河南省2002－2014年HIV暴露儿童死亡水平及影响因素分析

王奇; 马楠; 司珩; 马彦民; 李宁; 聂玉刚; 孙定勇; 王哲

Abstract

王奇,马楠,司珩,马彦民,李宁,聂玉刚,孙定勇,王哲.河南省2002－2014年HIV暴露儿童死亡水平及影响因素分析[J].Chinese journal of Epidemiology,2017,38(12):1629-1633

河南省2002－2014年HIV暴露儿童死亡水平及影响因素分析

Study on the risk of mortality and associated factors among HIV-exposed children in Henan province, 2002-2014

Received:May 14, 2017

DOI：10.3760/cma.j.issn.0254-6450.2017.12.009

KeyWord: 艾滋病病毒儿童死亡率影响因素

English Key Word: HIV Children Mortality Risk factors

FundProject:河南省医学科技攻关计划项目（201403229）；河南省科技重大专项（2012ZX10004905）

Author Name	Affiliation	E-mail
Wang Qi	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Ma Nan	Henan Provincial Academy of Medical Science
Si Heng	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Ma Yanmin	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Li Ning	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Nie Yugang	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Sun Dingyong	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Wang Zhe	Institute of STD and AIDS Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China	wangzhe@hncdc.com.cn

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Abstract:

目的了解2002-2014年河南省HIV暴露儿童生存与死亡情况，分析HIV暴露儿童死亡的相关影响因素。方法 2002年1月1日至2014年12月31日，河南省开展预防HIV母婴传播工作中发现并报告的HIV暴露儿童1 705例，年龄范围为0~18月龄，存活儿童随访至18月龄。分别对HIV暴露儿童1、3、6、9、12、18月龄进行随访，收集孕产妇母婴阻断服务、儿童药物阻断、儿童传染病发病、生存状况等情况，采用logistic回归对影响HIV暴露儿童死亡的相关因素进行分析。结果截止2014年12月31日，共随访到1 705例HIV暴露的儿童，其中18月龄随访时存活儿童共1 536例（占90.09%），随访过程中失访58例（占3.40%），死亡111例（占6.51%），HIV暴露儿童累计死亡率为67.39‰，新生儿死亡率为23.07‰，婴儿死亡率为57.01‰。不同年份的儿童死亡率无下降趋势（χ²=1.57，P=0.201）。死因构成以肺炎为主（36例，占32.43%），其次为疑似AIDS （18例，占16.21%）。死亡儿童均未进行过HIV早期检测。多因素分析结果显示，HIV暴露儿童死亡的危险因素主要是儿童低出生体重（OR=4.97，95% CI：3.12~7.92）。可能的保护因素包括产妇孕12周前初检（OR=0.46，95% CI：0.26~0.80），儿童联合药物阻断（OR=0.25，95% CI：0.15~0.42）。结论 2002-2014年河南省HIV暴露儿童的死亡率较高，应积极开展HIV暴露儿童早期诊断及抗病毒治疗，预防肺炎等常见传染病，加强营养指导及生长发育监测。

English Abstract:

Objective To investigate the status of survival and related risk factors among HIV-exposed children in Henan province from 2002 to 2014.Methods A follow-up program was set up when infants as 1, 3, 6, 9, 12, 18 month olds. Data regarding the HIV-exposed children and their mothers were collected, including service of PMTCT, antiviral therapy, incidence of infectious disease and survival status of infants. Univariate and multivariate logistic regression models were used to explore the risk factors.Results A total number of 1 705 HIV-infected infants were reported from 2002 to 2014. Among them, 1 536 infants (90.09%) were still alive when they were at one and a half years old, with another 58 (3.40%) lost to follow up and 111 (6.51%) infants were dead. The cumulative mortality rates in HIV-exposed children, newborn, and HIV-exposed infants were 67.39‰, 23.07‰, and 57.01‰, respectively. No statistical significance was found on the decreasing tendency of mortality in different years. The leading cause of death was noticed as pneumonia, with a proportion of 32.43%, followed by suspected AIDS. Early diagnosis had not been made in infants. Low-birth weight (OR=4.97, 95% CI:3.12-7.92) seemed to be a risk factor. Early detection in pregnancy (OR=0.46, 95% CI:0.26-0.80) and HARRT provided to children (OR=0.25, 95% CI:0.15-0.42) were recognized as protective factors.Conclusions The mortality of HIV-exposed children were high, which called for the development of programs on early infant diagnosis and HARRT. Measures should be taken to prevent pneumonia and other infectious diseases, together with nutrition support and monitor program on growth.

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