| [Objectives]This study aims to assess the effectiveness and the impact of factors of free antiretroviral therapy program for AIDS patients in shanghai area and to expore therapeutic regimen and treatment time. In order to offer the experience for AIDS patients to improve their morbidity, mortality and life expectancy and to provide scientific evidence for better administering antiretroviral therapy and their dissemination in China.[Methods]This is retrospective cohort study which enrolled 410 AIDS patients from 30 September,2005 to 31 December,2008. First, all patients receieved epi-demiologicai investigation and laboratory tests in the initiation of the ART. Then, patients were followed up at months routinely. At last, their clinical datas, immunological response, virological response and drug effects were evaluated. The final time of observation is 31st December,2012. Data entry was using Epidata software while data analysis was performed using SPSS 17.0 software package.[Results]Of the 410 patients,89 were females while 321 were males, the average age of these patients was 42.1 years old.71.7% of them were 20-49 years old and 57.6% of them were married or cohabitants. The major routes of HIV transmission were sexual contacted while heterosexual transmission accounted for 52.2% and homosexual transmission accounted for 22.4%. About 3.7% had ever been treated with Chinese herbal medicines and 19.5% were previously treated with an-tiretroviral drugs. Most of them were at the advanced stage of HIV at the initiation of ART, about 75.9% had CD4+T cell counts less than 200 cells/μl. The baseline median CD4+ T cell counts was (121.1±111.8) cells/μl. The median follow-up time was (59.4±1.3) months.As the treating time passing by, the plasma HIV-1 RNA level was sig-nificantly decreased. The virus controlling rate was presently 23.4% for 12 months,64.4% for 24 months,73.4% for 36 months,86.7% for 48 months,87.2% for 60 months and 84% for 72 months. The count of CD4+T cell was significantly increased. The amount was presently 199 for the 3rd month,220 for the 6th month, 264 for the 12th month,310 for the 24th month,345 for the 36th month,373 for the 48th month,386 for the 60th month and 395 for the 72th month. Meaning while, significant increases in the median CD4+T cell count were found at all points after treatment initiation(P<0.001).Until the endpoint of the study,13 patients were lost to follow-up,8 patients were transferrered to other clinics,1 committed suicide,31 died of AIDS and 357 still continuing to receive ART treatment. Among these dead patients, their average age was 52.2 years old, and the averge time of treatment was 5.1 months (2days～29months). During the antiretroviral therapy of the 1st, 2nd,3rd,4th,5th,6th and 7th year, the survival rate was presently 0.93,0.92, 0.92,0.92,0.92,0.92, and 0.92. According to the univariate Cox’S proportional hazard model, the harzd of death was significantly different with patient age (<44 years old group,44-59 years old group and >60 years old group)and the CD4+T cell count at baseline (>=100 cells/μl versue<100 cells/μl) and (P<0.05). Data from the multivariate Cox’S proportional hazard model analysis indicated that, after adjustment for age, gender, and marital status, the baseline CD4+T cell counts could significantly predicate the rates of survival. Patients with at least 100 cells/μl at the start of treatment had a lower hazard of death than those with CD4 cell counts of less than 100 cells/μl(HR=0.21,95% CI:0.15-0.78).During this study, about 71.2% of the patients presented with antiviral drug related toxicity, mainly with nausea and vomiting, appetite reduction and other gastrointestinal symptoms. But most adverse reactions were much slighter and relieved by symptomatic treatment, only 125 patients changed therapeutic regimen because of drug adverse effects.[Conclusion]HAART is effective for AIDS paitents in Shanghai area. During the treatment period, paitents who received ART, have got rapid immunological and antiviral response and improved their morbidity, mortality and life expec-tancy. In the long-term follow-up period, we found the main reason to chang therapeutic regimen for the side effects. We must consolidate monition over the side effects of various anti-virus drugs, provide proper stragedy for pa-tients, enhence the adherence of them and reduce the patients and frequency of alternating drugs, thus reaching the best performance of the remedy within the limited choices of drugs. |
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