目的 了解1996-2021年湖北省荆州市艾滋病病毒感染者和艾滋病患者(HIV/AIDS)确证后1年内死亡情况,为促进艾滋病早发现早治疗提供依据.方法 通过中国疾病预防控制信息系统艾滋病综合防治信息系统收集1996-2021年荆州市HIV/AIDS病例的基本情况和随访资料,分析确证后1年内死亡密度及变化趋势,以及死亡病例的人口学特征、检测发现、治疗和死亡原因等情况;采用Cox比例风险回归模型分析确证后1年内死亡的影响因素.结果 纳入HIV/AIDS病例3 304例,确证后1年内死亡508例,死亡密度为17.43/100人年,1996-2021年死亡密度呈下降趋势(x2趋势=21.053,P＜0.001).死亡病例中,男性占77.76％,≥45岁占67.72％,异性性接触感染占83.86％,医疗机构检测发现占83.66％,未进行ART占62.20％,未检测CD4细胞占47.83％,死亡原因为艾滋病无关死亡占58.86％.确证年龄≥30岁(HR:1.781～4.644,95％CI:1.073～7.784)、医疗机构检测发现(HR=2.130,95％CI:1.306～3.474)、首次CD4+T淋巴细胞(CD4细胞)计数＜200个/μL(HR:2.649～12.879,95％CI:1.669～19.189)、未进行ART(HR=7.945,95％CI:5.743～10.993)和确证后4～12个月启动ART(HR=1.636,95％CI:1.005～2.662)的病例确证后1年内死亡风险较高.结论 1996-2021年荆州市HIV/AIDS病例确证后1年内死亡密度呈下降趋势;确证年龄较大,经异性性接触感染、医疗机构检测发现、CD4细胞水平低、ART不及时或未进行ART与确证后1年内死亡有关.

Objective: To analyze the case fatality rate of HIV/AIDS cases and influencing factors in Jingzhou. Methods: The data were retrieved from HIV/AIDS Comprehensive Response Information System and the cases diagnosed with HIV/AIDS in Jingzhou during 1996-2021 and aged 15 years or older were selected for the study. The death curve was drawn with Kaplan-Meier method, and Cox proportional-hazards model was used to identify influencing factors for death. Results: A total of 3 304 HIV/AIDS cases were followed up for 16 091.5 person-years, and 893 cases died, with a case fatality rate of 5.5/100 person-years. The cumulative case fatality rates of 1, 5 and 10 years were 15.4%, 25.0% and 34.6% respectively, the cumulative case fatality rates of 1, 5 and 10 years were 6.9%, 14.4% and 23.7% in the cases with access to antiretroviral therapy (ART), and 68.0%, 90.1% and 98.7% in the cases without access to ART. The results of Cox proportional hazards regression model showed that the risk for death was higher in those without access to ART than in those with access to ART (aHR=9.85, 95%CI: 8.19-11.85). The risk factors for death in those with access to ART included being men (aHR=1.64, 95%CI: 1.29-2.08), age ≥60 years old at diagnosis (aHR=3.52, 95%CI: 2.38-5.20), being infected by injecting drug use/others (aHR=2.38, 95%CI:1.30-4.34), being detected by medical institution (aHR=1.53, 95%CI: 1.11-2.11), CD4+T lymphocytes(CD4) counts <50 cells/μl (aHR=2.58, 95%CI: 1.87-3.58). The protective factor for death was high education level (high school and technical secondary school: aHR=0.64,95%CI:0.46-0.90; college and above: aHR=0.42, 95%CI: 0.24-0.73). The risk factors for HIV/AIDS death in those without access to ART included older age at diagnosis (30-44 years old: aHR=2.32, 95%CI: 1.40-3.84; 45-59 years old:aHR=2.61, 95%CI: 1.59-4.27; ≥60 years old: aHR=3.31, 95%CI: 2.01-5.47), lower CD4 counts (<50 cells/μl: aHR=10.47, 95%CI: 6.47-16.56; 50-199 cells/μl: aHR=2.31, 95%CI: 1.08-4.94; 200-349 cells/μl: aHR=2.35, 95%CI: 1.46-3.79). Conclusions: The case fatality rate of HIV/AIDS was relatively high in Jingzhou from 1996 to 2021, the first CD4 counts, ART and age at diagnosis were the major factors affecting HIV/AIDS death, "Expanding testing" and "prompt treatment upon diagnosis" should be continued and enhanced to improve the efficacy of ART and HIV/AIDS case survival.

目的 分析2003-2021年我国HIV/AIDS患者ART工作的进展情况.方法 利用2021年12月底国家艾滋病综合防治基本信息系统数据库,采用连续横断面研究方法,描述性分析我国2003-2021年ART工作的覆盖面和有效性两方面共4个指标的变化情况和主要特征.结果 截至2003、2006、2009、2012、2015、2018和2021年各年统计时点,我国HIV/AIDS累计启动ART的人数分别为3 965人、30 202人、78 302人、203 816人、463 767人、851 039人和1 262 749人,报告存活HIV/AIDS患者中正在接受ART的比例分别为15.9％、28.0％、35.7％、52.1％、69.5％、83.6％和92.6％;2006、2009、2012、2015、2018和2021年正在接受ART者病毒载量检测比例分别为5.2％、55.8％、90.1％、93.2％、90.9％和94.6％,在治且做过病毒载量检测者的病毒载量抑制比例(＜400copies/mL)分别为57.5％、77.1％、85.4％、89.6％、92.8％和95.4％.结论 近20年来,我国HIV/AIDS患者累计启动ART的人群规模增长迅猛,正在接受ART的比例不断提升;2012年以来病毒载量检测比例持续稳定在90％以上,正在接受ART者病毒载量抑制比例稳步提高并保持高水平.

目的 了解我国中小学校开设健康教育相关课程的状况及影响因素,为促进我国学校卫生建设提出意见和建议.方法 采用x2检验进行组间比较,构建二元Logistic回归模型识别影响开课因素,分析不同因素对开展卫生相关课程/讲座的影响.结果 本次调查共收集了全国31个省、自治区、直辖市及新疆生产建设兵团总计193 392所学校的相关数据,共覆盖学生151 327 628人.中小学的健康教育的开课率为90.13％.多因素分析结果显示:东部和西部地区相对于中部地区开课率较高(东部:AOR为1.16,95％CI:1.12～1.21;西部:AOR 为 1.13,95％CI:1.08～1.18).中学比小学开课率高(AOR 为 1.31,95％CI:1.24～1.38).寄宿制、学校人数大于等于600人的非寄宿制相对于人数少于600人的非寄宿制开课率高(寄宿制:AOR为2.12,95％CI:2.00～2.23;大于等于600人的非寄宿制:AOR为1.98,95％CI:1.89～2.07).配备保健教师、保健室、校医、卫生室的都有利于学校卫生健康相关课程或讲座的开展(保健教师:AOR为4.53,95％CI:4.35～4.72;保健室:AOR为 1.34,95％CI:1.28～1.39;校医:AOR为2.24,95％CI:2.09～2.40;卫生室:AOR 为 1.25,95％CI:1.18～1.33).结论 目前全国中小学健康教育课总体开课率较高,但在不同经济发展地区、不同学段、不同寄宿制类型卫生保健情况区别明显.在政策制定中,需要因地制宜,因人(学校类别)制宜.

自1981年首例艾滋病病例报告以来,艾滋病一直是全球最重要的公共卫生挑战之一.1987年AZT成为首个被证实能抑制HIV的药物,随后抗病毒药物不断研发并应用于临床,1996年高效联合抗反转录病毒治疗的出现是人类治疗与控制艾滋病的里程碑,艾滋病从绝症逐渐转化为可防可控的慢性传染病.抗病毒治疗通过抑制HIV在人体内的复制,减少HIV对人体CD4细胞的破坏,使人体免疫功能得以重建,有效降低HIV/AIDS患者相关并发症的发生率和病死率,延长患者期望寿命,提高患者的生活质量,同时可以有效控制HIV的传播.实践证明,ART已经成为艾滋病防治策略中最为有效的一环.根据联合国艾滋病规划署统计显示,2020年全球预计约有3770万例感染者,其中2750万例接受抗病毒治疗,治疗覆盖率占已经发现病例的87％,治疗成功率为90％(70％～98％)[1].

Objective: To understand the current status of national free antiretroviral therapy in interprovincial migrating people living with HIV/AIDS (PLWHA) and influencing factors in China. Methods: Descriptive and trend test analyses were performed to evaluate the historical characteristics and trends of main descriptive indicators on national free antiretroviral therapy for the interprovincial migrating PLWHA by using the data collected from National Comprehensive HIV/AIDS Information System from 2011 to 2015. Logistic regression model was used to explore the main factors that influencing the coverage of national free antiretroviral therapy among the interprovincial migrating PLWHA in China. Results: The proportion of interprovincial migrating PLWHA gradually increased in last 5 years from 7.1% (17 784/250 645) in 2011 to 10.3% (54 596/528 226) in 2015 (Z=51.38, P<0.000 1) in China. The coverage rate of free antiretroviral therapy in interprovincial migrating PLWHA increased from 37.3% (6 641/17 784) in 2011 to 71.0% (38 783/54 596) in 2015, showing a significant rising tendency (Z=96.23, P<0.000 1), but it was slightly lower than that in non-interprovincial migrating PLWHA in 2015 (71.5%, 338 654/473 630). Multivariate logistic regression analysis showed that the PLWHA who were females, aged ≥50 years, of Han ethnic group, married or had spouse, had the educational level of high school or above, infected through homosexual intercourse, with CD(4)(+)T cells counts ≤500 cells/μl at the first visit, identified to be infected with HIV in medical setting, living in urban areas et al, were more likely to receive free antiretroviral therapy. Conclusions: The coverage rate of free antiretroviral therapy varied among the interprovincial migrating PLWHA with different characteristics. It is still necessary to take effective measures to further increase the coverage of free antiretroviral therapy in interprovincial migrating PLWHA and to include the free antiretroviral therapy in interprovincial migrating PLWHA into standardized management system as soon as possible.

ARIMA模型全称为自回归积分滑动平均模型(autoregressive integrated moving average model),是由博克思(Box)和詹金斯(Jenkins)于上世纪70年代初提出,依据时间序列数据的过去值及现在值预测未来值的著名时间序列预测方法,称为Box-Jenkins模型,其基本思想是将预测对象随时间推移而形成的数据序列视为一个随机序列,用一定的数学模型近似描述这个序列.模型结构为ARIMA(p,d,q)(P,D,Q)s,称为差分自回归移动平均复合季节模型,AR是自回归,MA为移动平均,其中参数p为非季节性自回归阶数、d为一般差分阶数、q为非季节性移动平均阶数,P为季节性自回归阶数、D为季节差分阶数、Q为季节性移动平均阶数,s为季节模型的时间单位相应的周期;如果时间序列没有季节性,则参数P,D,Q,s均为0,则模型简化为ARIMA (p,d,q).

Objective: To compare the differences of CD(4) (+) T lymphocyte (CD(4)) counts between patients aged 18 and over, to explore the effect of age on treatment, 36 months after having received the China National Free AIDS Antiretroviral Treatment on HIV/AIDS. Methods: Through the National ART Information Ssystem, we selected those HIV/AIDS patients who initiated the ART 36 months after the ART, between January 1, 2010 and December 31, 2012 in Guangzhou, Liuzhou and Kunming. Patients were divided into age groups as 18-49, 50-59 and 60 or over year olds, at the baseline of treatment. Under different levels of baseline CD(4) counts, we chose the baseline and different time-point of CD(4) counts as dependent variables, applied mixed linear model to analyze the effects of age, viral suppression, gender, baseline CD(4)/CD(8) ratio and initial treatment regimen. Results: A total of 5 331 HIV/AIDS patients were recruited. No differences were found on age group ratios between different levels of baseline CD(4) counts. At the level of baseline CD(4)<200 cells/μl, both the 50-59 and 60 or above years old groups had lower CD(4) counts than the 18-49 year-old group, within 36 months after the initiation of ART. However, at the baseline CD(4) level of 200-350 cells/μl, no significant differences on CD(4) counts between the 50-59 year-old and 18-49 year-old groups were noticed. CD(4) counts seemed lower in the 60 and above year-old group than in the 18-49 year-old group. Conclusion: Age might serve as an influencing factor on CD(4) counts within 36 months after the initiation of ART, suggesting that earlier initiation of ART might be of help to the recovery of immune function in the 50-59 year-old group.

Objective To explore the efficacy and safety of a raltegravir (RAL)-containing regimen among patients on methadone maintenance therapy.Methods From January 2010 to November 2010, 30 virus (HIV) treatment naive patients who were on methadone maintenance therapy were enrolled from a HIV clinic in Kunming, Yunnan Province and a HIV clinic in Hengyang, Hunan Province.All patients were given RAL, tenofovir (TDF) and lamivudine (3TC) as highly active antiretroviral therapy (HARRT).Patients were followed up for 48 weeks to evaluate the adjustment of methadone dose, opiate withdrawal reaction, antiretroviral efficacy and safety.Results From January 2010 to November 2010, 30 HIV patients were enrolled from the two appointed HIV clinics.The mean age was 39±6 years, with 73.3% male patients and 97% Han population.Before the treatment, their mean CD4+T lymphocyte counts was 210 /μL.Ninety percent of patients were co-infected with hepatitis C.Twenty-nine patients who completed study follow-up were included in final analysis.Five (17.8%) patients reported opiate withdrawal symptoms and increased methadone dose 4 weeks after HARRT.At 24 weeks and 48 weeks of HARRT, the average increase of CD4+T lymphocyte counts were (136±71) /μL and (185±88)/μL, respectively.Among patients who provided valid HIV-1 RNA testing results, 82.6% (19/23) and 95.8% (23/24) of patients had undetectable viral load at week 24 and week 48.Six grade 1-2 adverse events were reported in 4 patients.Conclusions In this pilot study, the new regimen containing RAL, TDF and 3TC appears to be an ideal option for patients on methadone maintenance therapy, because of its limited impact on methadone dose and good efficacy and safety profile.

目的 了解中国成人艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗失访比例及其影响因素.方法 对全国免费抗病毒治疗库中,2012年1月1日至12月31日开始抗病毒治疗的HIV/AIDS病人失访情况进行随访,随访截止到2014年12月31日.采用Cox比例风险模型分析队列失访率及其影响因素.结果 共有26 742名HIV感染者进入队列.12个月的累积失访率为7.6/100人年,24个月的累积失访率为10.5/100人年.Cox比例风险模型多因素分析显示,基线高CD4+T淋巴细胞组、注射吸毒、异性性传播以及初始治疗方案为齐多夫定/司坦夫定+拉米夫定+依非韦伦/奈韦拉平与较高的失访率相关(P＜0.05).结论 应该重点强化注射吸毒HIV/AIDS病人的干预措施,加强对高基线CD4+T淋巴细胞HIV/AIDS病人感染者的医疗咨询,对治疗药物有不良反应的病人要及时处理或更换治疗方案.

目的 了解伊宁市成人艾滋病病毒感染者/艾滋病患者(human immunodeficiency virus infection and acquired immune deficiency syndrome,HIV/AIDS)抗病毒治疗效果并分析其影响因素.方法 在国家艾滋病抗病毒治疗数据库中收集2005-2015年抗病毒治疗者的治疗信息;采用回顾性研究和Logistic回归方法进行分析.结果 共3 740例艾滋病抗病毒治疗者纳入研究,异性感染和吸毒感染分别占46.3％和32.0％,基线CD4+T淋巴细胞计数为278(170,395)个/μl.治疗满6、12、24、36、60个月时病毒抑制率分别为70.4％(1 568/2 228)、64.4％(1 695/2631)、66.3％(1 590/2 400)、70.1％(1 345/1 919)和73.6％(550/747),治疗满12个月的病毒抑制率低于其他时间(均有P ＜0.05).多因素分析显示药物漏服在治疗满12、36和60个月均为病毒抑制失败的危险因素,调整比值比(A0R) (95％ CI)分别为3.581(2.943 ～4.357)、2.496(1.957 ～3.182)和3.137(1.969 ～4.998);在治疗满12个月时,吸毒感染(AOR=1.544,95％ CI:1.164～2.048)和基线CD4+T淋巴细胞计数(个/μL)＜200(AOR=1.371,95％ CI:1.086 ～1.731)是病毒抑制失败的危险因素.结论 伊宁市抗病毒治疗病毒抑制失败率较高,药物漏服是病毒抑制失败的主要危险因素,需加强吸毒感染及晚期治疗患者的依从性教育和服药指导,提高乡镇级卫生院的诊疗水平,进一步提高治疗效果.

目的 分析伊宁市艾滋病抗病毒治疗者的生存率及其影响因素.方法 采用回顾性研究方法,数据资料来源于国家艾滋病抗病毒治疗信息系统,研究纳入2005-2015年首次接受抗病毒治疗、治疗年龄≥15岁的成人艾滋病病毒感染者/病人,采用Kaplan-Meier法进行生存分析,采用Cox比例风险模型分析抗病毒治疗者生存率的影响因素.结果 4921例研究对象的男女比为1.32∶1,15～59岁初始治疗者占98.1％,已婚/同居占63.7％,感染途径以异性性传播(43.6％)和注射吸毒(36.0％)为主.新治疗人数逐年增加,2011-2015年新治疗人数占73.5％,基线CD4+T淋巴细胞(简称CD4细胞)计数＜200个/μL者构成比由2005-2008年的58.2％降至2015年的26.1％;基线CD4细胞计数≥350个/μL者构成比从2005-2010年的2.3％增加到2015年的43.7％.研究对象总体病死率为4.4/100人年,治疗第1年死亡数占整个观察期的37.4％.累计生存率分析显示,基线CD4细胞计数＜50个/μL、50～199个/μL、200～349个/μL和≥350个/μL组5年生存率分别为63.6％、72.7％、85.6％和89.2％;异性性行为感染和注射毒品感染组5年生存率分别为89.4％和70.5％,不同组间生存率差异有统计学意义(P＜0.001).Cox回归分析显示,男性抗病毒治疗者的病死风险高于女性,调整后[风险比(HR)和95％可信区间(CI)为1.65(1.19～2.29)];吸毒感染抗病毒治疗者的病死风险高于异性性行为感染者,调整后HR(95％CI)为1.55(1.09～2.21);基线合并丙型肝炎病毒感染患者的病死风险高于未感染者,调整后HR(95％CI)为1.34(1.06～1.69);基线CD4细胞计数＜50个/μL、50～199个/μL和200～349个/μL者的死亡风险高于≥350个/μL者,调整后HR(95％CI)分别为4.96(3.40～7.25)、3.03(2.25～4.10)和1.58(1.16～2.15);已婚/同居是生存时间的保护因素.结论 伊宁市推动早期治疗有助于降低艾滋病病死率;男性、未婚/离异、吸毒感染、基线CD4细胞计数较低的艾滋病抗病毒治疗者死亡风险大.

目的 比较中国艾滋病抗病毒治疗标准调整前后,接受抗病毒治疗的成年艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的生存状况,以及探讨死亡相关的影响因素.方法 通过国家艾滋病抗病毒治疗综合防治信息系统,收集病人的基线情况和随访信息,计算病死率以及建立COX比例风险回归模型进行分析.结果 共收集到开展抗病毒治疗的HIV/AIDS病人270 313例,其中2008年及以前入组的病人5年累计生存率为0.79;2009-2011年入组的病人5年累计生存率为0.85;2012-2013年入组的病人3年累计生存率大于0.90.多因素COX回归结果显示,治疗标准调整年份≤2008年开始抗病毒治疗者,其死亡风险是2012-2013年开始抗病毒治疗者的1.28倍.除此之外,性别、年龄、婚姻状况、感染途径、药物治疗方案均影响病人死亡.结论 艾滋病抗病毒治疗标准调整后,使得更多的HIV/AIDS病人在免疫水平较高时开始接受抗病毒治疗,对降低病死率、延长生存时间具有重要意义.

OBJECTIVE:To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago. METHODS:Retrospective cohort study and cross-sectional analysis had been conducted in this study. 368 449 cases that had received the ' free antiviral therapy' from 2002 to 2014 were selected from the National Treatment Database. Data from the baseline (initial time of ART, CD(4) cell count, and antiretroviral regimen) and from the follow-up program (dates and status of follow-up, CD(4) cell counts) were gathered and analysed by SAS 9.3. RESULTS:The number of cases that having received new treatment was increasing year by year, accounting for 75.4% of all the cases identified from 2010 to 2014. Constituent ratios of patients with baseline CD(4) cell count <200 cells/µl and clinical diagnosis of AIDS were decreasing from 81.0% in 2006 to 39.7 % in 2014. Status on drug optimization showed that: 3TC replaced DDI, EFV replaced NVP and TDF replaced D4T, making the utilization rates as 99.5%, 75.7%, and 60.6%, respectively, by 2014. Regions that were covered by the treatment accounted for 75.4% of all the counties/districts involved. The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model. Proportion on the twice-CD(4)-testing model had been 75.2% since 2010, with the rate of virological detection increased from 70.8% in 2010 to 87.4% in 2014 and the virological unsuccessful testing rate decreased from 17.6% in 2010 to 11.8% in 2014. Among all the patients, the 1, 5 and 10 year survival rates appeared as 92.2%, 80.5% and 69.6%, respectively. For patients with baseline CD(4) cell counts as <50 cells/µl or >350 cells/µl, the corresponding survival rates showed as 81.6% , 69.9% , 60.9% and 97.9%, 89.8% , 81.0%, respectively. CONCLUSION:China' s HIV/AIDS free antiretroviral therapy program appeared as a national treatment cohort which involved large number of participants, with new patients joining in, annually. Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO. Management program on treatment had gradually turned to hospital-based, with follow-up and laboratory testing programs guaranteed, ended up with satisfactory treatment effects.

目的 探讨自回归滑动平均混合模型(autoregressive integrated moving average model,ARIMA)模型在北京市昌平区肺结核发病数预测中的应用,阐述建模过程并预测2015年昌平区肺结核发病数,为制定防治策略合理配置资源等提供参考.方法 采用全国结核病网络专报系统中2009-2014年现住址为北京市昌平区的肺结核报告发病数数据,通过模型识别、参数估计、检验诊断及模型评价,建立昌平区结核病发病数的ARIMA模型,并预测其2015年肺结核发病数.结果 现住址为昌平区的肺结核发病数预测模型为ARIMA(0,1,1)(0,l,1)12,预测2015年的新发报告肺结核患者总数为851例,模型2015年第一、二季度(1-6月)预测误差率为1.65％,不到10％,模型预测精度较好.结论 ARIMA模型适用于昌平区肺结核发病数的早期预测.

Objective: To evaluate excess mortality across calendar time comparing HIV-infected patients receiving combination antiretroviral therapy (cART) with the general Chinese population.Methods: Patients receiving free cART through the National Free Antiretroviral Therapy Program (NFATP) between January 1, 2003, and December 31, 2009, were included. Observed mortality rates, excess mortality rates, and standardized mortality ratios were calculated by calendar periods. Factors associated with excess mortality across calendar time were evaluated in multivariable Poisson regression models.Results: Among 64,836 HIV-infected patients, the observed and excess mortality rates in 2003-2004 were 9.5 deaths per 100 personyears [95% confidence interval (CI): 8.8 to 10.2] and 9.1 (95% CI: 8.5 to 9.8); in 2008-2009, these decreased to 5.6 (95% CI: 5.4 to 5.8) and 5.2 (95% CI: 5.0 to 5.4), respectively. The adjusted excess hazard ratio (eHR) for 2003-2004 in comparison to 2008-2009 was 1.27 (95% CI: 1.11 to 1.45). Patients initiating cART at CD4 cell counts,50 cells per microliter in comparison with >= 350 cells per microliter had an adjusted eHR of 9.92 (95% CI: 8.59 to 11.44). Patients starting cART at older ages also had greater excess mortality with an eHR of 1.63 (95% CI: 1.47 to 1.82) comparing ages >= 45 to 18-29 years. Standardized mortality ratio results were consistent with those for excess mortality.Conclusions: Substantial decreases in excess mortality were observed from 2003 to 2009 in China among HIV-infected patients receiving free cART. However, mortality among HIV-infected patients remained higher than the general Chinese population. As more efficacious first-and second-line cART regimens become increasingly available to Chinese HIV-infected patients, further reductions in overall and excess mortality are likely.

Background: China's National Free Antiretroviral Treatment program has scaled-up rapidly since 2002, leading to a significant reduction of mortality among its participants. However, few studies have evaluated indicators for patient access to medical care and their association with mortality. Methods: Patients enrolled into this national program between June 2002 and June 2009 for at least 7.5 months were retrospectively analyzed. Results: Twenty-seven thousand five hundred four patients were included into the analysis, among whom 10,034 (37%) had at least 1 missed visit during the first 6 months of treatment. In Cox proportional hazard regression analysis, controlled for baseline demographic and clinical factors, patients with more missed visits had a higher risk of mortality, with an adjusted hazard ratio of 1.3 (95% confidence interval: 1.1 to 1.5) for 1–2 missed visits and 1.7 (95% confidence interval 1.4 to 2.2) for ≥3 missed visits compared with patients with no missed visits. In multivariate logistic regression models, factors independently associated with a higher likelihood of early missed visits included female gender, age >60, HIV transmission via injection drug use or via plasma donation compared with sexual transmission, baseline alanine aminotransferase >100 IU/L, having more symptoms at antiretroviral therapy initiation and receiving a didanosine-based regimen compared with lamivudine-based regimen. Lower baseline CD4 count was protective against missed visits. Conclusions: Missing early visits occurred in a sizable number of patients in this cohort and was associated with a higher mortality rate. Early missed visits may serve as an early warning indicator to trigger additional outreach effort.

艾滋病是严重危害人类健康的传染病,抗病毒治疗是防治艾滋病的一种公共卫生策略.基于2005-2009年国家免费抗病毒治疗数据和中国艾滋病联合防治评估报告数据,利用一个离散数学模型研究了不同的抗病毒治疗覆盖率和治疗效果对于基本再生数的影响.结果表明,抗病毒治疗后由于感染者体内病毒载量的减少而导致的传染性降低的多少是影响我国艾滋病流行的关键因素.