中心 [4]山西省运城市疾病预防控制中心

出　　处：《中华流行病学杂志》2015年第10期1113-1118,共6页Chinese Journal of Epidemiology

摘　　要：目的 了解江苏省南京市及山西省运城市两地2004年6月至2014年6月间HIV感染者及艾滋病患者（HIV/AIDS）终止抗病毒治疗（ART）情况及其影响因素.方法 回顾性队列分析,以开始治疗时间作为进入队列时间,Kaplan-Meier法绘制ART终止治疗、死亡、停药的累计发生率曲线,运用Cox比例风险回归模型分析其影响因素.结果 运城市纳入分析1 006人,ART随访时间M=49.59（QR：20.02 ～ 92.84）个月;南京市纳入分析976人,ART随访时间M=19.93（QR：11.48 ～ 34.07）个月.运城、南京地区ART治疗3个月、6个月、1年、2年、4年、8年终止治疗累计发生率分别为8.19％、9.23％、11.08％、13.75％、17.74％、27.66％,3.01％、5.17％、7.47％、10.97％、17.45％、28.72％.多因素分析结果显示：年龄越大停药的风险越低,但死亡风险越高;离异/分居/丧偶者停药的风险较未婚者高;采血浆或输血传播是停药的保护因素,静脉吸毒是停药和终止治疗的危险因素,同性性传播者死亡风险较低.治疗起始时CD4＋T淋巴细胞计数越高停药的风险越高,死亡的风险越低;观察截止时患者的WHO临床分期越高,则终止治疗、停药、死亡的风险均越高.结论 运城、南京地区ART保持情况整体较好,建议加强年龄较小、离异/分居/丧偶者、静脉吸毒者、开始治疗时CD4＋T淋巴细胞计数较高、现时WHO临床分期较高者的干预,以减少停药.加大检测覆盖面,尽早发现及治疗,以减少HIV/AIDS死亡率.Objective To understand the incidence of drop out of antiretroviral therapy （ART） in people living with AIDS/HIV and related factors in Nanjing,Jiangsu province,and Yuncheng,Shanxi province.Methods Retrospective cohort analysis was conducted.The cumulative incidence curves of drop out of ART,mortality and drug withdrawal were drawn with Kaplan-Meier method.The related factors were identified with Cox proportional hazards regression model.Results A total of 1 006 patients were included in Yuncheng,the median length of ART follow-up was 49.59 months （QR：20.02-92.84）,and 976 patients were included in Nanjing,the median length of ART follow-up was 19.93 months（QR：11.48-34.07）.The cumulative incidence of drop out of ART at 3 months,6 months,1 year,2 years,4 years,8 years after ART was 8.19%,9.23%,11.08%,13.75%,17.74%,27.66% in Yuncheng,and 3.01%,5.17%,7.47%,10.97%,17.45%,28.72% in Nanjing respectively.Age,marital status,infection route,baseline CD4 cell count,the clinical stage classified by WHO at the end of the observation were correlated with the drop out of ART.Conclusion In order to reduce the drop out of ART among people living with AIDS/HIV,it is necessary to conduct effective nterventions targeting the patients with young age,the patients who divorced/widowed,the patients who were intravenous drug users,the patients with higher CD4 cell count at the beginning of ART and clinical stage Ⅲ or Ⅳ at the end of the follow-up and increase the coverage of HIV test.

关 键 词：艾滋病 抗病毒治疗 终止治疗 影响因素 

分 类 号：R512.91[医药卫生—内科学]