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目的了解贵州省艾滋病患者退出抗病毒治疗的情况及其影响因素。方法采用回顾性队列研究方法,分析贵州省2005-2015年入组抗病毒治疗的艾滋病患者退出治疗的情况,运用COX比例风险回归模型分析其影响因素。结果 13 632例患者中,开始治疗时的年龄18.00~90.25岁(41.79±14.19)岁,已婚或同居者占58.38%(7 958/13 632),退出治疗比例为23.12%(3 152/13 632),治疗患者的随访时间中位数M=20.00[四分位数间距(IQR):10.00~37.00]个月,治疗6个月、1年、5年的退出累计发生率分别为0.13%,0.18%,0.35%。COX比例风险分析结果显示:女性患者退出治疗的风险是男性的0.84倍[95%可信区间(CI):0.77~0.92];随着年龄增高退出治疗、死亡、停药的风险亦增高,其中≥60岁组退出治疗、死亡、停药的风险,分别是<30岁组的2.18倍(95%CI:1.89~2.53)、3.06倍(95%CI:2.45~3.83)、1.84倍(95%CI:1.40~2.43)。注射吸毒是退出治疗的危险因素,注射吸毒者退出治疗、死亡的风险,分别是输血或单采供血者的4.13倍(95%CI:2.05~8.31)和3.90倍(95%CI:1.74~8.79)。基线CD4+T淋巴细胞计数越高,患者退出治疗和死亡的风险越低,但停药的风险越高。其中基线CD4+T淋巴细胞≥400个/mm3组退出治疗、死亡、停药的风险分别是<100个/mm3组的0.67倍(95%CI:0.57~0.78)、0.22倍(95%CI:0.16~0.30)、2.17倍(95%CI:1.56~3.03)。2012-2015年启动治疗的患者退出治疗、停药的风险,分别是2005-2011年者的1.74倍(95%CI:1.56~1.95)和2.56倍(95%CI:1.95~3.36)。结论建议重点加强艾滋病患者抗病毒治疗前、后的依从性教育,在扩大治疗人数的同时注重提高医疗水平和服务质量,优化用药方案,加强家庭和社会支持,以防止退出治疗。
Objective To understand the situation of AIDS patients with withdrawal from antiviral therapy in Guizhou Province and its influencing factors. Methods A retrospective cohort study was conducted to analyze the withdrawal of AIDS patients from 2005 to 2015 in Guizhou Province. COX proportional hazards regression model was used to analyze the influencing factors. Results Among 13 632 patients, the age at onset of treatment was 18.00-90.25 years (41.79 ± 14.19) years, married or cohabited 58.38% (7 958/13 632), and withdrawal from treatment was 23.12% (3 152/13 632). The median follow-up time for treatment was M = 20.00 [interquartile range (IQR): 10.00-37.00] months, and the cumulative incidence of withdrawal 6 months, 1 year and 5 years after treatment was 0.13% , 0.18%, 0.35%. COX proportional hazards analysis showed that the risk of withdrawing women was 0.84 times higher than that of men (95% confidence interval (CI): 0.77 to 0.92]. Withdrawal of treatment with age increased the risk of death and withdrawal The risk of withdrawal from treatment, death and discontinuation in patients ≥60 years of age was 2.18 times (95% CI: 1.89-2.53), 3.06 times (95% CI: 2.45-3.83), 1.84 times (95% CI: 1.40 ~ 2.43). Injecting drug addicts is a risk factor for withdrawal from treatment. The risk of death from injecting drug users is 4.13 times (95% CI: 2.05 ~ 8.31) and 3.90 times (95% CI: 1.74 ~ 8.79 ). The higher the baseline CD4 + T-lymphocyte count, the lower the patient’s risk of withdrawal from treatment and death, but the higher the risk of discontinuation. The risk of death or discontinuation of withdrawal from treatment with baseline CD4 + T lymphocyte count ≥400 / mm3 was 0.67 times (95% CI: 0.57-0.78) and 0.22 times (95% CI: 0.16-0.30), 2.17-fold (95% CI: 1.56-3.03). Patients who started treatment between 2012 and 2015 were at 1.74 times (95% CI: 1.56 to 1.95) and 2.56 times (95% CI: 1.95 to 3.36), respectively, of withdrawal from treatment and withdrawal from 2005-2011. Conclusions It is suggested to strengthen the education of AIDS patients’ pre and post-anti-virus treatment compliance. While expanding the treatment population, we should pay attention to improving medical quality and service quality, optimizing medication plan and strengthening family and social support so as to prevent withdrawal from treatment.