Survival status and influencing factors of HIV/AIDS on highly active anti-retrovial therapy in Shandong province / 中华流行病学杂志

ABSTRACT

Objective To understand the survival status and influencing factors for HIV/AIDS patients on highly active anti-retroviral therapy (HAART) in Shandong province.Methods Both Kaplan-Meier (K-M) method and cumulative incidence function (CIF) were used to calculate the cumulative incidence of AIDS-related death respectively,and Fine-Gray model was used to identify the influencing factors related to survival time.Results Through K-M method,a higher AIDS-related cumulated death rate than the CIF,was estimated.Among all the HIV/AIDS patients who initiated HAART from 2003 to 2015 in Shandong,5 593 of them met the inclusion criteria.The cumulative incidence rate for AIDS-related death was 3.08％ in 1 year,4.21％ in 3 years,5.37％ in 5 years,and 7.59％ in 10 years respectively by CIF.Results from the F-G analysis showed that HIV/AIDS patients who were on HAART,the ones who had college degree or above (HR=0.40,95％CI0.24-0.65) were less likely to die of AIDS-associated diseases.However,HIV/AIDS patients who were on HAART and living in the western areas of Shandong (HR=1.33,95％CI1.01-1.89),diagnosed by medical institutions (HR=1.39,95％CI1.06-1.80),started to receive care ≥1 year after diagnosis (HR=2.02,95％CI1.30-3.15),their CD,cell count less than 200 cells/μl (HR=3.41,95％CI2.59-4.59) at the time of diagnosis,with NVP in antiviral treatment (ART) regime (HR=1.36,95％CI1.03-1.88),at Ⅲ/Ⅳ clinical stages (HR=2.61,95％CI1.94-3.53) and CD4 cell count less than 350 cells/μl (HR=5.48,95％CI2.32-12.72) at initiation of HAART ect.,were more likely to die of AIDS-associated diseases.Conclusions With the existence of competing risks,the cumulative incidence rate for AIDS-related death was overestimated by K-M,suggesting that competing risk models should be used in the survival analysis.Measures as early diagnoses followed by timely care and early HAART could end up with the reduction of AIDS-related death.