Analysis On Survival Effect And Effect Factors After Initiating Antiretroviral Treatment Among AIDS Patients

Objective The aim of this this study is to explore the survival rate of AIDS patients after receiving antiretroviral therapy in Henan province and to determine factors associated with survival status.Methods 30 376 AIDS patients who received antiretroviral therapy during 2005 to December 2014 from six counties of Henan province were enrolled in this study. Retrospective study method was used to collecte the basic information, clinical features, laboratory test and treatment of status information. The exported data from the system were collected and sorted out using Excel 2010, and the data were statistically analyzed by SPSS 16.0 software. The death probability and cumulative survival rate of the patients in the two groups were calculated using life table method, and the survival curve were described in the two groups using life table method The contact of risk factors for survival outcome was tested using univariate and multivariate Cox proportional hazards models.Results Total 30 376 AIDS patients with mean age of43.7±11.3 years were enrolled in this study. 866 cases of male, accounting for 58.8%, 12510 cases of females, accounting for 41.2%, male to female ratio is 1.4:1. 1. The general characteristics of all cases: The research objects were main farmers/migrant workers, degree of education were main primary and secondary schools. There are 18 548 cases, accounting for 61.1% were infected mainly through blood. The Log- rank test showed that patients with antiviral treatment survival in gender, age, marital status, infection, occupation and education degree distribution difference was statistically significant. 2. Antiviral treatment related clinical features: The results showed that, of all cases, 2.6% has a history of TB, 22.5% has taken the TP-SMZ. The initial treatmentwere main Stavudine(D4T) or Zidovudine(AZT)+Lamivudine(3TC)+Nevirapine(NVP) or Efevirenz(EFV). 24.0% of cases had switched the second-line drugs in ART. 7.6% cases’ had missed drug in the past 7 days. Log- rank test showed that in addition to the TP- SMZ taking history, survival rate after antiviral treatment in patients with baseline history, clinical stage, initial presence of TB treatment, baseline symptoms, missing drug in the past 7 days, switching to the second-line drugs in ART, treatment levels of the distribution of the difference is statistically significant. 3. Outcome in patients with AIDS: During the follow-up period, a total of 4827 patients with HIV/AIDS died, of which 3927 cases accounting for 81.3% died from HIV/AIDS related diseases. The mortality of all patients was 3.2/100 person year. The median survival time was 1.3(IQR are much less: 0.3 ~ 3.3) years. 4. Analyse of Influence factors of survival time: Stepwise regression was used to conduct the time multiple factors analysis, the results showed that women, lower age, married, same-sex sexual transmission, no history of tuberculosis(TB), clinical staging forⅠorⅡperiod, initial treatment were main Stavudine(D4T) or Zidovudine(AZT)+Lamivudine(3TC)+Nevirapine(NVP) or Efevirenz(EFV), no missing drug in the past 7 days may has a longer survival time. Compared to cases with CD4 + T lymphocyte count of 0 ~ 200 cells/mm3, cases with CD4 + T lymphocyte count of 201~350cells/mm3、351~500cells/mm3、501~cells/mm3 have lower risk of death after antiviral treatment(adjusted HR were 0.6, 0.5, 0.4).Conclusions 1. Antiviral treatment can reduce the mortality of patients and prolong survival time of AIDS patients in Henan province. 2. Lower age, female, initial treatment were main Stavudine(D4T) or Zidovudine(AZT)+Lamivudine(3TC)+Nevirapine(NVP) or Efevirenz(EFV), no missing drug in the past 7 days, switching to the second-line drugs in ART during treatment has a longer survival time.