| 杨文杰,刘洋,李洁,马彦民,李宁.河南省2002-2019年抗病毒治疗15岁及以上HIV/AIDS死亡状况分析[J].中华流行病学杂志,2021,42(9):1594-1600 |
| 河南省2002-2019年抗病毒治疗15岁及以上HIV/AIDS死亡状况分析 |
| Analysis on mortality in HIV/AIDS cases aged 15 years and older under antiretroviral treatment in Henan province, 2002-2019 |
| 收稿日期:2021-03-08 出版日期:2021-09-27 |
| DOI：10.3760/cma.j.cn112338-20210308-00184 |
| 中文关键词: 艾滋病 抗病毒治疗 死亡状况 分析 |
| 英文关键词: AIDS Antiretroviral treatment Mortality Analysis |
| 基金项目:国家科技重大专项（2018ZX10715009）；河南省科技攻关计划（182102310188） |
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| 中文摘要: |
| 目的 分析河南省抗病毒治疗（ART）≥ 15岁HIV/AIDS的死亡状况，为降低HIV/AIDS病死率提供参考依据。方法 资料来源于艾滋病综合防治信息系统2002-2019年河南省开始ART ≥ 15岁HIV/AIDS，采用回顾性队列研究方法，应用Cox比例风险回归模型分析HIV/AIDS死亡的相关因素。采用SPSS 23.0软件进行统计学分析。结果 研究对象共72 986例HIV/AIDS，死亡16 634例，死亡病例以年龄≥ 40岁（68.5%，11 393/16 634）、男性（62.6%，10 419/16 634）、血液传播感染（71.7%，11 927/16 634）、农民/农民工（91.7%，15 249/16 634）为主。以因艾滋病相关疾病死亡为主（73.7%，12 261/16 634），病死率为16.8%（12 261/72 986）。34.6%（4 237/12 261）的HIV/AIDS在开始ART第1年因艾滋病相关疾病死亡，开始ART第10年和第18年的累积生存率分别为78.3%和71.8%。≥ 15岁HIV/AIDS开始ART的基线CD4+T淋巴细胞计数（CD4）<200个/μl的比例为45.5%（30 432/66 898）。Cox比例风险回归模型分析结果显示，研究对象基线CD4<200个/μl组和200~个/μl组的死亡风险分别是≥ 350个/μl组的1.78倍（95% CI：1.64~1.94）和1.24倍（95% CI：1.13~1.36）；基线有症状的死亡风险是无症状的1.25倍（95% CI：1.16~1.35）；最近1次病毒载量值≥ 1 000拷贝数/ml的死亡风险是<1 000拷贝数/ml的7.09倍（95% CI：6.65~7.54）。结论 2002-2019年河南省ART ≥ 15岁HIV/AIDS的死亡病例以血液传播感染和农民/农民工为主，艾滋病相关疾病是导致HIV/AIDS死亡的主要原因。随着河南省逐步推行ART策略，HIV/AIDS能长时间保持较高的生存率。应继续加强CD4检测工作，尽早纳入符合条件的HIV/AIDS进行规范化ART，以降低病死率、提高生存质量。 |
| 英文摘要: |
| Objective To analyze the mortality in HIV/AIDS cases aged ≥ 15 years under antiretroviral treatment (ART) in Henan province from 2002 to 2019, and provide evidence for reducing the mortality rate of HIV/AIDS and AIDS prevention and treatment. Methods Data of HIV/AIDS cases aged ≥ 15 years who received ART in Henan from 2002 to 2019 were obtained from "Infectious Disease Surveillance System-Basic Information on AIDS Prevention and Control". In this retrospective study, Cox proportional risk model was used to analyze the influencing factors for HIV/AIDS related deaths. Software SPSS 23.0 was used for statistical analysis. Results From 2002 to 2019, a total of 72 986 HIV/AIDS cases aged ≥ 15 years received ART, in whom, 16 634 died during this period. Most of the death cases were aged ≥ 40 years old (68.5%,11 393/16 634), males (62.6%,10 419/16 634), infected through blood-borne transmission (71.7%,11 927/16 634), and farmers or migrant workers (91.7%,15 249/16 634). Most of the deaths were due to AIDS related diseases (73.7%, 12 261/16 634), and the case fatality rate was 16.8% (12 261/72 986). A total of 34.6% (4 237/12 261) of HIV/AIDS cases died of AIDS-related diseases in the first year of ART, and the cumulative survival rates at 10 and 18 years of ART were 78.3% and 71.8%, respectively. The proportion of the HIV/AIDS cases with baseline CD4+T lymphocyte (CD4) counts <200 cells/μl at age 15 years when ART started was 45.5% (30 432/66 898). Cox proportional risk regression model showed that, compared with the cases with baseline CD4 counts ≥ 350 cells/μl, the risk of death was 1.78 times higher than in the cases with CD4 counts <200 cells/μl (95%CI:1.64-1.94) and 1.24 times higher in the cases with CD4 counts ≥ 200 cells/μl (95%CI:1.13-1.36), respectively. The risk of death in symptomatic cases at baseline survey was 1.25 times higher than that in asymptomatic cases (95%CI:1.16-1.35). The cases with a latest viral load ≥ 1 000 copies/ml had 7.09 times higher risk of death than those with a last viral load<1 000 copies/ml (95%CI:6.65-7.54). Conclusions The majority of HIV/AIDS deaths occurred in the cases aged ≥ 15 years receiving ART in Henan province during 2002-2019, who were infected through blood-borne transmission and farmers/migrant workers, and AIDS-related diseases were the main causes of the deaths. With the gradual implementation of ART policy, the high survival rate in HIV/AIDS cases can be maintained for a long time in Henan. To reduce the case fatality rate and improve the quality of life of HIV/AIDS patients, CD4 counts test should be further strengthened and eligible HIV/AIDS patients should be covered by standard ART in a timely manner. |
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