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Objective:To explore the risk factors of bacterial infections in patients with decompensated hepatitis B cirrhosis and to construct a risk prediction model.Methods:The clinical data of 198 patients with decompensated hepatitis B cirrhosis admitted in Zhejiang Provincial People’s Hospital from January 2014 to April 2020 were retrospectively analyzed. There were 86 patients with bacterial infection (infection group) and 112 patients without bacterial infections (non-infection group). The risk factors of bacterial infections were analyzed by multivariate Logistic regression. R language was used to establish a nomogram model to predict the risk of bacterial infection in patients with decompensated hepatitis B cirrhosis. Receiver operating characteristic (ROC) curve was used to explore the prediction efficiency of the nomogram model for bacterial infection.Results:Multivariate logistic regression analysis showed that previous smoking history, prothrombin time, neutrophil count and hypersensitive C protein were independent risk factors for bacterial infection in patients with decompensated hepatitis B cirrhosis ( P<0.05 or <0.01), while regular antiviral treatment and high-density lipoprotein were protective factors ( P<0.05 or <0.01). ROC curve showed that the area under the curve (AUC) of risk prediction model for bacterial infections was 0.872 (95% CI 0.820-0.924, P<0.01), and AUC of MELD score for predicting bacterial infections was 0.670 (95% CI 0.599-0.735, P<0.01); the risk prediction model was superior to MELD score in prediction ( Z=4.89, P<0.01). Conclusions:The established risk prediction model in this study can more accurately predict the occurrence of bacterial infections in patients with decompensated hepatitis B cirrhosis.
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Objective@#To evaluate the effectiveness and to explore the releated factors of antiretroviral therapy among HIV/AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan Province.@*Methods@#The method of convenience sampling was adopted in July 2017 to select the research objects who were accepted antiretroviral therapy (ART) over 6 months, older than 18 years and had HIV viral load in 2016, totally 400 cases. A retrospective study was used to collect the data, including social demography, medicine use, information of medical service acquisition, their own behaviors and cognition. 395 questionnaires were effectively recovered. χ2 test and logistic regression were performed to examine relationships between factors and effects.@*Results@#All of the 395 respondents were Yi-nationality. The average age of all cases was (39.23±7.52) years old and 223 were male (56.5%). Among 395 cases patients who were detect Viral load in 2016, 221 cases were under the number of 400 copies, thze effective rate of ART was 55.9%. Multivariate analysis showed that HIV/AIDS patients who missed the medication during the antiviral therapy had poor antiviral effects. Compared to those who adhered to medication, the treatment-ineffective OR (95%CI) of the patients missing the medication during the therapy was 7.06 (3.67-13.58); Compared to those who had adverse reactions that affect the therapy, the treatment-ineffective OR (95%CI) of the patients with mild adverse reactions that did not affect the therapy was 0.45 (0.23-0.87); Compared to the patients who used drugs during the treatment, the treatment-ineffective OR (95%CI) value of the antiretroviral therapy effect of non-drug users was 0.39 (0.16-0.91);Compared to the patients who have a correct cognition that insisting on taking medicine correctly can extend their life expectancy as a common person, the treatment-ineffective OR (95%CI) values for those who hold the view that could be prolonged by 10-20 years and not/unknown were 4.18 (1.59-10.99) and 6.64 (2.67-16.53).@*Conclusion@#The HIV/AIDS patients who receive ART were less effective in Liangshan, Prefecture. Missings drugs is one of the main influencing factors for the ineffective treatment.
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Objective To investigate the epidemiologic and behavioral characteristics of HIV among community population in Liangshan prefecture.Methods We collected social demographic,behavioral and serological information by means of the monitoring questionnaire and serological tests.Data was analyzed by using the chi-square test and logistic regression.Results From April to June of 2010 to 2015,14 092 cases of community population were selected as the study objects,with 267 cases diagnosed as HIV positive patients.The HIV positive rates were 3.24％,3.07％,1.17％,1.38％,1.42％ and 1.25％,respectively.We observed that when community population having the following characteristics as:living in Butuo country (OR=3.83),being males (OR=1.77),being Yi nationality (OR=4.40) being widowed (OR=28.57),with history of drug abuse (OR=3.71) or injecting drug use (PWID) (OR=4.92),or history of needle sharing among PWID (OR=8.53),were under higher risks for HIV infection.With histories as:having had secondary or above levels of schooling (OR=0.59),having protected sex with regular parmers (OR =0.21) and with non-regular partners (OR =0.46),they seemed to be somehow protected for getting HIV infection.Conclusion The positive HIV rates of HIV among community population in Dechang,Ningnan and Butuo varied from 0.10％ to 8.77％while the HIV transmission among general population remained challenging.
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Objective To analyze the HIV-infection related behaviors among unmarried youths in rural areas of Liangshan prefecture from 2011 to 2013 and factors that influencing the HIV transmission in the population under research.Methods According to the HIV sentinel surveillance methods for data collection,EpiData 3.1 and SPSS 19.0 were used to handle data and both Chi-square test and logistic regression were used to explore the related factors.Results A total number of 5 871 qualified youths were involved in this study from 2011 to 2013 with the prevalence rate on HIV infection among those unmarried youths from the rural areas as 3.45％ (201/5 833).27.56％ (1 607/ 5 833) of them had been working outside their hometown area.31.72％ (1 850/5 833) of the unmarried youths had sexual experiences,with 41.46％ (767/1 850) of them had casual sex but the rate of consistent condom use was only 3.46％ (64/1 850).5.04％ (294/5 833) of the unmarried youths admitted of ever having used drugs,with 34.35％ (101/294) of them having the experiences of injecting,with 84.16％ (85/101) of them sharing needles.Rates on factors as:working outside the resident areas,ever having had casual sexual behaviors,drug use and injecting drug use were seen higher among HIV infections,with differences statistically significant (X2=88.72,104.43,4.20,154.39,55.94,P＜0.05).Results from the logistic regression showed that factors as:being male,Yi ethnicity,illiteracy,experience of working outside the resident area,never or casual condom use and needle-sharing drug use etc.would significantly increase the risk of HIV infection.Conclusions HIV infection among unmarried youths from rural areas in Liangshan prefecture called for attention because of the high rates of risk behaviors.Factors as:having had sexual experiences with low condom use,popular injecting drug use with needle sharing,being male,under Yi ethnicity,with lower education level and ever working outside the resident area etc.were under risks that related to HIV infection for unmarried youths in this area.
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Objective To investigate the epidemiologic and behavioral characteristics of HIV among community population in Liangshan prefecture.Methods We collected social demographic,behavioral and serological information by means of the monitoring questionnaire and serological tests.Data was analyzed by using the chi-square test and logistic regression.Results From April to June of 2010 to 2015,14 092 cases of community population were selected as the study objects,with 267 cases diagnosed as HIV positive patients.The HIV positive rates were 3.24％,3.07％,1.17％,1.38％,1.42％ and 1.25％,respectively.We observed that when community population having the following characteristics as:living in Butuo country (OR=3.83),being males (OR=1.77),being Yi nationality (OR=4.40) being widowed (OR=28.57),with history of drug abuse (OR=3.71) or injecting drug use (PWID) (OR=4.92),or history of needle sharing among PWID (OR=8.53),were under higher risks for HIV infection.With histories as:having had secondary or above levels of schooling (OR=0.59),having protected sex with regular parmers (OR =0.21) and with non-regular partners (OR =0.46),they seemed to be somehow protected for getting HIV infection.Conclusion The positive HIV rates of HIV among community population in Dechang,Ningnan and Butuo varied from 0.10％ to 8.77％while the HIV transmission among general population remained challenging.
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Objective To analyze the HIV-infection related behaviors among unmarried youths in rural areas of Liangshan prefecture from 2011 to 2013 and factors that influencing the HIV transmission in the population under research.Methods According to the HIV sentinel surveillance methods for data collection,EpiData 3.1 and SPSS 19.0 were used to handle data and both Chi-square test and logistic regression were used to explore the related factors.Results A total number of 5 871 qualified youths were involved in this study from 2011 to 2013 with the prevalence rate on HIV infection among those unmarried youths from the rural areas as 3.45％ (201/5 833).27.56％ (1 607/ 5 833) of them had been working outside their hometown area.31.72％ (1 850/5 833) of the unmarried youths had sexual experiences,with 41.46％ (767/1 850) of them had casual sex but the rate of consistent condom use was only 3.46％ (64/1 850).5.04％ (294/5 833) of the unmarried youths admitted of ever having used drugs,with 34.35％ (101/294) of them having the experiences of injecting,with 84.16％ (85/101) of them sharing needles.Rates on factors as:working outside the resident areas,ever having had casual sexual behaviors,drug use and injecting drug use were seen higher among HIV infections,with differences statistically significant (X2=88.72,104.43,4.20,154.39,55.94,P＜0.05).Results from the logistic regression showed that factors as:being male,Yi ethnicity,illiteracy,experience of working outside the resident area,never or casual condom use and needle-sharing drug use etc.would significantly increase the risk of HIV infection.Conclusions HIV infection among unmarried youths from rural areas in Liangshan prefecture called for attention because of the high rates of risk behaviors.Factors as:having had sexual experiences with low condom use,popular injecting drug use with needle sharing,being male,under Yi ethnicity,with lower education level and ever working outside the resident area etc.were under risks that related to HIV infection for unmarried youths in this area.
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<p><b>OBJECTIVE</b>To investigate the survival time and affecting factors among AIDS patients under antiretroviral treatment, between 2008 and 2013 in Liangshan, Sichuan province.</p><p><b>METHODS</b>Observational retrospective cohort study method was applied. AIDS patients were chosen from China's national comprehensive prevention and control management system of AIDS in Liangshan, during 2008-2013. Related information on demographics, source of infection, pathogenesis, treatment and death was collected. Cox proportional hazards model was applied to analyze the factors that might affect the survival on patients.</p><p><b>RESULTS</b>Among the 8 321 cases, ranging from 18 to 87.5 years old (mean age as 34.2 ± 9.8), 3 021 died and 3 721 patients had received HAART treatment. The total mortality rate dropped from 43.9/100 person-years to 20.7/100 person-years from 2008 to 2013. In the treatment group, mortality rate dropped from 27.3/100 person-years to 5.1/100 person-years, while in the untreated group it remained high-between 45.0/100-50.8/100 person-years. Proportion for the treatment coverage increased gradually, from 5.8% in 2008 to 54.5% in 2013. Median survival time of all the AIDS patients was 35.1 months, but 18.4 months in the untreated group. Survival of all the AIDS patients was associated with factors as: treatment, age when AIDS diagnosis was made and route of HIV infection (P < 0.05). The risk of death among untreated patients was 5.78 times to the treated ones, but did not seem to relate to gender or nationality (P > 0.05). Survival of the treated group was associated with factors as gender, age when AIDS diagnosis was made, nationality, route of HIV infection, CD4(+) T cell count when AIDS diagnosis was made, CD4(+) T cell count at treatment baseline, anemia at the treatment baseline (P < 0.05). Survival of the untreated group was mainly associated with age when AIDS was diagnosed (P < 0.05) while other factors did not seem to be significantly related (P > 0.05).</p><p><b>CONCLUSION</b>Antiretroviral therapy appeared an important factor that affecting the survival of AIDS patients, timely treatment and CD4(+) T cell count provided at the baseline for treatment, were two key factors that affecting the outcome of treatment. Our findings pointed out that tactic factors as: strengthening the detection, monitoring on CD4(+) T cell count, early diagnose and treatment, expanding the coverage of antiretroviral therapy, and appropriate timing for treatment etc., were important ways to enhance the effects of treatment, so as to reduce the mortality rate and prolong the time of survival.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Acquired Immunodeficiency Syndrome , Drug Therapy , Mortality , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , China , Epidemiology , Proportional Hazards Models , Retrospective Studies , Survival Rate , Time-to-Treatment , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment (ART) of Liangshan Yi Autonomous Prefecture, Sichuan province.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the information of AIDS patients over 18 years old initially received ART in Liangshan Yi Autonomous Prefecture during 2005-2013, which were downloaded from Chinese AIDS Antiretroviral Therapy DATA Fax Information System. Cox proportion hazard regression model was used to identify impact factors related survival time.</p><p><b>RESULTS</b>Among 8 310 ART AIDS patients who initially received ART, their mean age was (34.59 ± 9.10) years old, 65.50% (5 443 cases) were infected with HIV through injecting drug use, the mean time from testing HIV positive to starting ART were (24.68 ± 21.69) months. 436 cases died of AIDS related diseases, 28.67% (125 cases) of them died within the first 6 months of treatment. The cumulative survival rate of receiving ART in 1, 2, 3, 4 5 years were 97.11%, 93.41%, 90.61%, 88.81%, 86.02%, respectively. Multivariate Cox regression analysis showed the male patients receiveing ART were at a higher risk death of AIDS related diseases compared to the females (HR = 1.57, 95% CI: 1.13-2.182), the patients infected with HIV through injecting drug use were at a higher risk deathcompared to the infected through heterosexual transmission (HR = 1.64, 95% CI: 1.20-2.24), before the treatment patients with tuberculosis in recent1 year had higher death hazard as compared to those without tuberculosis (HR = 1.53, 95% CI: 1.05-2.21), in the treatment of the first 3 months of AIDS related diseases or symptoms of AIDS patients had higher death hazard as compared to those not suffer these diseases (HR = 1.80, 95% CI: 1.39-2.34). The patients with baseline CD4 (+) T lymphocytes cell counts < 50/µl (HR = 9.79, 95% CI: 6.03-15.89), 50-199/µl (HR = 3.26, 95% CI: 2.32-4.59), 200-349/µl (HR = 1.69, 95% CI: 1.22-2.34), were at a higher risk death than those with CD4 (+) T lymphocytes cell counts ≥ 350/µl.</p><p><b>CONCLUSION</b>Accumulate survival rate was higher after initial antiretroviral treatment among AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan province. AIDS patients who are males, have tuberculosis in recent year, infected HIV via route of intravenous drug use, with AIDS-related illness or symptoms in 3 months before ART, lower baseline CD4 (+) T lymphocyte count have higher risk of death.</p>
Subject(s)
Adult , Female , Humans , Male , Acquired Immunodeficiency Syndrome , Drug Therapy , Mortality , Anti-Retroviral Agents , Therapeutic Uses , Asian People , China , Lymphocyte Count , Proportional Hazards Models , Retrospective Studies , Risk Factors , Substance Abuse, Intravenous , Survival Rate , TuberculosisABSTRACT
<p><b>OBJECTIVE</b>To analyze the survival time and its related factors among AIDS patients in Liangshan prefecture of Sichuan province from 1995 to 2012.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the information of 5 263 AIDS patients. The data were collected from Chinese HIV/AIDS Comprehensive Information Management System. Life table method was applied to calculate the survival proportion, and Kaplan-Meier and Cox proportion hazard regression model were used to identify the factors related to survival time.</p><p><b>RESULTS</b>Among 5 273 AIDS patients, 819 (15.6%)died of AIDS related diseases; 2 782(52.9%) received antiretroviral therapy. The average survival time was 126.7 (117.1-136.2) months, and the survival rate in 1, 5, 10, 15 years were 95.4%, 78.8%, 54.2%, and 31.8% respectively. Univariate analysis showed a significant difference in survival time of age diagnosed as AIDS patients, nationality, transmission route, AIDS phase, CD4(+)T cell counts in the last testing, receiving antiretroviral therapy or not. Multivariate Cox regression showed age diagnosed AIDS below 50 years old ( < 15 years old:HR = 0.141, 95%CI:0.036-0.551;15-49 years old:HR = 0.343, 95%CI:0.241-0.489), HIV infection diagnosed phase (HR = 0.554, 95%CI:0.432-0.709), CD4(+)T cell counts last testing ≥ 350/µl (HR = 0.347, 95%CI:0.274-0.439) reduced the risk of dying of AIDS related diseases among AIDS patients. The patients having not received antiretroviral therapy had a higher risk of death(HR = 3.478, 95%CI:2.943-4.112) compared to those who received antiretroviral therapy.</p><p><b>CONCLUSION</b>Survival time of AIDS patients was possibly mainly influenced by the age of diagnosed as AIDS patients, AIDS phase, CD4(+)T cell counts and whether or not received antiretroviral therapy. The early initiation of antiretroviral therapy could extend the survival time.</p>
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , Mortality , China , Epidemiology , Cohort Studies , HIV Infections , Proportional Hazards Models , Retrospective Studies , Survival Analysis , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To analyze the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment (ART) in Liangshan prefecture during 2004-2012.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the information of AIDS patients who initially received ART. Data on patients was collected from the Chinese AIDS Antiretroviral Therapy DATAFax Information System. Life table was applied to calculate the survival proportion, and Cox proportion hazard regression model was used to identify impact factors that were related to the time of survival.</p><p><b>RESULTS</b>Among 5 525 AIDS patients who initially received ART, the median age was (34.5± 9.0) year old, with 73.9% being males, 65.8% were infected through injecting drug use, time from HIV tested HIV positive to starting ART was (23.0±20.1) months. 287 cases died of AIDS related diseases, and their median time of receiving ART was (12.7±10.6) months, and 32.8% of them died within the first 6 months of treatment. Cumulative survival rates of the patients who had received ART in 1, 2, 3, 4, 5 years were 97%, 93%, 89%, 88%, 84%, respectively. Results from multivariate Cox regression showed that female patients who received ART were at a lower risk to the death of AIDS related diseases(HR = 0.556, 95%CI:0.367-0.872), when compared to the males. Patients infected with HIV through injecting drug use were at a higher risk to death (HR = 1.569, 95% CI:1.061-2.321) when compared to those who were infected through heterosexual transmission. Patients with baseline CD4(+) T cells counts at <50 cells/mm(3) (HR = 11.996, 95% CI: 6.714-21.435) or 50-200 cells/mm(3) (HR = 2.481, 95%CI:1.620-3.798) were at a higher risk to death than those with CD4(+)T cell counts ≥350 cells/mm(3). Patients without pulmonary tuberculosis were at a lower risk to death(HR = 0.511, 95% CI:0.330-0.791)when compared to those with pulmonary tuberculosis a year before starting the treatment.</p><p><b>CONCLUSION</b>Antiretroviral treatment could prolong the survival time of AIDS patients and with a better rate on survival. Programs on follow-up and CD4(+)T cell counts for AIDS patients should be conducted regularly, as well as timely initiated the antiretroviral therapy.</p>