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目的了解宁波市接受抗病毒治疗的≥60岁的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的流行病学特征及生存情况。方法采用回顾性队列研究方法,对≥60岁HIV/AIDS病人的主要流行病学特征和生存状况进行描述性分析,Kaplan-Meier法绘制生存曲线,寿命表法计算生存率,COX比例风险回归模型分析影响死亡的危险因素。结果 157例≥60岁的研究对象中,接受抗病毒初始治疗的年龄中位数为65[四分数位间距(IQR):62.0~69.5]岁,以男性、本地、已婚或同居、异性性传播、基线CD4+T淋巴细胞(简称CD4细胞)<200个/μL、世界卫生组织(WHO)分期Ⅰ期为主。第1、2、5、7年的累计生存率分别为86%、79%、72%和72%。≥60岁组的病死率高于<60岁组,不同年龄组的KLM曲线,经Log-rank检验差异有统计学意义。多因素COX比例风险回归模型分析显示,≥60岁组,基线WHO临床分期Ⅳ期的死亡危险,是Ⅰ期病人的4.308倍[风险比(HR)=4.308,95%可信区间(CI):1.661~11.173];<60岁组、WHO临床分期Ⅰ期是研究对象死亡的保护因素。在<60岁研究对象中,基线CD4细胞为200~350个/μL组的死亡风险,低于CD4细胞<200个/μL组(HR=0.225,95%CI:0.110~0.460);但不同的基线CD4细胞水平对≥60岁组死亡率影响无统计学意义。在60岁及以上病人中,异性性传播病例的死亡风险低于经同性性行为感染的病例(HR=0.018,95%CI:0.002~0.189),但<60岁组死亡率在不同传播途径间无差异。结论宁波市接受抗病毒治疗的60岁以上HIV/AIDS病人的生存率不高,应根据老年人群的流行特征和死亡危险因素采取针对性的治疗干预策略,早诊断早治疗仍然是提高老年病人生存率的关键。
Objective To understand the epidemiological characteristics and survival of HIV / AIDS patients aged 60 years or more in Ningbo City (referred to as HIV / AIDS patients) receiving antiviral therapy. Methods A retrospective cohort study was conducted to describe the major epidemiological characteristics and survival status of HIV / AIDS patients aged 60 and older. Kaplan-Meier method was used to draw the survival curves, life-table method to calculate survival rate, COX proportional hazard regression model Analysis of the risk factors affecting death. Results Among 157 subjects ≥60 years of age, the median age at first initiation of antiviral therapy was 65 (IQR: 62.0-69.5) years old, with male, local, married or cohabiting, heterosexual Transmission, baseline CD4 + T lymphocytes (CD4 cells for short) <200 / μL, the World Health Organization (WHO) stage Ⅰ-based. The cumulative survival rates at 1, 2, 5, and 7 years were 86%, 79%, 72% and 72%, respectively. The case-fatality rate in the group of 60 years old was higher than that in the group of <60 years old. The KLM curve of different age groups had significant difference by Log-rank test. Multivariate COX proportional hazard regression model analysis showed that the risk of death in the stage of the WHO WHO stage IV was 4.308 times higher than that of stage I in the group of ≥60 years [hazard ratio (HR) = 4.308, 95% confidence interval (CI) 1.661 ~ 11.173]; <60-year-old WHO staging stage Ⅰ is the protective factor of death. In subjects <60 years of age, baseline CD4 cell death was less than 200 cells / μL for CD4 cells (HR = 0.225, 95% CI: 0.110-0.460) in the 200-350 cells / μL group; however, The baseline CD4 cell level had no significant effect on the mortality rate of ≥60 years old group. Among patients 60 and older, the risk of death from heterosexual transmission was lower than that from homosexual transmission (HR = 0.018, 95% CI: 0.002 to 0.189), but the mortality in the 60-year-old group was significantly lower among different transmission routes No difference. Conclusion The survival rate of HIV / AIDS patients over the age of 60 in Ningbo City is not high. According to the epidemiological characteristics of the elderly population and the risk factors of death, targeted treatment intervention strategies should be taken. Early diagnosis and early treatment are still to improve the survival of elderly patients Rate the key.