贵州省艾滋病病人退出抗病毒治疗的情况及其影响因素分析  

Impact factors of withdrawal from antiretroviral therapy among HIV/AIDS patients in Guizhou province

作　　者：陈洋[1] 申莉梅[1] 李豫[1] 黄璐[1] 安竹[1] 李志坚[1] 鲁俊端[1] 张晓萍[1] 刘跃辉[1] 

机构地区：[1]贵州省疾病预防控制中心,贵阳550004

出　　处：《中国艾滋病性病》2017年第5期397-401,共5页Chinese Journal of Aids & STD

基　　金：贵州省科技计划项目(黔科合SY[2013]3052号)~~

摘　　要：目的了解贵州省艾滋病患者退出抗病毒治疗的情况及其影响因素。方法采用回顾性队列研究方法,分析贵州省2005-2015年入组抗病毒治疗的艾滋病患者退出治疗的情况,运用COX比例风险回归模型分析其影响因素。结果 13 632例患者中,开始治疗时的年龄18.00~90.25岁(41.79±14.19)岁,已婚或同居者占58.38%(7 958/13 632),退出治疗比例为23.12%(3 152/13 632),治疗患者的随访时间中位数M=20.00[四分位数间距(IQR):10.00~37.00]个月,治疗6个月、1年、5年的退出累计发生率分别为0.13%,0.18%,0.35%。COX比例风险分析结果显示:女性患者退出治疗的风险是男性的0.84倍[95%可信区间(CI):0.77~0.92];随着年龄增高退出治疗、死亡、停药的风险亦增高,其中≥60岁组退出治疗、死亡、停药的风险,分别是<30岁组的2.18倍(95%CI:1.89~2.53)、3.06倍(95%CI:2.45~3.83)、1.84倍(95%CI:1.40~2.43)。注射吸毒是退出治疗的危险因素,注射吸毒者退出治疗、死亡的风险,分别是输血或单采供血者的4.13倍(95%CI:2.05~8.31)和3.90倍(95%CI:1.74~8.79)。基线CD4+T淋巴细胞计数越高,患者退出治疗和死亡的风险越低,但停药的风险越高。其中基线CD4+T淋巴细胞≥400个/mm3组退出治疗、死亡、停药的风险分别是<100个/mm3组的0.67倍(95%CI:0.57~0.78)、0.22倍(95%CI:0.16~0.30)、2.17倍(95%CI:1.56~3.03)。2012-2015年启动治疗的患者退出治疗、停药的风险,分别是2005-2011年者的1.74倍(95%CI:1.56~1.95)和2.56倍(95%CI:1.95~3.36)。结论建议重点加强艾滋病患者抗病毒治疗前、后的依从性教育,在扩大治疗人数的同时注重提高医疗水平和服务质量,优化用药方案,加强家庭和社会支持,以防止退出治疗。Objective To understand the incidence of withdrawal and related factors among HIV/AIDS patients receiving antiretroviral therapy （ART） in Guizhou province. Methods A retrospective cohort analysis was conducted to analyze the information of HIV/AIDS patients receiving ART. The related factors were identified with Cox proportional hazards regression model. Results Among the 13 632 respondents, the median age was 18.00-90.25 （41.79±14.19）yearsold. 58.38% （7958/13632） were married. 23. 12% （3152/13632） withdrew from ART. The median length of ART follow-up was 20.00（IQR： 10.00-37.00） months. Cumulative incidence of withdrawal from ART in 6 months, 1 year, and 5 years was 0.13, 0.18, 0.35 respectively. Results from multivariate COX regres sion showed that female patients with ART were at a lower risk to withdrew compared to the males （ HR： 0.84, 95 % CI：O. 77-0.92）. The rates of withdrawal, death and ceasing medication of the patients with age≥60 years were higher than those〈30 years old, with HR（CI： 2.18（1.89-2.53）, 3.06（2.45-3.83）, 1.84（1.40-2.43）, respectively. HIV-infected through injecting drug use were more likely to withdraw from ART and die of HIV/AIDS than those infected through blood-borne transmission, with HR（CI： 4. 13（2.05-8.31）, and 3.90（1.74-8.79）, respectively. Those with baseline CD4＋ T cell count≥400/mm3 were at a lower risk to withdraw from ART than those with CD4＋ T cell count〈100/mm3, HR（CI： 0.67 （0.67-0.78） and 0.22（0.16-0.30）, respectively, and the risk of drug discontinuance with baseline CD4＋ T cell count≥400/mm3 was 2.17 times （95% CI：1.56- 3.03） compared to patients with CD4＋T cell count〈 100/mm3. Those receiving ART during the period of 2012 to 2015 were more likely to withdraw and cease taking medication than those with ART initiated during the period of 2005 to 2011, HR （CI： 1.74 （ 1.56-1.95）, and 2.56 （ 1.95-3.36）, respectively. Conclusion To reduce the withdrawal from ART among HI

关 键 词：艾滋病患者 抗病毒治疗 退出 影响因素 

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