| 姚仕堂,何春燕,曹东冬,章银娣,时允,李品银,冯艳玲,魏华,肖桂芳,孙进廷,叶润华,杨跃诚,王继宝,何纳,丁盈盈,段松.德宏傣族景颇族自治州2010-2019年HIV感染者抗病毒治疗后艾滋病和非艾滋病相关死亡及其影响因素分析[J].中华流行病学杂志,2021,42(4):632-637 |
| 德宏傣族景颇族自治州2010-2019年HIV感染者抗病毒治疗后艾滋病和非艾滋病相关死亡及其影响因素分析 |
| Incidence and influencing factors of AIDS-related and non-AIDS-related deaths after receiving antiretroviral therapy among HIV-positive individuals in Dehong Dai and Jingpo Autonomous Prefecture, 2010-2019 |
| 收稿日期:2020-09-03 出版日期:2021-04-22 |
| DOI：10.3760/cma.j.cn112338-20200903-01121 |
| 中文关键词: 艾滋病病毒 相关死亡 竞争风险模型 影响因素 |
| 英文关键词: HIV Related death Competing risk model Influencing factors |
| 基金项目:国家科技重大专项（2018ZX10715006-001，2018ZX10721102-004） |
| 作者 | 单位 | E-mail | | 姚仕堂 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 何春燕 | 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室, 上海 200032 | | | 曹东冬 | 德宏傣族景颇族自治州人民医院, 芒市 678400 | | | 章银娣 | 德宏傣族景颇族自治州人民医院, 芒市 678400 | | | 时允 | 芒市人民医院 678400 | | | 李品银 | 瑞丽市民族医院 678600 | | | 冯艳玲 | 陇川县人民医院 678700 | | | 魏华 | 盈江县人民医院 679300 | | | 肖桂芳 | 德宏傣族景颇族自治州中医医院, 芒市 678400 | | | 孙进廷 | 梁河县人民医院 679200 | | | 叶润华 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 杨跃诚 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 王继宝 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | | | 何纳 | 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室, 上海 200032 | | | 丁盈盈 | 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室, 上海 200032 | dingyy@fudan.edu.cn | | 段松 | 德宏傣族景颇族自治州疾病预防控制中心, 芒市 678400 | dhduansong@sina.com.cn |
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| 中文摘要: |
| 目的 分析德宏傣族景颇族自治州（德宏州）2010-2019年HIV感染者开始抗病毒治疗（ART）后艾滋病相关死亡和非艾滋病相关死亡情况、变化趋势及其影响因素。方法 基于国家HIV感染者ART库，分析德宏州2010-2019年开始ART的HIV感染者。用累积发生函数（CIF）估算HIV感染者的死亡概率，用亚分布比例风险模型（F-G模型）比较发生艾滋病相关死亡和非艾滋病相关死亡的差异，并分析其影响因素。结果 共7 068例HIV感染者纳入分析，其中艾滋病相关死亡388例，非艾滋病相关死亡570例。对于艾滋病相关死亡和非艾滋病相关死亡，研究对象接受ART后第1、2、3、4、5、7、9年的累积发生率分别为2.27%、3.46%、4.47%、5.03%、5.84%、6.61%、7.40%和1.63%、3.11%、4.68%、6.02%、7.42%、10.49%、12.75%。F-G模型多因素结果显示，开始ART年龄较大、男性、未婚、注射吸毒感染途径、基线BMI低、基线CD4+T细胞计数较低、基线肝纤维化指数（FIB-4）>3.25、基线贫血是艾滋病相关死亡的危险因素；开始ART年龄≥45岁、男性、傣族、景颇族、未婚、注射吸毒感染途径、基线BMI低、基线FIB-4>3.25、基线肾小球滤过率估算值<60 ml·min-1·1.73 m-2、基线贫血是非艾滋病相关死亡的危险因素。结论 2010-2019年德宏州HIV感染者开始ART后死亡的累积发生率较低，发生非艾滋病相关死亡的累积发生率总体高于艾滋病相关死亡的累积发生率。艾滋病相关死亡和非艾滋病相关死亡的影响因素也存在差异，应针对非艾滋病相关死亡的影响因素加强干预。 |
| 英文摘要: |
| Objective To explore the changing trends and influencing factors of AIDS-related and non-AIDS-related deaths after receiving antiretroviral therapy (ART) among HIV-positive individuals in Dehong Dai Jingpo autonomous prefecture (Dehong) from 2010 to 2019. Methods Based on the Chinese National treatment database, HIV patients who initiated ART from 2010 to 2019 were included in the analysis. The cumulative incidence function was used to estimate the cumulative incidence of AIDS-related death and non-AIDS-related death, respectively. The Fine-Grey model was used to compare the differences between AIDS-related and non-AIDS-related deaths and analyze its influencing factors. Results A total of 7 068 HIV-positive individuals were included, of which 388 were AIDS-related deaths and 570 were non-AIDS-related deaths. The cumulative mortality rate at years 1, 2, 3, 4, 5, 7 and 9 after receiving ART were 2.27%, 3.46%, 4.47%, 5.03%, 5.84%, 6.61%, 7.40% for AIDS-related deaths, and 1.63%, 3.11%, 4.68%, 6.02%, 7.42%, 10.49%, 12.75% for non-AIDS-related deaths, respectively. In the Fine-Grey model, older age at ART initiation, male, unmarried, injection drug use as the transmission route, lower baseline BMI, lower baseline CD4+ T cell counts, baseline FIB-4 score >3.25, and baseline anemia were risk factors for AIDS-related death. In contrast, age at ART initiation ≥ 45 years, male, Dai, and Jingpo minority ethnicities, unmarried, injection drug use as the transmission route, lower baseline BMI, baseline FIB-4 score >3.25, baseline eGFR <60 ml·min-1·1.73 m-2, and baseline anemia were risk factors for non-AIDS-related deaths. Conclusions The cumulative mortality rate was low among HIV-positive individuals after receiving ART in Dehong during 2010-2019. The mortality of non-AIDS-related deaths was higher than that of AIDS-related deaths. There were also differences in the factors influencing AIDS-related and non-AIDS-related deaths and interventions should be intensified to target the influencing factors for non-AIDS-related deaths. |
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