2000―2021年南京市HIV/AIDS患者生存状况及影响因素的回顾性队列

徐园园; 李小杉; 王静文; 仇蓓蓓; 吴苏姝; 李昕; 时红杰; 朱正平

doi:10.16462/j.cnki.zhjbkz.2024.12.012

2000―2021年南京市HIV/AIDS患者生存状况及影响因素的回顾性队列

doi: 10.16462/j.cnki.zhjbkz.2024.12.012

1.
南京市疾病预防控制中心艾滋病性病防制科，南京 210003
2.
南京医科大学附属无锡市人民医院肺移植中心，无锡 214023
3.
南京市疾病预防控制中心慢性传染病防制科，南京 210003

基金项目:

国家自然科学基金 82103896

江苏省社科应用研究精品工程课题 23SYC-007

南京市卫生科技发展专项资金项目 ZKX23059

南京市卫生科技发展专项资金项目 YKK23192

南京医科大学南京公共卫生研究院创新强基项目 NQJ2301

南京市疾控中心青年人才科研培育团队项目 NPY2307

详细信息

通讯作者:
朱正平，E-mail：zzp@njcdc.cn

中图分类号: R183
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出版历程
- 收稿日期: 2023-08-16
- 修回日期: 2024-06-14
- 网络出版日期: 2025-01-24
- 刊出日期: 2024-12-10

Analysis on the survival status and influencing factors of HIV/AIDS: a retrospective cohort study from 2000 to 2021 in Nanjing, China

1.
Department of AIDS/STD Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China
2.
Department of Lung Transplant Center, Nanjing Medical University Affiliated Wuxi People′s Hospital, Wuxi 214023, China
3.
Department of Chronic Infectious Disease Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China

Funds:

National Natural Science Foundation of China 82103896

Jiangsu Province Social Science Application Research Excellent Engineering projects 23SYC-007

Nanjing Medical Science and Technology Development Project ZKX23059

Nanjing Medical Science and Technology Development Project YKK23192

Nanjing Medical University Nanjing Institute of Public Health Strengthening Project NQJ2301

Nanjing CDC Young Talents Research and Development Team Project NPY2307

More Information

Corresponding author: ZHU Zhengping, E-mail: zzp@njcdc.cn

摘要

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。
- 人类免疫缺陷病毒 /
- 艾滋病 /
- 抗逆转录病毒治疗 /
- 生存时间 /
- 死亡率 /
- 危险因素
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.
- Human immunodeficiency virus /
- Acquired immune deficiency syndrome /
- Antiretroviral therapy /
- Survival time /
- Mortality /
- Risk factor

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图 1 2000―2021年南京市HIV/AIDS患者的Kaplan-Meier生存曲线

HIV: 人类免疫缺陷病毒; AIDS: 艾滋病; A：确诊至首次治疗不同间隔时间；B：不同治疗前首次CD4计数；C：不同基线病毒载量。

Figure 1. Kaplan-Meier survival curves of HIV/AIDS in Nanjing from 2000 to 2021

HIV: human immunodeficiency virus; AIDS: acquired Immune deficiency syndrome; A: different time interval from diagnosis to ART; B: different first CD4 count; C: different baseline viral load.

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图 2 2000―2021年南京市确诊至首次治疗不同间隔时间HIV/AIDS患者的Kaplan-Meier生存曲线

HIV: 人类免疫缺陷病毒; AIDS: 艾滋病; A：治疗前首次CD4计数 < 200个/μL亚组；B：治疗前首次CD4计数200~＜500个/μL亚组；C：治疗前首次CD4计数≥500个/μL亚组。

Figure 2. Kaplan-Meier survival curves of HIV/AIDS in Nanjing by different time interval from 2000 to 2021

HIV: human immunodeficiency virus; AIDS: acquired Immune deficiency syndrome; A: first CD4 count before ART < 200 cells/μL subgroup; B: first CD4 count before ART 200~ < 500 cells/μL subgroup; C: first CD4 count before ART ≥ 500 cells/μL subgroup.

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表 1 2000―2021年南京市HIV/AIDS患者AIDS相关死亡单因素Cox比例风险模型分析

Table 1. Univariate cox proportional hazard regression analysis of the factors associated with AIDS-related mortality of HIV/AIDS in Nanjing from 2000 to 2021

变量 Variable	总人数Total^① (n=5 903)	死亡Death^① (n=279)	HR值value (95% CI)	P值 value
性别Gender
男性Male	5 450(92.3)	235(4.3)	1.000
女性Female	453(7.7)	44(9.7)	2.208(1.600~3.048)	< 0.001
确诊时年龄/岁Age at diagnosis/years
15~＜25	1 375(23.3)	11(0.8)	1.000
25~＜50	3 445(58.4)	160(4.6)	5.620(3.050~10.353)	< 0.001
50~91	1 083(18.3)	108(10.0)	13.921(7.484~25.893)	< 0.001
婚姻状况Marital status
未婚Single	3 227(54.6)	70(2.2)	1.000
已婚Married	1 839(31.2)	142(7.7)	3.577(2.686~4.763)	< 0.001
离异/丧偶Divorced/widowed	796(13.5)	61(7.7)	3.264(2.313~4.606)	< 0.001
未知Unknown	41(0.7)	6(14.6)	5.982(2.597~13.778)	0.055
民族Nationality
汉族The Han nationality	5 782(98.0)	274(4.7)	1.000
其他Minority	121(2.0)	5(4.1)	0.905(0.374~2.192)	0.825
文化程度Education
大专及以上College or above	3 060(51.8)	47(1.5)	1.000
高中Senior	1 344(22.8)	74(5.5)	3.354(2.326~4.835)	< 0.001
初中及以下Junior or below	1 499(25.4)	158(10.5)	6.771(4.887~9.382)	< 0.001
感染途径Infection route
同性Homosexual	4 023(68.2)	99(2.5)	1.000
异性Heterosexual	1 639(27.7)	132(8.1)	3.463(2.668~4.495)	< 0.001
注射毒品Injecting drug	176(3.0)	31(17.6)	6.151(4.102~9.224)	< 0.001
不详Unkown	65(1.1)	17(26.2)	10.720(6.400~17.958)	< 0.001
样本来源Sample source
咨询检测Voluntary counseling and testing	2 736(46.4)	51(1.9)	1.000
医疗机构Medical institution	2 356(39.9)	195(8.3)	4.490(3.304~6.102)	< 0.001
其他Others	811(13.7)	33(4.1)	1.328(0.803~2.195)	0.269
首次CD4计数/(个·μL^-1) The first CD4 count before ART/(cells·μL^-1)
< 200	1 386(23.5)	108(7.8)	1.000
200~＜500	3 139(53.2)	61(1.9)	0.251(0.183~0.344)	< 0.001
≥500	1 235(20.9)	19(1.5)	0.188(0.116~0.306)	< 0.001
未检测Untested	143(2.4)	91(63.6)	19.035(13.905~26.056)	< 0.001
基线VL Baseline VL/(copies·mL^-1)
< 20 000	510(8.6)	3(0.6)	1.000
20 000~＜80 000	477(8.1)	5(1.0)	1.854(0.443~7.756)	0.398
≥80 000	405(6.9)	17(4.2)	7.401(2.169~25.255)	0.001
未检测Untested	4 511(76.4)	254(5.6)	6.792(2.172~21.239)	0.001
确诊至首次治疗间隔时间Time interval from diagnosis to ART/d
未治疗Untreated	406(6.9)	167(41.1)	1.000
≥31	3 347(56.7)	80(2.4)	0.030(0.023~0.040)	< 0.001
＞7~＜31	1 665(28.2)	29(1.7)	0.034(0.023~0.050)	< 0.001
≤7	485(8.2)	3(0.6)	0.014(0.004~0.044)	< 0.001
注：HIV, 人类免疫缺陷病毒; AIDS, 艾滋病; VL, 病毒载量; ART, 抗病毒治疗。 ①以人数(占比/%)表示。 Note：HIV, human immunodeficiency virus; AIDS, acquired Immune deficiency syndrome; VL, viral load; ART, antiretroviral therapy. ① Number of people (proportion/%).

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表 2 2000―2021年南京市HIV/AIDS患者AIDS相关死亡单因素Cox比例风险模型分析

Table 2. Univariate cox proportional hazard regression analysis of the factors associated with AIDS-related mortality of HIV/AIDS in Nanjing from 2000 to 2021

变量 Variable	β值 value	s_x值 value	Wald χ²值 value	aHR值value (95% CI)	P值 value
确诊时年龄/岁Age at diagnosis/years
15~＜25				1.000
25~＜50	0.835	0.319	6.850	2.305(1.233~4.307)	0.009
50~91	0.949	0.334	8.097	2.584(1.344~4.968)	0.004
文化程度Education
大专及以上College or above				1.000
高中Senior	0.676	0.183	13.670	1.833(1.257~2.673)	0.002
初中及以下Junior or below	0.606	0.192	9.916	1.967(1.374~2.815)	< 0.001
样本来源Sample source
咨询检测Voluntary counseling and testing				1.000
医疗机构Medical institution	0.433	0.348	1.008	1.541(1.104~2.151)	0.011
其他Others	-0.350	0.260	0.020	0.705(0.356~1.395)	0.315
治疗前首次CD4计数/(个·μL^-1)The first CD4 count before ART/(cells·μL^-1)
< 200				1.000
200~＜500	-1.303	0.168	59.890	0.272(0.195~0.378)	< 0.001
≥500	-1.805	0.262	47.354	0.164(0.098~0.275)	< 0.001
未检测Untested	0.200	0.181	1.229	1.222(0.857~1.742)	0.268
基线VL Baseline VL/(copies·mL^-1)
< 20 000				1.000
20 000~＜80 000	0.519	0.732	0.502	1.680(0.400~7.062)	0.479
≥80 000	1.878	0.628	8.943	6.540(1.910~22.391)	0.003
未检测Untested	0.894	0.586	2.328	2.444(0.775~7.702)	0.127
确诊至首次治疗间隔时间Time interval from diagnosis to ART/d
未治疗Untreated				1.000
≥31	-4.137	0.594	48.441	0.044(0.031~0.063)	< 0.001
＞7~＜31	-3.323	0.232	205.863	0.036(0.023~0.057)	< 0.001
≤7	-3.116	0.178	305.650	0.016(0.005~0.051)	< 0.001
注：HIV, 人类免疫缺陷病毒; AIDS, 艾滋病。 Note：HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome.

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