2010—2019年凉山州初始抗病毒治疗HIV/AIDS育龄妇女生存分析  

Survival analysis of women of childbearing age with HIV/AIDS initiating antiviral therapy in Liangshan Prefecture from 2010 to 2019

作　　者：车双双 黄玉玲 王鑫 张芹[1] 张波 曾亚莉[2] 任建华 杨薇[2] 李天露 卓玛拉措 高鑫 杨一挥[2] CHE Shuang-shuang;HUANG Yu-ling;WANG Xin;ZHANG Qin;ZHANG Bo;ZENG Ya-li;REN Jian-hua;YANG Wei;LI Tian-lu;ZHUO-MA La-cuo;GAO Xin;YANG Yi-hui(Nanchong Center for Disease Control and Prevention,Nanchong 637000,Sichuan Province,China;Sichuan Center for Disease Control and Prevention,Chengdu 610041,Sichuan Province,China;Wenjiang Center for Disease Control and Prevention,Chengdu 611100,Sichuan Province,China;Liangshan Center for Disease Control and Prevention,Xichang 615000,Sichuan Province,China)

机构地区：[1]南充市疾病预防控制中心,四川南充637000 [2]四川省疾病预防控制中心,成都610041 [3]成都市温江区疾病预防控制中心,成都611100 [4]凉山州疾病预防控制中心,四川西昌615000

出　　处：《预防医学情报杂志》2022年第9期1181-1190,共10页Journal of Preventive Medicine Information

基　　金：四川省科技计划项目(项目编号:2020YJ0449);四川省疾病预防控制中心科研课题(项目编号:ZX201901)。

摘　　要：目的了解四川省凉山州2010—2019年初始抗病毒治疗HIV/AIDS育龄妇女患者生存现状及其影响因素。方法采用回顾性队列研究的方法,从艾滋病基本防治信息系统选取2010—2019年现住址在凉山州并已经开始抗病毒治疗(HAART)的HIV/AIDS育龄妇女患者,共10684例,采用寿命表法进行生存率分析,Cox比例风险回归模型对影响抗病毒治疗HIV/AIDS患者病死率的相关因素进行分析。结果2010—2019年现住址在凉山州实施抗病毒治疗(HAART)的HIV/AIDS育龄妇女患者平均年龄为(32.00±7.37)岁,至随访观察终止时间,死亡683例,病死率为1.67/100人年;Cox回归分析结果显示,40~49岁[AHR(95%CI)=2.299(1.144~4.619)]、静脉吸毒传播[AHR(95%CI)=1.482(1.228~1.788)]、治疗前BMI<18.5 kg/m^(2)[AHR(95%CI)=1.796(1.482~2.178)]、WHO临床Ⅳ期[AHR(95%CI)=2.411(1.575~3.692)]、抗病毒治疗方案TDF/AZT+3TC+NVP[AHR(95%CI)=4.175(3.137~5.558)]、确证至启动治疗时间间隔≥12月[AHR(95%CI)=1.352(1.006~1.818)]、治疗前感染乙肝或丙肝、县级及以上医院治疗随访机构、样本来源于医疗机构、入组治疗地区为州内和启动治疗时CD4^(+)T淋巴细胞计数<200个/μl是死亡的危险因素。结论为降低凉山州育龄妇女中HIV/AIDS患者死亡风险,应尽早启动抗病毒治疗,提倡早期发现、早期诊断、进一步扩大抗病毒治疗的覆盖面和提升服务及治疗质量,加强追踪随访和管理。关注40岁及以上静脉吸毒、样本来源医疗机构、治疗前BMI<18.5 kg/m^(2)、启动治疗时WHOⅣ期、确证至启动治疗时间间隔≥12月、治疗前感染乙肝或丙肝和初始治疗CD4^(+)T淋巴细胞计数较低的对象,优化治疗方案,提高其生存质量。Objective To understand the survival status and influencing factors of women of childbearing age with human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)initiating antiretroviral therapy(HAART)in Liangshan Prefecture,Sichuan Province from 2010 to 2019.Methods A retrospective cohort study was conducted to select HIV/AIDS women of childbearing age who had started HAART in Liangshan Prefecture from 2010 to 2019 from the Basic HIV/AIDS Prevention and Treatment Information System.A total of 10684 cases were enrolled.Life table method was used to analyze the survival rate.Cox proportional hazard regression model was used to analyze the related factors affecting the mortality of HIV/AIDS cases with antiviral therapy.Results The average age of the study subjects was 32.00±7.37 years old.By the end of follow-up observation,683 cases died,with a fatality rate of 1.67/100 person-years.The results of Cox regression analysis showed that cases with the following situations had higher risk for death:1)40~49years old(accumulated hazard rate(AHR):2.299,95%confidence interval(CI):1.144~4.619);2)transmitted through intravenous drug abuse(1.482,1.228~1.788);3)body mass index(BMI)<18.5 before treatment(1.796,1.482~2.178);4)clinical stage IV by the World Health Organization(WHO)(2.411,1.575~3.692);5)treated with the program of TDF/AZT+3TC+NVP(4.175,3.137~5.558);6)the interval between diagnosis to start of treatment≥12 months(1.352,1.006~1.818);7)infected by hepatitis B or C before treatment;8)treated or follow-up by hospitals of county or above level;9)samples collected from medical institutions;10)enrolled into the treatment within the Prefecture;and 11)CD4^(+)T lymphocyte count<200 cells/μL at the start of treatment.Conclusions In order to reduce the risk of death among women of childbearing age with HIV/AIDS in Liangshan Prefecture,antiretroviral treatment should be initiated as soon as possible.Early detection,early diagnosis,further expansion of the coverage of antiretroviral treatment and improvement of

关 键 词：育龄妇女 HIV/AIDS患者 抗病毒治疗 生存分析 

分 类 号：R512.91[医药卫生—内科学]