| Objective: Though Highly Active Anti-Retroviral Therapy(HAART)has been available in Ningbo for over ten years,survival status of HIV/AIDS patients receiving antiretroviral therapy have not been described.It is essential to understand the effect of HAART,to learn the compliance of HAART for HIV/AIDS patients,and to find the risk factors of mortality.The purpose of this analysis is to identify ways to improve HIV treatment outcomes and provide theoretical basis for advanced strategies in Ningbo.Methods: 1、A retrospective cohort study was conducted among HIV/AIDS patients diagnosed between 2004 and 2015 with epidemiology characteristics analysis.Time-to-event methods were used to analyze predictors of immune recovery and mortality.2、A cross-sectional study was conducted among adult HIV/AIDS patients(≥15 years)diagnosed between 2004 and 2015 with random sampling.Self-administrated questionnaire was used to collected data about treatment adherence.CASE(Center for Adherence Support ~Evaluation)index was used to evaluate criterion of HIV/AIDS patients’ adherence.3、Life Tables were used to estimate Survival probabilities,Kaplan-Meier curve with Log rank test were used to describe the survival curves and the Cox proportional hazard model was applied to determine predictors of mortality.Chi-square test and multivariate Logistic regression were used to analyze impact factors associated adherence.Results: 1、Of 2347 subjects,the median age when starting HAART was 35(IQR:27~45)years.Most of them were male(79.08%),local(54.41%),married(45.76%),infected by heterosexual sexual transmission(58.12%),with baseline CD4 T cells count≤200 cells /μl(46.74%),WHO clinical stage I(77.55%).Highly Active Anti-Retroviral Therapy(HAART)can effectively reverse the progression of AIDS,rebuild body’s immune function for HIV/AIDS patients and reduce viral replication to limit the transmission of human immunodeficiency virus type.As treatment time was prolonged,average follow-up CD4 count increased continuously(R2=0.77).Immune recovery was found in 40.38% of HIV/AIDS patients(CD4≥500 个/μl),while the overall median time to immune recovery was 3.00 years(IQR:2.65~3.35).92.91% was viral suppression(viral load less than 400 copies/ml).2 、 For HIV/AIDS patients receiving antiretroviral therapy,the cumulative survival probability was 96.75% for the first year,92.36% for the second year,91.87% for the fifth year and 90.02%for the seventh year.Elevated risks of mortality were associated to older age,WHO clinical stage IV(HR=2.83,95%CI: 1.67~4.80,vs.WHO clinical stage I),drug resistance(HR=3.26,95%CI : 1.77 ~ 6.01,VS.without drug resistance).Lower CD4+Tcell level,BMI<18.5,unmarried were proved to be risk factors for mortality.3、of cases receiving antiretroviral therapy who completed questionnaire,87.92% showed good adherence(case index >10).The main reason for stopping or missing drugs was forgetting(48.4%).Most of side effects were queasiness,vomiting and rash.Good understanding of knowledge about persisting treatment was protective factors to drug adherence,while the using of reminders was benefit to improve patients’ adherence。Conclusion: HAART programme has obtained remarkable treatment effects for HIV/AIDS patients in Ningbo,especially at viral suppression.It is recommended to pay more attention to adverse effects,modify regimen in time and strengthen virology failure,drug-resistance monitoring.The finding indicates that publicity education and large screening should be strengthened.Early discovery,early diagnosis,early treatment are still the effective ways to diminish the mortality.Paying more attention to elder patients,improving HIV/AIDS patients’ adherence may be the key points. |
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