山西省南部地区HIV/AIDS病死率及其影响因素分析

宁少萍; 薛子东; 卫军; 穆生财; 续雅娟; 贾少贤; 仇超; 徐建青

Abstract

宁少萍,薛子东,卫军,穆生财,续雅娟,贾少贤,仇超,徐建青.山西省南部地区HIV/AIDS病死率及其影响因素分析[J].Chinese journal of Epidemiology,2015,36(3):245-249

山西省南部地区HIV/AIDS病死率及其影响因素分析

HIV/AIDS related mortality in southern Shanxi province and its risk factors

Received:September 01, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.03.012

KeyWord: 艾滋病病死率抗病毒治疗 Cox比例风险回归分析

English Key Word: Acquired immune deficiency sydrome Mortality rate Antiretroviral therapy Cox proportional hazards survival regression

FundProject:国家科技重大专项(2012ZX10001-006)

Author Name	Affiliation	E-mail
Ning Shaoping	Yuncheng Center for Disease Control and Prevention, Yuncheng 044000, China
Xue Zidong	Shanxi Provincial Center for Disease Control and Prevention
Wei Jun	Yuncheng Center for Disease Control and Prevention, Yuncheng 044000, China	0359-2052102@163.com
Mu Shengcai	Shanxi Provincial Center for Disease Control and Prevention
Xu Yajuan	Shanxi Provincial Center for Disease Control and Prevention
Jia Shaoxian	Yuncheng Center for Disease Control and Prevention, Yuncheng 044000, China
Qiu Chao	Institutes of Biomedical Sciences Fudan University and Shanghai Public Health Clinical Center
Xu Jianqing	Institutes of Biomedical Sciences Fudan University and Shanghai Public Health Clinical Center

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Abstract:

目的探索HIV/AIDS病死率的影响因素和提高抗病毒治疗效果的方法。方法采用回顾性队列研究方法,通过艾滋病综合防治信息系统,选择山西省南部4市截至2012年底的HIV/AIDS病例报告和抗病毒治疗信息,收集资料补充调查,计算病死率、治疗比例,采用Cox比例风险回归模型进行分析。结果共收集HIV/AIDS确诊病例4 040例,平均年龄为(36.0±12.9)岁,男性占65.3%,已婚者占56.5%,文化程度初中及以下占73.5%,农民占58.4%,经性传播占54.3%(其中异性传播占40.1%、同性传播占14.2%)、经血传播占38.9%(其中采血浆占20.2%、输血/血制品占16.2%、注射毒品占2.4%)。接受抗病毒治疗比例由2004年的14.8%上升到2012年的63.4%,同期HIV/AIDS病死率从40.2/100人年降低到6.3/100人年。Cox回归分析显示:最主要死亡风险是未接受抗病毒治疗(RR=14.9,95%CI:12.7～17.4)。对1 938例接受抗病毒治疗病例进行Cox回归分析显示:治疗前BMI过低和肥胖病例的死亡风险高于正常和超重病例(RR=2.7,95%CI:1.6～4.5)、治疗前CD₄⁺T淋巴细胞≤50 cell/μl者的死亡风险高于>50 cell/μl者(RR=2.6,95%CI:1.5～4.5)。对2 102例未接受抗病毒治疗病例Cox回归分析显示:首次诊断为AIDS的死亡风险高于首次诊断为HIV病例(RR=3.4,95%CI:2.9～4.0)。结论抗病毒治疗显著降低了HIV/AIDS的病死率,提示强化抗病毒治疗工作可进一步降低病死率。

English Abstract:

Objective To explore factors influencing mortality rate of HIV/AIDS and to improve the effectiveness of antiretroviral therapy (ART). Methods By means of retrospective cohort study and the AIDS control information system,HIV/AIDS case reports and antiviral treatment information of 4 cities in southern Shanxi province up to end of December 2012 were selected,to calculate the mortality rate and treatment coverage based on further data collected,along with analysis using the Cox proportional hazards survival regression. Results 4 040 cases confirmed of HIV/AIDS were included in this study. The average age was (36.0±12.9) years,with 65.3% being male,56.5% being married,73.5% having junior high school education or lower,58.4% being peasants,54.3% with sexually transmitted infection (40.1% were heterosexual,14.2% were homosexual),and 38.9% were infected via blood transmission(20.2% were former plasma donors,16.2% blood transfusion or products recipients,2.4% were injection drug users). Overall mortality decreased from 40.2 per 100 person/year in 2004 to 6.3 per 100 person/year in 2012,with treatment coverage concomitantly increasing from almost 14.8% to 63.4%. Cox proportional hazards survival regression was used on 4 040 qualified cases,demonstrating the top mortality risk factor was without antiretroviral therapy (RR=14.9,95%CI:12.7-17.4). Cox proportional hazards survival regression was made on 1 938 cases of antiviral treatment,demonstrating that the mortality risk of underweight or obese before treatment was higher than those of normal and overweight cases (RR=2.7,95%CI:1.6-4.5),and the mortality of those having a CD₄⁺ T-lymphocyte count ≤50 cells per μl before treatment was more than 50 cases (RR=2.6,95%CI:1.5-4.5);Cox proportional hazards survival regression was made on 2 102 cases of untreated cases,demonstrating the mortality risk of those initially diagnosed as AIDS was higher than those initially diagnosed as HIV(RR=3.4,95%CI:2.9-4.0). Conclusion The ART could successfully make lower HIV/AIDS mortality rate,indicating effective ART can further decrease mortality.

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