山东省2017-2021年HIV感染者艾滋病相关死亡的影响因素分析

赵文煜; 朱晓艳; 李玲; 张娜; 黄鹏翔; 廖玫珍; 李亚君; 王国永; 康殿民

Abstract

赵文煜,朱晓艳,李玲,张娜,黄鹏翔,廖玫珍,李亚君,王国永,康殿民.山东省2017-2021年HIV感染者艾滋病相关死亡的影响因素分析[J].Chinese journal of Epidemiology,2023,44(10):1634-1640

山东省2017-2021年HIV感染者艾滋病相关死亡的影响因素分析

Analysis of factors influencing AIDS-related deaths among HIV-infected people in Shandong Province， 2017-2021

Received:March 10, 2023

DOI：10.3760/cma.j.cn112338-20230310-00138

KeyWord: 艾滋病病毒相关死亡 Cox比例风险回归模型影响因素

English Key Word: HIV Related death Cox proportional hazards regression model Influencing factor

FundProject:江西省卫生健康委员会科技计划（202211291）

Author Name	Affiliation	E-mail
Zhao Wenyu	School of Public Health and Health Management, Shandong First Medical University & amp Shandong Academy of Medical Sciences, Ji'nan 250117, China
Zhu Xiaoyan	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China
Li Ling	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China
Zhang Na	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China
Huang Pengxiang	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China
Liao Meizhen	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China
Li Yajun	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China
Wang Guoyong	Institute of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Ji'nan 250014, China	yshhl@163.com
Kang Dianmin	School of Public Health and Health Management, Shandong First Medical University & amp Shandong Academy of Medical Sciences, Ji'nan 250117, China	dmkang66@163.com

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Abstract:

目的分析山东省HIV感染者艾滋病相关死亡的影响因素，为降低死亡风险及延长生存时间提供参考。方法研究对象为2017-2021年山东省HIV感染者，采用Cox比例风险回归模型分析艾滋病相关死亡及确证1年内死亡的影响因素。结果 2017-2021年山东省报告的14 700例HIV感染者中，发生艾滋病相关死亡351例，占2.4%（351/14 700）。多因素Cox比例风险回归模型分析结果显示，HIV感染者艾滋病相关死亡的危险因素包括文化程度为初、高中/中专（aHR=1.37，95%CI：1.01~1.84）、样本来源自医疗机构（aHR=1.61，95%CI：1.22~2.12）、病程为艾滋病期（aHR=9.86，95%CI：6.86~14.19）、未检测基线CD4⁺T淋巴细胞（CD4）（aHR=3.93，95%CI：2.69~5.75）、抗病毒治疗（ART）时间<6个月（aHR=3.46，95%CI：2.42~4.93）和未ART（aHR=1.45，95%CI：1.02~2.07）、末次CD4<200个/μl（aHR=3.51，95%CI：2.18~5.65）和末次CD4未检测（aHR=10.58，95%CI：6.15~18.19）、末次病毒载量（VL）值为50~999拷贝数/ml、≥1 000拷贝数/ml和未检测（aHR=2.59，95%CI：1.07~6.26；aHR=9.50，95%CI：5.60~16.12；aHR=15.33，95%CI：8.91~26.36）；HIV感染者确证1年内发生艾滋病相关死亡风险较高的因素包括样本来源自医疗机构（aHR=1.68，95%CI：1.19~2.36）、病程为艾滋病期（aHR=10.60，95%CI：7.13~15.75）、基线CD4未检测（aHR=3.71，95%CI：2.34~5.90）、ART时间<6个月（aHR=4.30，95%CI：2.85~6.49）和未ART（aHR=2.05，95%CI：1.35~3.13）、末次CD4<200个/μl（aHR=5.45，95%CI：2.04~14.60）和末次CD4未检测（aHR=20.95，95%CI：7.69~57.04）、末次VL值为50~999、≥1 000拷贝数/ml和未检测（aHR=15.21，95%CI：2.54~91.21；aHR=42.93，95%CI：9.64~191.20；aHR=61.35，95%CI：13.85~271.77）。结论扩大检测覆盖面，促进早发现和早治疗，加强对HIV感染者的定期随访和检测，掌握病程进展并进行精准管理和治疗，对降低HIV感染者病死率和延长生存时间有重要作用。

English Abstract:

Objective To explore the influencing factors of AIDS-related deaths among HIV-infected patients in Shandong Province, to help reduce the risk of death and prolong survival time. Methods The study population was HIV-infected patients in Shandong Province from 2017-2021, and Cox proportional hazards regression model was used to analyze the influencing factors of AIDS-related deaths and deaths within one year of confirmation. Results Among 14 700 HIV- infected patients reported in Shandong Province in 2017-2021, 351 AIDS-related deaths occurred, accounting for 2.4% (351/14 700). The results of multifactorial Cox proportional hazards regression model analysis showed that the risk factors for AIDS-related deaths among HIV-infected patients included education level of junior high school, high school, and secondary school (aHR=1.37, 95%CI:1.01-1.84), sample source from healthcare institutions (aHR=1.61, 95%CI:1.22-2.12), duration of disease in AIDS stage (aHR=9.86,95%CI:6.86-14.19), baseline CD4⁺T lymphocytes (CD4) undetected (aHR=3.93, 95%CI:2.69-5.75), duration of antiviral treatment (ART) <6 months (aHR=3.46, 95%CI:2.42-4.93) and no ART (aHR=1.45, 95%CI:1.02-2.07), final CD4 <200 cells/μl (aHR=3.51, 95%CI:2.18-5.65) and final CD4 undetected (aHR=10.58, 95%CI:6.15-18.19), and final viral load (VL) values of 50-999 copies/ml,≥1 000 copies/ml and undetected (aHR=2.59, 95%CI:1.07-6.26; aHR=9.50, 95%CI:5.60-16.12; aHR=15.33, 95%CI:8.91-26.36). Factors with higher risk of AIDS-related deaths within one year of confirmation of HIV-infected patients included samples originating from healthcare facilities (aHR=1.68, 95%CI: 1.19-2.36), AIDS stage of disease (aHR=10.60, 95%CI:7.13-15.75), baseline CD4 undetected (aHR=3.71, 95%CI:2.34-5.90), duration of ART <6 months (aHR=4.30, 95%CI:2.85-6.49) and no ART (aHR=2.05, 95%CI:1.35-3.13), final CD4 <200 cells/μl (aHR=5.45,95%CI:2.04-14.60) and final CD4 undetected (aHR=20.95, 95%CI: 7.69- 57.04), and final VL values of 50-999 copies/ml, ≥1 000 copies/ml and undetected (aHR=15.21, 95%CI: 2.54-91.21; aHR=42.93, 95%CI:9.64-191.20; aHR=61.35, 95%CI:13.85-271.77). Conclusions Expanding the coverage of testing, promoting early detection and treatment, strengthening regular follow-up and the test of HIV-infected patients, grasping the progress of the disease to provide accurate management and treatment are important for reducing the disease mortality rate and prolonging the survival time of HIV-infected patients.

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