文章摘要
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)
作者单位E-mail
杨文杰 河南省疾病预防控制中心, 郑州 450016  
刘洋 河南省疾病预防控制中心, 郑州 450016  
李洁 河南省疾病预防控制中心, 郑州 450016  
马彦民 河南省疾病预防控制中心, 郑州 450016  
李宁 河南省疾病预防控制中心, 郑州 450016 lining0386@yeah.net 
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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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