| 倪明健,陈学玲,马媛媛,胡晓远.新疆维吾尔自治区艾滋病抗病毒治疗者不同性别死亡率及其影响因素分析[J].中华流行病学杂志,2015,36(9):971-975 |
| 新疆维吾尔自治区艾滋病抗病毒治疗者不同性别死亡率及其影响因素分析 |
| Sex specific mortality in HIV/AIDS patients receiving antiretroviral therapy and risk factors in Xinjiang Uygur autonomous region |
| 收稿日期:2015-02-15 出版日期:2015-09-10 |
| DOI：10.3760/cma.j.issn.0254-6450.2015.09.014 |
| 中文关键词: 艾滋病抗病毒治疗 性别 死亡率 生存分析 |
| 英文关键词: Highly active antiretroviral therapy Sex Mortality Survival analysis |
| 基金项目:国家科技重大专项(2013ZX10004907) |
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| 中文摘要: |
| 目的 了解不同性别抗病毒治疗者死亡率及其影响因素,为提高抗病毒治疗效果提供思路和方法。方法 以新疆维吾尔自治区(新疆)2004年7月至2013年6月进行高效抗反转录病毒治疗的男性8 061例,女性6 001例为研究对象。数据来源于国家“艾滋病综合防治信息系统”中“抗病毒治疗信息系统”。采用回顾性研究方法,分析不同性别抗病毒治疗者死亡率和累积生存率,采用Cox回归模型分析死亡的影响因素。结果 HIV传播途径男性以静脉注射吸毒为主,女性以性途径为主。男性抗病毒治疗者年龄偏大,基线CD4+T淋巴细胞计数水平偏低;整体死亡率高于女性,治疗早期死亡率高达10.87/100人年,两年后降至7.00/100人年以下。女性治疗早期死亡率为4.77/100人年,两年后降至3.00/100人年。Cox回归分析结果显示:死亡率的影响因素为基线CD4+T淋巴细胞计数水平和感染途径。CD4+T淋巴细胞计数(cell/μl)< 200者(对照为≥350),男性的HR=4.08(95%CI:2.96～5.62),女性的HR=5.11(95%CI:3.16～8.35)。静脉注射吸毒者(对照为性途径感染),男性的HR=1.99(95%CI:1.66～2.40),女性的HR=1.77(95%CI:1.24～2.52)。累积生存率分析结果显示:常规治疗组经性途径感染的男性与女性5年生存率分别为81%与87%,经静脉吸毒感染的男性与女性5年生存率分别为66%与75%,性别差异有统计学意义。早治疗组经性途径感染的男性与女性5年生存率分别为97%与98%,经静脉吸毒感染的男性与女性5年生存率分别为86%与97%,无性别差异。结论 新疆男性抗病毒治疗者较高的死亡率,源于该群体较低的基线CD4+T淋巴细胞计数水平及较高的经静脉注射吸毒感染比例。另外,男性主动服药意愿偏弱及服药依从性偏低为深层次影响因素。 |
| 英文摘要: |
| Objective To analyze the sex specific mortality in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART) and risk factors in Xinjiang Uyghur autonomous region(Xinjiang),and provide evidence for the evaluation of the effect of HAART. Methods A retrospective analysis was conducted on the mortality and survival of 8 061 male cases and 6 001 female cases of HIV infection,who received HAART during July 2004-June 2013 in Xinjiang. The information of the cases were downloaded from national antiretroviral therapy reporting sub-system in national HIV/AIDS reporting system. Cox proportional hazard model was used to identify the risk factors of deaths. Results The male cases were older and had lower CD4 value at baseline compared with the female cases. The major transmission route was injecting drug use in males,but sexual contact in females. The overall mortality of the male cases was higher than that of the females,which was 10.87/100 person-years during the first three month after receiving HAART,and 7.00/100 person-years two years later in males,but 4.77/100 person-years during the first three month and 3.00/100 person-years two years later in females. The results from Cox analysis showed that the risk factors were the CD4 value at baseline and transmission route. Compared with the cases who had lower CD4 value (CD4< 200 cells/μl) at baseline,the HR for the cases who had higher CD4 value (CD4≥350 cells/μl) was 4.08 (95%CI:2.96-5.62) in males and 5.11(95%CI:3.16-8.35) in females. Compared with sexual transmission,the HR for IDUs was 1.99(95%CI:1.66-2.40) in males and 1.77(95%CI:1.24-2.52) in females. The results of cumulative survival analysis showed that in conventional treatment group (CD4< 350 cells/μl),the five year survival rates were 81% and 87% for the males and females infected through sexual contact and 66% and 75% for the males and females infected through injecting drug use,and in early treatment group (CD4≥350 cells/μl),the five year survival rates were 97% and 98% for the males and females infected through sexual contact and 86% and 97% for the males and females infected through injecting drug use. Conclusion In Xinjiang,the higher mortality in male HIV infection cases receiving HAART was related with lower CD4 value at baseline and higher infection rate through injecting drug use. Besides the weak intention for treatment and poor compliancy would be the deeper risk factors. |
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