摘要
目的了解初始抗病毒治疗(ART)儿童HIV感染者死亡和脱失情况及其影响因素。方法采用回顾性队列研究方法,从我国艾滋病综合防治信息系统ART信息系统下载广西壮族自治区(广西)2004-2019年初始ART儿童HIV感染者数据库,采用Cox比例风险回归模型分析其死亡和脱失情况。结果共计943例儿童HIV感染者进入队列,总体病死率和脱失率分别为1.00/100人年和0.77/100人年。初始治疗后第1年病死率和脱失率分别为3.90/100人年和1.67/100人年。初始ART后第1、2、5、10年的累计生存率分别为96.14%、95.80%、93.68%、91.54%。多因素Cox比例风险回归分析显示:女性(aHR=2.00,95%CI:1.17~3.40)、基线CD4^(+)T淋巴细胞(CD4)计数<200个/μl(aHR=2.79,95%CI:1.54~5.06)、基线年龄别体重Z评分<-2(aHR=2.38,95%CI:1.32~4.26)、基线血红蛋白<80 g/L(aHR=2.47,95%CI:1.24~4.92)和初始ART方案含LPV/r(aHR=5.05,95%CI:1.15~22.12)是儿童HIV感染者死亡的关联性因素;女性(aHR=2.23,95%CI:1.22~4.07)和初始ART方案含LPV/r(aHR=2.02,95%CI:1.07~3.79)是儿童HIV感染者脱失的关联性因素。结论广西儿童HIV感染者ART效果较好,但初始ART后第1年病死率和脱失率较高。需针对死亡和脱失的影响因素,加强医护人员培训和儿童HIV感染者及其父母的宣传教育以提高ART效果。
Objective To investigate death and attrition in HIV-infected children under initial antiretroviral therapy(ART)and associated factors in Guangxi Zhuang autonomous region.Methods This retrospective cohort study was conducted in HIV-infected children under initial ART in Guangxi from 2004 to 2019,data from ART information system of National comprehensive AIDS prevention and treatment information system.Cox proportional hazards models were used to assess factors associated with the death and attrition.Results In 943 HIV-infected children,the overall mortality and attrition rates were 1.00/100 person-years and 0.77/100 person-years,respectively.The mortality and attrition rates within the first year of ART were 3.90/100 person-years and 1.67/100 person-years,respectively.The cumulative survival rate during the first,second,fifth and tenth year after ART was 96.14%,95.80%,93.68%and 91.54%,respectively.Multivariate Cox proportional hazards models results showed that being female(aHR=2.00,95%CI:1.17-3.40),CD4^(+)T lymphocytes(CD4)counts before ART<200 cells/μl(aHR=2.79,95%CI:1.54-5.06),weight-for-age Z score before ART<-2(aHR=2.38,95%CI:1.32-4.26),hemoglobin before ART<80 g/L(aHR=2.47,95%CI:1.24-4.92),initial ART with LPV/r(aHR=5.05,95%CI:1.15-22.12)were significantly associated with death;being female(aHR=2.23,95%CI:1.22-4.07)and initial ART with LPV/r(aHR=2.02,95%CI:1.07-3.79)were significantly associated with attrition.Conclusions The effect of ART in HIV-infected children in Guangxi was better,but the mortality and attrition rates were high within the first year of treatment.It is necessary to strengthen the training in medical staff and health education in HIV-infected children and their parents in order to improve the treatment effect.
作者
周业胜
罗柳红
林玫
陈宏利
黄精华
朱秋映
陈欢欢
沈智勇
李剑军
冯毅
李丹
廖玲洁
邢辉
邵一鸣
阮玉华
蓝光华
Zhou Yesheng;Luo Liuhong;Lin Mei;Chen Hongli;Huang Jinghua;Zhu Qiuying;Chen Huanhuan;Shen Zhiyong;Li Jianjun;Feng Yi;Li Dan;Liao Lingjie;Xing Hui;Shao Yiming;Ruan Yuhua;Lan Guanghua(State Key Laboratory of Infectious Disease Prevention and Control,National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Guangxi Key Laboratory for Major Infectious Diseases Prevention and Control and Biosafety Emergency Response,Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention,Nanning 530028,China)
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2022年第9期1430-1435,共6页
Chinese Journal of Epidemiology
基金
国家自然科学基金(82160636,11971479)
广西壮族自治区自然科学基金(2020GXNSFAA159020)
广西壮族自治区艾滋病防控与成果转化研究重点实验室(ZZH2020010)
广西八桂学者专项。
关键词
艾滋病病毒
抗病毒治疗
儿童
死亡
脱失
HIV
Antiretroviral therapy
Children
Mortality
Attrition
