ФАКТОРЫ, ВЛИЯЮЩИЕ НА ВЫЖИВАЕМОСТЬ ЛИЦ, ЖИВУЩИХ С ВИЧ, В ТЕРРИТОРИЯХ С НИЗКОЙ ПЛОТНОСТЬЮ НАСЕЛЕНИЯ

Abstract

Significance Since areas with low population density have a number of specific parameters, in order to reduce mortality from the disease caused by HIV, it is advisable to assess the influence of factors affecting life expectancy of people living with HIV. The purpose of the study was to analyze predictors and risk factors of death that arise or are present during the follow-up and treatment of people living with HIV in low-populated areas. Material and Methods: A survival analysis was carried out for 133 people living with HIV registered at the AIDS-Center of the Kamchatka Territory in 2017 after a 6-year follow-up period. To analyze the influence of nominal characteristics on life expectancy of people living with HIV, Cox regression analysis was undertaken using the “Survival”, “Survminer”, “ggpubr” packages in the R environment. To study the effect of viral load and immune status on survival, a correlation analysis was used. Results: risk factors of early death from HIV in low-populated areas are as follows: parenteral transmission (p=0.0026), late detection (p<0.0001), failure to achieve the undetectable viral load (p<0.0001), lack of restoration of the immune status (p<0.0001), alcohol (p=0.00015), drug use (p=0.036), tuberculosis (p<0.0001). Participation in the patient school improved the prognosis (p=0.05). Living in rural areas (p=0.23), having a family (p=0.8), including couple discordance (p=0.7), viral load (r=-0.2; p=0.2), CD4+ cell count at detection (r=0.2; p=0.3), refusal of further treatment in case of its initiation (p=0.8), viral hepatitis C (p=0.4), and adverse events (p=0.32) did not affect a 6-year survival. Conclusion: in order to increase survival, the following target parameters of the quality of organization of treatment of patients living with HIV in low-populated areas can be set: achieving the undetectable viral load, abstaining from alcohol and drugs, and attending the patient school. Scope of application. The results obtained can be used to develop programs of care delivery to people living with HIV.