HIV单阳家庭配偶阳转情况及先证者生存分析

符院生; 章奇; 刘学雯; 丁志强; 汪秀; 戴色莺; 范引光

doi:10.16462/j.cnki.zhjbkz.2020.03.012

HIV单阳家庭配偶阳转情况及先证者生存分析

doi: 10.16462/j.cnki.zhjbkz.2020.03.012

1.
230032 合肥, 安徽医科大学公共卫生学院流行病与卫生统计学系, 炎症免疫性疾病安徽省实验室
2.
230032 合肥, 安徽医科大学2018级预防医学专业
3.
236000 阜阳, 阜阳市京九区卫生站
4.
230032 合肥, 安徽医科大学科技处
5.
230601 合肥, 安徽省疾病预防控制中心艾滋病防治科

符院生和章奇为共同第一作者

基金项目: 安徽省自然科学基金(1608085MH174);安徽医科大学博士科研资助基金(xj201526)

详细信息

通讯作者:
范引光, E-mail:fanyinguang@163.com

中图分类号: R512.91
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出版历程
- 收稿日期: 2020-02-19
- 修回日期: 2020-03-01
- 刊出日期: 2020-03-10

Analysis of the positive conversion rate of negative spouse and survival analysis on HIV sero-discordant couples

1.
Department of Epidemiology, School of Public Health, Anhui Medical University, Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei 230032, China
2.
Preventive Medicine, 2018 Grade, Anhui Medical University, Hefei 230032, China
3.
Health Station of Jingjiu District, Fuyang City, Fuyang 236000, China
4.
Science and Technology Department, Anhui Medical University, Hefei 230032, China
5.
AIDS Department of Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China

FU Yuan-sheng and ZHANG Qi contributed equally to this article

Funds: Natural Science Fund of Anhui Province(1608085MH174); Scientific Research of BSKY from Anhui Medical University(xj201526)

More Information

Corresponding author: FAN Yin-guang, E-mail:fanyinguang@163.com

摘要

摘要: 目的分析安徽省阜阳市艾滋病病毒(human immunodeficiency virus, HIV)单阳家庭配偶阳转的比例及先证者抗病毒治疗的生存分析。方法资料来源于艾滋病综合防治数据信息系统中的病例报告数据库, 筛选出1997年9月1日-2018年9月1日间确诊的HIV单阳家庭, 建立队列, 根据研究对象进行抗病毒治疗的时机, 将研究对象分为未治疗组、常规治疗组和提前治疗组, 比较三组阴性配偶阳转率及生存状况。结果共纳入单阳家庭598户, 三组人群总随访时间分别为:258.92人年、4 987.17人年和862.25人年, HIV阳转率分别为6.18/100人年, 0.48/100人年和0.23/100人年, 多因素Cox比例风险模型显示:相对于未治疗组, 常规治疗组(HR=0.052, 95% CI:0.037~0.074)和早期治疗组(HR=0.011, 95% CI:0.003~0.035)患者死亡的风险有下降的趋势; 女性死亡风险低于男性(HR=0.667, 95% CI:0.472~0.944);年龄越大, 其死亡风险越高(HR=1.041, 95% CI:1.026~1.056), 而相对于农民, 无业者死亡风险较高(HR=1.571, 95% CI:1.037~2.381)。结论应针对不同特征的单阳家庭制定有针对性的干预措施, 以推动尽早开展抗病毒治疗。
- 人类免疫缺陷病毒 /
- 单阳家庭 /
- 阳转 /
- 生存分析
Abstract: Objective To analyze the positive conversion rate of negative spouse and the survival analysis on HIV sero-discordant couples. Methods Data were collected from the case report database of the integrated AIDS prevention and control data and information system. HIV sero-discordant couples diagnosed between September 1, 1997 and September 1, 2018 were recruited into the cohort. The participants were divided into three groups as untreated subgroup, routine treatment subgroup and early treatment subgroup according to the situation when they started HIV treatment. The positive conversion rate of negative spouse and the survival were compared among the three subgroups. Results 598 HIV sero-discordant couples were recruited and the overall survival time of the three subgroups were 258.92, 4 987.17 and 862.25 person-year. The rate of positive conversion were 6.18/100, 0.48/100 and 0.23/100 person-year. Multivariate Cox regression model showed that the hazard ratio of routine treatment subgroup(HR=0.052, 95% CI:0.037-0.074) and early treatment subgroup(HR=0.011, 95% CI:0.003-0.035)were lower than untreated subgroup. The risk of death of women was lower than that of men(HR=0.667, 95% CI:0.472-0.944); the older the age, the higher the risk of death(HR=1.041, 95% CI:1.026-1.056); and the risk of death of the unemployed is higher than that of farmers(HR=1.571, 95% CI:1.037-2.381). Conclusion Targeted interventions methods and early antiviral therapy should be taken urgently for sero-discordant couples.
- HIV /
- HIV sero-discordant couples /
- Positive conversion /
- Survival analysis

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图 1 不同治疗方法的HIV单阳家庭先证者生存曲线

Figure 1. The survival curve of the proband of HIV single positive family with different treatment methods

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表 1 不同处理组研究对象的一般情况[n (%)]

Table 1. Basic characteristics of subjects in different treatment groups[n (%)]

先证者特征	未治疗组(n=111)	常规治疗组(n=423)	早期治疗组(n=64)	χ²/F值	P值
性别				1.840	0.399
男	74(66.7)	251(59.3)^a	38(59.4)
女	37(33.3)	169(40.0)	26(40.6)
年龄[(x±s)岁]	43.9±11.3	39.5±10.0	39.5±9.8	8.772	< 0.001
民族				0.681	0.711
汉族	107(96.4)	412(97.4)	63(98.4)
其他	4(3.6)	11(2.6)	1(1.6)
文化程度				3.404	0.182
文盲或小学	87(78.4)	361(85.3)	52(81.3)
初中及以上	24(21.6)	62(14.7)	12(18.7)
职业				2.934	0.569
农民	60(54.1)	240(56.7)	40(62.5)
无业	20(18.0)	90(21.3)	12(18.8)
其他	31(27.9)	93(22.0)	12(18.7)
个人月收入(元)				14.127	0.007
< 1 000	67(60.4)	314(74.2)	47(73.4)
1 000~	23(20.7)	37(8.8)	8(12.5)
2 000~	21(18.9)	72(17.0)	9(14.1)
感染途径				8.919	0.178
商业异性传播	18(16.2)	69(16.3)	10(15.6)
偶然异性性伴	21(18.9)	72(17.0)	12(18.8)
采血(浆)	47(42.3)	229(54.1)	34(53.1)
其他	25(22.5)	53(12.5)	8(12.5)
注:^a表示常规治疗组性别有3例数据缺失。

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表 2 单阳家庭中的阴性配偶HIV阳转情况

Table 2. HIV positive transition of negative spouse in HIV sero-discordant couples

HIV阳转配偶特征	未治疗组 (n=111)	常规治疗组 (n=423)	早期治疗组 (n=64)	χ²值	P值
配偶HIV阳转				1.955	0.003
是	16	24	2
否	95	399	62
随访时间(人年)	258.92	4987.17	862.25	6.072	0.048
配偶HIV阳转率(95%CI值) (/100人年)	6.18 (3.05~8.63)	0.48 (0.28~0.67)	0.23 (0.00~0.55)
HIV阳转年限 (年)				-^a	0.070
<1	8	8	0
2~	8	8	1
3~	0	5	0
4~	0	3	1
注：^a表示Fisher确切概率法。

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表 3 HIV单阳家庭598例先证者生存状况分析

Table 3. Analysis of the survival conditions of 598 probands in HIV sero-discordant couples

随访时间(年)	期初例数	删失例数	有效观察例数	死亡例数	死亡概率(%)	累计生存率(%)	累计生存率(%)	累计生存率标准误
0	598	0	598.0	53	8.86	91.14	91.14	0.01
1	545	7	541.5	20	3.69	96.31	87.77	0.01
2	518	6	515.0	17	3.30	96.70	84.87	0.01
3	495	11	489.5	18	3.68	96.32	81.75	0.02
4	466	14	459.0	20	4.36	95.64	78.19	0.02
5	432	15	424.5	12	2.83	97.17	75.98	0.02
6	405	11	399.5	9	2.25	97.75	74.27	0.02
7	385	5	382.5	6	1.57	98.43	73.10	0.02
8	374	7	370.5	7	1.89	98.11	71.72	0.02
9	360	10	355.0	5	1.41	98.59	70.71	0.02
10	345	11	339.5	4	1.18	98.82	69.88	0.02
11	330	15	322.5	7	2.17	97.83	68.36	0.02
12	308	9	303.5	5	1.65	98.35	67.24	0.02
13	294	5	291.5	4	1.37	98.63	66.31	0.02
14	285	50	260.0	3	1.15	98.85	65.55	0.02
15	232	105	179.5	1	0.56	99.44	65.18	0.02
16	126	79	86.5	0	0.00	100.00	65.18	0.02
17	47	9	42.5	1	2.35	97.65	63.65	0.03
18	37	2	36.0	2	5.56	94.44	60.11	0.03
19	33	0	33.0	0	0.00	100.00	60.11	0.03
20	33	0	33.0	1	3.03	96.97	58.29	0.04
21	32	5	29.5	1	3.39	96.61	56.32	0.04
22	26	26	13.0	0	0.00	100.00	56.32	0.04

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表 4 HIV单阳家庭先证者死亡的单因素和多因素Cox比例风险模型分析

Table 4. Univariate and multivariate Cox proportional risk model analysis of probands death in HIV sero-discordant couples

变量	单因素Cox比例风险模型			多因素Cox比例风险模型
变量	β值	HR(95% CI)值	P值	β值	HR(95% CI)值	P值
治疗方法
未治疗组		1.000			1.000
常规治疗组	-3.065	0.047(0.034~0.065)	< 0.001	-2.956	0.052(0.037~0.074)	< 0.001
早期治疗组	-4.595	0.010(0.003~0.032)	< 0.001	-4.535	0.011(0.003~0.035)	< 0.001
性别
男		1.000			1.000
女	-0.561	0.571(0.416~0.782)	< 0.001	-0.404	0.667(0.472~0.944)	0.022
年龄(岁)	0.054	1.055(1.042~1.069)	< 0.001	0.040	1.041(1.026~1.056)	< 0.001
职业
农民		1.000			1.000
无业	0.197	1.303(0.886~1.918)	0.179	0.452	1.571(1.037~2.381)	0.033
其他	0.159	2.349(1.720~3.209)	< 0. 001	0.442	1.507(0.914~2.649)	0.104
个人月收入(元)
< 1 000		1.000			1.000
1 000~	0.196	2.530(1.716~3.701)	< 0. 001	0.153	1.165(0.725~1.870)	0.528
2 000~	0.164	2.632(1.910~3.629)	< 0. 001	0.293	1.341(0.914~2.649)	0.341
HIV感染途径
商业异性传播		1.000			1.000
偶然异性性伴	0.178	1.191(0.809~1.753)	0.375	0.235	1.265(0.832~1.923)	0.272
采血(浆)	-0.898	0.407(0.278~0.598)	< 0. 001	-0.319	0.727(0.465~1.136)	0.161
其他	-0.173	0.842(0.539~1.313)	0.447	-0.450	0.638(0.385~1.055)	0.080
结婚年限(年)
< 5		1.000			1.000
5~	0.276	1.318(0.831~2.090)	0.241	-0.189	0.828(0.510~1.344)	0.445
15~	0.120	1.128(0.710~1.792)	0.610	0.199	1.220(0.739~2.017)	0.437
25~	-0.636	0.529(0.343~0.817)	0.004	0.026	1.026(0.631~1.668)	0.917

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