山东省抗病毒治疗HIV/AIDS生存状况及影响因素分析
Survival status and influencing factors of HIV/AIDS on highly active anti-retrovial therapy in Shandong province
目的 了解山东省抗病毒治疗HIV/AIDS的生存状况及影响因素.方法 运用Kaplan-Meier(K-M)法及累积发生函数(CIF)估算2003-2015年山东省抗病毒治疗HIV/AIDS的艾滋病相关死亡发生率、部分分布比例风险回归模型(F-G模型)分析生存状况及影响因素.结果 竞争风险存在时,K-M法计算艾滋病相关死亡累积发生率高于CIF.CIF估算5 593例治疗HIV/AIDS随访1、3、5、10年艾滋病相关死亡累积发生率分别为3.08%、4.21%、5.37%和7.59%.大专及以上文化程度(HR=0.40,95 %CI:0.24~0.65)HIV/AIDS的艾滋病相关死亡发生危险较低,现住址在鲁西地区(HR=1.33,95%CI:1.01~1.89)、医疗机构检测发现(HR=1.39,95%CI:1.06~1.80)、治疗基线方案含NVP (HR=1.36,95%CI:1.03~1.88)、治疗基线临床症状Ⅲ/Ⅳ期(职=2.61,95%CI:1.94~3.53)、诊断1年后接受随访(HR=2.02,95%CI:1.30~3.15)、诊断基线CD;T淋巴细胞计数(CD4)≤200个/μl (HR=3.41,95%CI:2.59~4.59)、治疗基线CD4≤350个/μl(HR=5.48,95%CI:2.32~12.72)的HIV/AIDS发生艾滋病相关死亡风险高.结论 竞争风险存在时,K-M法高估艾滋病相关死亡累积发生率,优选竞争风险模型进行生存分析;早诊断、及时随访、早治疗可降低HIV/AIDS艾滋病相关死亡.
更多Objective To understand the survival status and influencing factors for HIV/AIDS patients on highly active anti-retroviral therapy (HAART) in Shandong province.Methods Both Kaplan-Meier (K-M) method and cumulative incidence function (CIF) were used to calculate the cumulative incidence of AIDS-related death respectively,and Fine-Gray model was used to identify the influencing factors related to survival time.Results Through K-M method,a higher AIDS-related cumulated death rate than the CIF,was estimated.Among all the HIV/AIDS patients who initiated HAART from 2003 to 2015 in Shandong,5 593 of them met the inclusion criteria.The cumulative incidence rate for AIDS-related death was 3.08% in 1 year,4.21% in 3 years,5.37% in 5 years,and 7.59% in 10 years respectively by CIF.Results from the F-G analysis showed that HIV/AIDS patients who were on HAART,the ones who had college degree or above (HR=0.40,95%CI:0.24-0.65) were less likely to die of AIDS-associated diseases.However,HIV/AIDS patients who were on HAART and living in the western areas of Shandong (HR=1.33,95%CI:1.01-1.89),diagnosed by medical institutions (HR=1.39,95%CI:1.06-1.80),started to receive care ≥1 year after diagnosis (HR=2.02,95%CI:1.30-3.15),their CD,cell count less than 200 cells/μl (HR=3.41,95%CI:2.59-4.59) at the time of diagnosis,with NVP in antiviral treatment (ART) regime (HR=1.36,95%CI:1.03-1.88),at Ⅲ/Ⅳ clinical stages (HR=2.61,95%CI:1.94-3.53) and CD4 cell count less than 350 cells/μl (HR=5.48,95%CI:2.32-12.72) at initiation of HAART ect.,were more likely to die of AIDS-associated diseases.Conclusions With the existence of competing risks,the cumulative incidence rate for AIDS-related death was overestimated by K-M,suggesting that competing risk models should be used in the survival analysis.Measures as early diagnoses followed by timely care and early HAART could end up with the reduction of AIDS-related death.
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