Objective To understand the living condition and influencing factors of HIV/AIDS patients who reported above 60 years old.
Methods A retrospective cohort study was conducted to collect demographic characteristics, survival-related and influencing factors of HIV/AIDS patients above 60 years old from 2004 to 2019 in Jiangmen city. The cumulative survival rate and survival rate were analysed by life table, and the influencing factors were analysed by Cox regression model with independent variables and multivariables.
Results The survival time of 796 cases were 0 to 12.61 years, the average was 2.22 years, median 1.21 years. At the end of the observation period, 297 cases were followed up, 32 cases were lost, 467 cases were death. Total mortality rate was 0.32/person year, the cumulative survival rate of 1 year, 5 years and 10 years was 52.67%, 30.33%, 18.40%. Univariate Cox analysis showed that male ( RR=1.39, 95% CI=1.07-1.81), age of older ( RR 70–79=1.37, 95% CI= 1.13-1.67; RR ≥80=1.80, 95% CI=1.31-2.47), and others transmission ( RR=1.64, 95% CI=1.14-2.36) were at higher risk of death. Education status of senior and above ( RR=0.65, 95% CI=0.44-0.98), commercial unmarried sex ( RR=0.77, 95% CI= 0.61-0.97), initiative testing of HIV ( RR=0.44, 95% CI=0.31-0.63), CD4 test regularly ( RR=0.25, 95% CI=0.21-0.31), antiviral therapy ( RR=0.23, 95%CI=0.19-0.28), high count of baseline CD4 cells( RR 200-349=0.46, 95%CI=0.32-0.67; RR 350-499= 0.43, 95% CI=0.26-0.70; RR ≥500=0.57, 95% CI=0.37-0.90) could reduce the risk of death. Multivariate Cox analysis showed that antiviral therapy ( RR=0.67,95% CI： 0.57-0.78), and high count of baseline CD4 cells ( RR 200-349=0.46,95% CI： 0.32-0.66， RR3 50-499=0.39，95% CI: 0.24-0.64， RR ≥500=0.37,95% CI: 0.24-0.59) could reduce the risk of death.
Conclusion Propaganda should be strengthened in older peoples in Jiangmen. Promotion of condom fit for olders should be adopted as well as the auxiliary supplies of sex. Early detection and treatment should be advocated as well as the CD4 test and antiviral therapy, which was aimed to improve the quality life of the elder HIV/AIDS peoples.
摘要：目的了解江门地区确诊时60岁及以上病例的生存状况和影响因素。 方法通过回顾性队列研究方法， 搜集2004—2019年现住址为江门本地、确诊时为60岁及以上HIV/AIDS病例的人口学信息、生存相关信息和相关影响 因素，生存率、累计生存率等指标采用寿命表分析方法，单因素和多因素Cox回归模型分析生存影响因素。 结果796 例病例生存时间为0~12.61年，平均2.22年，中位数1.21年，观察期终点，生存并能随访297例，失访32例，死亡467例， 总死亡率为0.32/人年，1年、5年和10年累计生存率分别为52.67%、30.33%和18.40%，单因素Cox分析显示男性(权权= 1.39, 95% CI=1.07~1.81)、年龄偏高(权权 70~79=1.37，95%67=1.13~1.67; RR ≥80=1.80, 95% CI=1.31~2.47)和其他感染方式( RR= 1.64, 95% CI=1.14~2.36)死亡风险较高；高中及以上文化程度（ RR=0.65, 95% CI=0.44~0.98)、商业（ RR=0.77, 95% CI= 0.61~0.97)、主动进行 HIV 检测（ RR=0.44, 95% CI=0.31~0.63)、接受 CD4检测( RR=0.25, 95% CI=0.21~0.31)、接受抗病毒 治疗（ RR=0.23, 95% CI=0.19~0.28)、基线 CD4 细胞计数较高（ RR 200~349=0.46, 95% CI=0.32~0.67; RR 350~499=0.43, 95% CI= 0.26~0.70； RR ≥500=0.57, 95% CI=0.37~0.90)有一定保护作用；多因素Cox分析显示接受抗病毒治疗（RR=0.67，95% CI: 0.57~0.78)和基线 CD4 细胞计数高者（ RR 200~349=0.46，95% CI： 0.32~0.66， RR 350~499=0.39,95% CI： 0.24~0.64， RR ≥500=0.37， 95% CI:0.24~0.59)对降低病例死亡风险有一定作用。 结论江门市应加强对老年人群艾滋病防治宣传，采用更适合老 年人特点的安全套推广策略，提供符合老年人特点的辅助性性行为用具，提倡早检测、早治疗，及时开展CD4检测，力口 强抗病毒治疗，提高老年HIV/AIDS患者生存质量。