河南省2002-2019年抗病毒治疗15岁及以上HIV/AIDS死亡状况分析

杨文杰; 刘洋; 李洁; 马彦民; 李宁

Abstract

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].Chinese journal of Epidemiology,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

Received:March 08, 2021

DOI：10.3760/cma.j.cn112338-20210308-00184

KeyWord: 艾滋病抗病毒治疗死亡状况分析

English Key Word: AIDS Antiretroviral treatment Mortality Analysis

FundProject:国家科技重大专项（2018ZX10715009）；河南省科技攻关计划（182102310188）

Author Name	Affiliation	E-mail
Yang Wenjie	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Liu Yang	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Li Jie	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Ma Yanmin	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Li Ning	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China	lining0386@yeah.net

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Abstract:

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。

English Abstract:

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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