Survival and associated factors among HIV/AIDS patients in Fujian province, 1987 – 2018

  Objective  To analyze the status and influencing factors of survival among patients with human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS) during 1987 – 2018 in Fujian province and to provide references for implementing better medical services to the HIV/AIDS.

  Methods  We retrospectively conducted case studies and periodical follow-ups among 14 973 HIV/AIDS patients registered in the province between January 1987 and December 2018. All-cause mortality rate, time of survival and survival rate were calculated for the patients. Cox proportional hazard model and classification and regression tree model were used to explore factors related to survival of the patients HIV/AIDS and receiver operating characteristic curve (ROC) was adopted to evaluate the efficiency of established survival model.

  Results  Among all the patients, totally 2 537 deaths were reported by the end of follow-up and the all-cause mortality rate was 5.25/100 person-years; the mean survival time was 210.3 months and the 5-year cumulative survival rate was 80%. The results of Cox proportional hazard model indicated that the patients being diagnosed with AIDS at the year of registration were at a higher risk of mortality; while the patients being female, aged 15 – 54 years, with the education of senior high school and above, receiving antiretroviral therapy, with a CD4⁺ T lymphocyte cell count of ≥ 200 /mm³ in the latest test, classified into key groups under HIV/AIDS surveillance, being detained during the follow-up period, and being recruited in the places other than medical institutions were at a lower risk of mortality. Analysis of classification and regression tree model demonstrated antiretroviral therapy was a main impact factor for to survival status; the standardized impact importance value of CD4⁺ T lymphocyte cell count in the latest test, population group at the registration, age at the diagnosis of HIV/AIDS, education, and disease status at the registration were 40.6, 22.0, 17.7, 13.5, and 7.8, respectively; the area under the ROC was 0.762 (95% confidence interval: 0.749 – 0.774) for the analysis.

  Conclusion  The survival of HIV/AIDS patients in Fujian province remained at a stable level during 1987 – 2018 and early diagnosis and antiretrovival therapy could decrease mortality and prolong survival time among the patients.