摘要目的 了解河南省艾滋病患者接受抗病毒治疗后的生存状况及影响患者治疗后生存时间的因素.方法 利用国家成年人DataFax抗病毒治疗信息系统,收集2003-2009年全省抗病毒治疗者的生存、死亡信息,采用Cox比例风险回归模型对影响艾滋病患者抗病毒治疗生存时问的因素进行分析.结果 共收集24 669例有效接受抗病毒治疗的艾滋病患者流行病学信息,其中存活18 683例,死亡5986例.艾滋病患者总病死率从2003年的20.1/100人年降到2008年的5.1/100人年.艾滋病患者CD4+T淋巴细胞计数水平不同、合并机会性感染情况不同的感染者生存曲线差异有统计学意义.多因素Cox回归分析显示,影响艾滋病患者生存时间的危险因素是:基线CD4+T淋巴细胞＜50 cells/μl(HR=4.4)、CD4+T淋巴细胞在50 ～ 199 cells/μl(HR=2.0)、血红蛋白＜90 g/L的中度贫血(HR=1.8)、基线合并机会性感染症状数多者死亡风险高(HR=1.7).其他影响艾滋病治疗者生存时间的危险因素为年龄≥60岁、男性、未婚或离异、谷丙转氨酶值较高、性传播或注射毒品传播(HR值分别为2.2、1.6、1.5、1.3、1.2).影响艾滋病患者治疗后生存时间的保护因素:开始抗病毒时间较早(HR=0.8)和抗病毒治疗前配偶也是HIV感染者(HR=0.8).结论 河南省艾滋病免费抗病毒治疗降低了艾滋病死亡率,延长患者的生存时间；需要进一步监测艾滋病患者的CD4+T淋巴细胞数量变化及机会性感染情况,及时开展艾滋病的抗病毒治疗.

abstractsObjective To study the effect of a government-provided-free highly activeantiretroviral treatment (HAART) program,on the reduction of mortality and relevant risk factorsamong adult (AIDS) patients in Henan province.Methods Data on the survival and deaths of AIDSpatients were collected from the National HAART reporting system between 2003 and 2009.Coxproportional hazards model was applied to analyze those factors that affecting the survival time of thepatients.Results 24 669 cases were enrolled to this study in Henan province,from 2003 to 2009.The overall mortality declined from 20.1/100 person-years in 2003 to 5.1/100 person-years in 2009.There was significant difference between the survival curves of different CD4 + T counts and differentnumbers of opportunistic infection syndromes.Results from the Multivariate Cox proportional hazardsregression analysis indicated that CD4+T cell counts ( ＞200 cells/μl,50-199 cells/μ l) was a riskfactor to death,with hazard ratio as 4.4 and 2.0 respectively.Hb of the patients that lower than 90,was a risk factor to death with the HR=1.8.Number of opportunistic infection (OIs) episodes was arisk factor to the mortality (HR=1.7).In addition,other risk factors would include age ( ≥60 years,old),being male,unmarried or divorced,ALT＞100 μl,and other routes of infection,other thanFormer Plasma Donors (FPDs),with HR as 2.2,1.6,1.5,1.3 and 1.2.However,the protectivefactors would include:(1)the earlier the HAART began,the longer the survival time would last(HR =0.8 ) ; (2) when one spouse had already had the infection of HIV,it seemed helpful for the otherspouse to live longer (HR=0.8).Conclusion The National Free Treatment Program hadsignificantly reduced the AIDS mortality rate.Some effective measures should be further taken tomonitor the CD4 + T and the opportunistic infection of the AIDS patients.Patients who were in need totake the HARRT should be adopted into the ART timely,At the same time,the occurrence ofopportunistic infections should be actively prevented.