【摘要】 目的 了解南京市人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者/艾滋病(acquired immune deficiency syndrome, AIDS)患者(简称HIV/AIDS患者)的生存状况及其影响因素。方法 利用2000―2021年艾滋病综合防治信息系统中HIV/AIDS患者相关数据，采用回顾性队列研究方法，采用Kaplan-Meier法拟合生存曲线、Cox比例风险回归模型分析AIDS相关死亡的影响因素。结果 5 903例HIV/AIDS患者中，AIDS相关死亡率为0.93/100人年，第1、5、10和22年的累积生存率分别为97.2%、95.3%、92.9%和90.0%。多因素Cox比例风险回归模型显示，与未治疗的HIV/AIDS患者相比，诊断后越早开始抗病毒治疗(antiretroviral therapy, ART)的患者，其AIDS相关死亡风险越低。基线病毒载量(viral load, VL)≥80 000 copies/mL者的死亡风险是<20 000 copies/mL者的6.54倍。与ART治疗前首次CD4~+T淋巴细胞(简称CD4)计数<200个/μL相比，CD4计数越高的AIDS相关死亡风险越低。ART对延长首次CD4计数<200个/μL的HIV/AIDS生存时间具有更好的效果。结论 南京市HIV/AIDS患者中AIDS相关死亡率较低，其中早期确诊、较低的基线VL、快速启动ART是AIDS相关死亡的保护因素。因此，在促进HIV早发现的基础上，应加强VL基线监测、优化随访管理流程、快速启动ART,从而进一步降低HIV/AIDS患者相关死亡风险。更多还原

【Abstract】 Objective To investigate the survival status and influencing factors of human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)(HIV/AIDS) patients in Nanjing. Methods The retrospective cohort study of newly diagnosed HIV was conducted in Nanjing and used citywide data from the HIV/AIDS Comprehensive Information Management System from 2000 to 2021. Kaplan-Meier and cox proportional hazard regression method were used to draw the survival curve and analyze the factors associated with AIDS-related deaths, respectively. Results Among 5 903 HIV/AIDS cases, the AIDS-related mortality was 0.93 per 100 person-years and the cumulative survival rates at 1, 5, 10, and 22 years were 97.2%, 95.3%, 92.9%, and 90.0%, respectively. Multivariate analysis revealed that compared to untreated HIV/AIDS, the earlier the initiation of antiretroviral therapy(ART) after diagnosis, the lower the AIDS-related death risk. The HIV/AIDS with a baseline viral load(VL) ≥80 000 copies/mL had 6.54 times higher AIDS-related death risk than those with VL <20 000 copies/mL. Compared to the first CD4 count before ART <200 cells/μL, the higher the CD4 level, the lower the AIDS related death risk. ART was more effective in prolonging survival time among those with first CD4 count before ART <200 cells/μL. Conclusions The AIDS-related mortality of HIV/AIDS is low in Nanjing. Early diagnosis, low baseline VL and rapid initiation of ART are protective factors for AIDS-related death. Therefore, on the basis of promoting the early diagnosis of HIV, we should strengthen the baseline monitoring of VL, optimize the follow-up management process to promote rapid ART, so as to further reduce the risk of AIDS-related death.更多还原