| ObjectiveTo investigate the survival condition and affecting factors among adult AIDS patients between 2008 and 2013 in Liangshan, Sichuan province; furthermore to provide a scientific basis for reducing the mortality rate, prolonging the survival time and formulating AIDS prevention and control strategies.MethodsQuantitative and qualitative researches were applied to study the survival condition and the relevant factors of the survival time of adult AIDS patients between 2008 and 2013 in Liangshan, Sichuan Province. Observational retrospective cohort study method was applied in the quantitative study. AIDS patients were chosen from China’s national comprehensive prevention and control management system of adult AIDS patients in Liangshan, which diagnosed during 2008～2013. Related information on demographics, source of infection, pathogenesis, treatment and death was collected. Life table method was applied to calculate the survival time, Cox proportional hazards model was applied to analyze the factors that might affect the survival on patients. Relevant information on the survival factors was collected from three different kinds of people, AIDS patients under highly active antiretroviral therapy (HAART), their family members and medical personnel in the qualitative research. Recommendations for a better promotion of HIV treatment and a better effect of the medication were collected from the local medical staff.Quantitative studyObservational retrospective cohort study method was conducted. Survival data of adult AIDS patients in China’s national comprehensive prevention and control management system of AIDS in Liangshan was analyzed during 2008-2013, which mainly included disease infection, treatment and living condition, so as to find out survival factors, thus providing evidence for scientific advice.Qualitative researchEasy sampling method was adopted to select the three kinds of people for interview according to the selection criteria, adult AIDS patients receiving HAART treatment, their family members and medical workers engaged in HIV treatment and management. The interview mainly included general condition of taking antiretroviral therapy, factors affecting the treatment loss of follow up, social support and the proposal of improving the survival. The main points of the interview were obtained from the coded and classified qualitative investigation.Results1. Among 8321 cases,3021 died and 3721 have received HAART, ranging from 18 to 87.5 years old (mean age as 34.2±9.8);2. Proportion for the treatment coverage increased gradually, from 5.8% in 2008 to 54.5% in 2013. Median survival time of all adult AIDS patients was 31.1 months and 17.4 months in the untreated group;3. 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 from27.3/100 person-years to 5.1/100 person-years, while in the untreated group it remained high--between 45.0/100～54.2/100 person-years;4. Cox multivariate analysis revealed that risk factors for survival of all AIDS patients as: not accepted HAART (HR=5.10), included through non-clinical diagnosis (first record of CD4+T< 200 cells/μl, HR=1.66, died within 3 years after HIV diagnosis and without treatment, HR=4.04) and older at age of AIDS diagnosis (≥45 years old, HR=1.85);5. Cox multivariate analysis proved that risk factors for survival of AIDS patients receiving HAART as:included through first record of CD4+T<200 cells/μl (HR=3.21), male (HR=1.22), older at age of AIDS diagnosis (≥45 years old, HR=1.54),Yi (HR=1.48), low CD4+T cell count at treatment baseline (CD4+T<50 cells/μl, HR=1.65) and anemia at treatment baseline (HR=2.29);6. Cox multivariate analysis showed that risk factors for survival of AIDS patients without HAART as:included through non-clinical diagnosis (first record of CD4+T< 200 cells/μl, HR=1.19, died within 3 years after HIV diagnosis and without treatment, HR=3.39) and older at age of AIDS diagnosis (≥45 years old, HR=1.30);7. The qualitative analysis suggested that factors affecting loss of follow up of HAART treatment were mainly migrant workers, side effects, the lack of disease awareness, forced to quit drug use.ConclusionAnalysis on survival data of AIDS patients between 2008 and 2013 in Liangshan Prefecture showed that AIDS mortality rate decreased gradually and proportion for the treatment coverage increased gradually; antiretroviral therapy appeared the most important factor that affecting the survival of AIDS patients. Receiving HAART can prolong the survival of the patients, reduce the mortality rate; patients inclusion pattern indirectly affected the estimation of survival through the date determination of AIDS diagnosis; the older at AIDS diagnosis, the shorter the survival was; there was a high risk of death in cases with low CD4+ T cell count and anemia at treatment baseline. Our findings suggested that tactic factors as:expanding the coverage of antiretroviral therapy, early detection and confirmation of AIDS patients, strengthening the detection and monitoring on CD4+ T cells, receiving the treatment as early as possible, which were important ways to prolong the survival. Disease prevention and medication publicity education should be strengthened according to the local situation, in order to reduce the treatment loss of follow up, so as to improve the quality of survival. |
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