【摘要】 目的了解上海市中心城区(静安区)艾滋病病毒(HIV)感染者的生存时间和影响因素。方法收集静安区自首次报告(1995年)至2015年确诊和管理的HIV感染者和艾滋病(AIDS)病人的信息,开展回顾性队列研究,计算HIV感染的病死率,使用Kaplan-Meier法绘制生存曲线,并采用Cox比例风险回归模型分析病死率的影响因素。结果 920例HIV感染者共随访36 056个月,中位生存时间为30[四分位数间距(IQR):18-54)]个月,接受抗病毒治疗的比例为68.0%。67例感染者在随访期间内死亡,病死率为2.23/100人年;其中已接受治疗的HIV感染者病死率为0.63/100人年,未接受治疗的HIV感染者病死率为8.15/100人年。多因素分析结果显示,被动检测[危险系数(HR)=2.968,95%可信区间(CI):1.545~5.700]和首次CD4+T淋巴细胞(CD4细胞)检测结果<200个/μL(HR=17.016,95%CI:7.638~37.910)的感染者死亡风险高,而已接受抗病毒治疗(HR=0.063,95%CI:0.034~0.117)的感染者死亡风险低。结论该研究中HIV感染者的病死率处于较低水平。确诊时首次CD4细胞检测结果和抗病毒治疗对HIV感染者的生存状况意义重大,应采取更积极措施推广患者的早发现和"确诊后立即治疗的"策略,以有效降低HIV感染者的病死率。更多还原

【Abstract】 Objective To study survival time and the influencing factors of HIV-infected patients in Jing’an district,Shanghai.Methods We collected the information of HIV-positive patients diagnosed and managed by Jing’an district from 1995(first HIV case)to 2015 to conduct a retrospective cohort study to know the HIV mortality,and survival curves by Kaplan-Meier method,and to analyze the influencing factors of mortality by Cox proportional hazard regression model.Results 920HIV-infected patients were followed up for 36 056 months,with the median survival time of 30(IQR:18-54)months.68.0% received antiretroviral therapy(ART).67 patients died during the follow-up.HIV mortality rates were 2.23/100person-years among all patients,0.63/100person-years among patients with ART and 8.15/100person-years among patients without ART.Multivariate analysis showed that the patients diagnosed passively(HR=2.968,95% CI:1.545-5.700)and with the first CD4 test result<200/μL(HR=17.016,95% CI:7.638-37.910)had higher hazards of mortality,and those with ART(HR=0.063,95% CI:0.034-0.117)had lower hazards.Conclusion HIV mortality rate is low in general.The first CD4 test result after diagnosis and ART is a main influencing factor on survival of HIV-infected patients,and more active measures should be taken such as early diagnosis and"immediate ART after HIV diagnosis"to reduce mortality of HIV-infected patients.更多还原