宁波市接受抗病毒治疗的≥60岁HIV/AIDS病人生存情况分析  

Survival analysis of elderly HIV/AIDS patients≥ 60 years old with highly active antiretroviral therapy in Ningbo

作　　者：张继红[1] 李怀亮[2] 史宏博[2] 姜海波[2] 洪航[2] 董红军[2] Zang Jihong Li Huailiang Shi Hongboz Jiang Haibo Hong Hang Dong Hongjun(Medical College of Ningbo University, Ningbo, 315211, China Ningbo Center for Disease Control and Prevention)

机构地区：[1]宁波大学医学院,浙江宁波315211 [2]宁波市疾病预防控制中心,浙江宁波315010

出　　处：《中国艾滋病性病》2016年第12期957-960,共4页Chinese Journal of Aids & STD

摘　　要：目的了解宁波市接受抗病毒治疗的≥60岁的艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）的流行病学特征及生存情况。方法采用回顾性队列研究方法,对≥60岁HIV/AIDS病人的主要流行病学特征和生存状况进行描述性分析,Kaplan-Meier法绘制生存曲线,寿命表法计算生存率,COX比例风险回归模型分析影响死亡的危险因素。结果 157例≥60岁的研究对象中,接受抗病毒初始治疗的年龄中位数为65[四分数位间距（IQR）：62.0~69.5]岁,以男性、本地、已婚或同居、异性性传播、基线CD4^＋T淋巴细胞（简称CD4细胞）〈200个/μL、世界卫生组织（WHO）分期Ⅰ期为主。第1、2、5、7年的累计生存率分别为86%、79%、72%和72%。≥60岁组的病死率高于〈60岁组,不同年龄组的KLM曲线,经Log-rank检验差异有统计学意义。多因素COX比例风险回归模型分析显示,≥60岁组,基线WHO临床分期Ⅳ期的死亡危险,是Ⅰ期病人的4.308倍[风险比（HR）=4.308,95%可信区间（CI）：1.661~11.173];〈60岁组、WHO临床分期Ⅰ期是研究对象死亡的保护因素。在〈60岁研究对象中,基线CD4细胞为200~350个/μL组的死亡风险,低于CD4细胞〈200个/μL组（HR=0.225,95%CI：0.110~0.460）;但不同的基线CD4细胞水平对≥60岁组死亡率影响无统计学意义。在60岁及以上病人中,异性性传播病例的死亡风险低于经同性性行为感染的病例（HR=0.018,95%CI：0.002~0.189）,但〈60岁组死亡率在不同传播途径间无差异。结论宁波市接受抗病毒治疗的60岁以上HIV/AIDS病人的生存率不高,应根据老年人群的流行特征和死亡危险因素采取针对性的治疗干预策略,早诊断早治疗仍然是提高老年病人生存率的关键。Objective To learn the characteristics and survival status of HIV/AIDS patients at more than 60 years old receiving highly active antiretroviral therapy（HAART）in Ningbo city.Methods A retrospective cohort study was conducted among HIV/AIDS patients（〉15years）diagnosed between 2004 and 2015.Comparison was made between the HIV/AIDS patients ≥60years,and the younger〈60years as a control group.Kaplan-Meier curve described the survival time,and the life table was used to estimate survival probabilities and Cox proportional hazard model was applied to determine factors influencing mortality.Results Of 157 subjects over 60 years old,the median age starting HAART was 65（IQR：62.0-69.5）years.Most of them were male,local,married,infected with HIV by heterosexual transmission,with baseline CD4counts〈200个/μL,as described in WHO clinical stageⅠ.The cumulative survival probability was 86%for the first year,79%for the second year,72%for the fifth year and 72%for the seventh year.The mortality rate of the≥60age group was higher than that of the〈60age group.Kaplan-Meier survival curves by age were different tested by Log-rank test.Older age significantly reduced mortality rates of both groups.Old group（≥60years）had high risks of mortality associated with WHO clinical stageⅣ（HR=4.308,95%CI：1.661-11.173.vs.WHO clinical stage I）.Compared with those infected by homosexual transmission,the HIV/AIDS patients infected by heterosexual transmission significantly reduced mortality rates（HR=0.018,95%CI：0.002-0.189）.On the contrary,WHO clinical stage I was proved to be a protective factor to mortality for younger group（〈60years）,and higher CD4 level at baseline was associated with reduced mortality rates（HR=0.225,95%CI：0.110-0.460,for CD4 200-350cells/μL compared with CD4 〈200cells/μL.Conclusion Survival probabilities of HIV/AIDS patients with HAART more than 60 years old in Ningbo city were not high.The treatment program needs to improve to make it adaptable to the characteristi

关 键 词：≥60岁艾滋病病毒感染者/艾滋病病人 高效抗反转录病毒治疗 生存率 危险因素 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]