อัตราการรอดชีวิตและปัจจัยพยากรณ์โรคของผู้ป่วยติดเชื้อเอชไอวีที่ได้รับยาต้านไวรัส

บทคัดย่อ

Background: Antiretroviral therapy (ART) for the treatment of HIV infection has been shown to improve survival and reduce HIV associated morbidity and mortality by restoring immunologic function through suppression of viral load. Despite of availability of ART, a substantial portion of HIV-infected patients has continued to die. Studies in many countries have found that differences in clinical, demographic, socio-economic, and behavioral factors related with the survival of HIV-infected patients re. Rceiving ART. Methods: A retrospective cohort study was conducted among HIV-infected patients who were initiated ART during the period from January 2010 to December 2018 at Sawangdaendin Crown Prince Hospitalesults: A total of 313 patients were studied, 12 (3.8%) patients died. The mean ± SD age was 34.2 ± 10.2 years, and about 63% of them were male. Median (range) baseline CD4 cell count was 104 (0-1253) cell/mm3. Within the first 5 years follow-up, median (range) baseline CD4 cell count had trend to increase from 269 (4-929) to 340 (3-1252), 358 (12-1169), 369 (43-1142) and 375 (13- 1031) cell/mm3, each year, respectively and the studied patients had trend to achieve undetectable HIV RNA increasing from 76.5% to 84.2%, 88.9%, 92.5% and 91.7%, each year, respectively. In Kaplan-Meier analysis, the 5-years follow-up time after initiation of ART, 94.7% of patients had probability to survive. From univariate analysis, hemoglobin level at baseline < 11 g/dl (HR 4.113; 95% CI 1.112-15.217; P = .034), hypertension-comorbidity (HR 7.762; 95% CI 1.674-35.999; P = .009), history of previous opportunistic infections including cryptococcal infection or toxoplasmosis (HR 7.140; 95% CI 2.240-22.754; P = .001), adherence to treatment < 95% (HR 3.810; 95% CI 1.112-13.048; P = .033), missed visit within the first 2 years (HR 5.808; 95% CI 1.167-28.899; P = .032) and CD4 cell count at 1 year (HR 0.994; 95% CI 0.990-0.999; P = .029) were statistically significant association with the mortality. From multivariate analysis, only missed visit within the first 2 years had a trend associated with mortality. By the log-rank test, patients who never had missed visit within the first 2 years had survival probability more than who had ever (P = .038). Conclusion: In the era of ART, which seems to improve survival and reduce HIV associated mortality, a portion of HIV-infected patients receiving ART has continued to die. In this study, patient who never had missed visit within the first 2 years had survival probability more than patient who had ever. So the patients should be emphasized the importance of follow-up especially during the first 2 years, to decrease the mortality rate.