邱涛,丁萍,张之,翟祥军.江苏省2005-2020年接受抗病毒治疗的HIV/AIDS合并HBV感染及生存分析[J].Chinese journal of Epidemiology,2024,45(2):220-224
Survival analysis on HIV/AIDS cases newly received antiretroviral therapy who coinfected with hepatitis B virus in Jiangsu Province, 2005-2020
Received:August 11, 2023  
KeyWord: 艾滋病病毒/艾滋病  乙型肝炎病毒  乙型肝炎病毒表面抗原  抗病毒治疗  合并感染  病死率
English Key Word: HIV/AIDS  HBV  HBsAg  Antiretroviral therapy  Coinfection  Mortality
Author NameAffiliationE-mail
Qiu Tao Department of HIV/STD Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China qiutao@jscdc.cn 
Ding Ping Department of HIV/STD Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China  
Zhang Zhi Department of HIV/STD Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China  
Zhai Xiangjun Department of HIV/STD Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China  
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      目的 分析2005-2020年江苏省接受抗病毒治疗的HIV/AIDS合并HBV感染和生存情况,为提高抗病毒治疗效果提供参考依据。方法 采用回顾性资料分析,研究对象来源于中国疾病预防控制信息系统江苏省2005-2020年HIV/AIDS首次入组抗病毒治疗基线和随访数据库,随访观察截止时间为2022年12月31日。采用SPSS 16.0软件进行统计学分析。运用Kaplan-Meier法绘制生存曲线和log rank检验法比较生存曲线,采用Cox比例风险回归模型分析接受抗病毒治疗HIV/AIDS死亡的影响因素。结果 江苏省2005-2020年首次入组抗病毒治疗HIV/AIDS共33 322例,总体HBsAg检测率为57.3%(19 098/33 322)。在进行HBsAg检测的HIV/AIDS中,男女性别比为7.1∶1(16 745∶2 353),年龄(39.4±14.0)岁,已婚/同居占49.5%(9 446/19 098)。同性性传播占57.8%(11 048/19 098),异性性传播占36.6%(6 990/19 098)。开始接受抗病毒治疗前的CD4+T淋巴细胞(CD4)计数的MQ1Q3)为297(166,445)个/μl。HIV/AIDS的HBsAg阳性率为8.2%(1 566/19 098,95%CI:7.8%~8.6%)。在随访观察截止期内共1 062例HIV/AIDS死亡。经log rank检验,是否合并HBV感染在接受抗病毒治疗后生存曲线差异有统计学意义(χ2=28.07,P<0.001)。Cox比例风险回归模型的多因素分析结果显示,入组年份、年龄、婚姻状况、HIV感染途径、抗病毒治疗前基线CD4计数和是否合并HBV感染是HIV/AIDS死亡的影响因素(均P<0.05),相比于2015年及以前入组者、年龄≥45岁和未婚者,2016-2020年入组治疗者、<45岁组和已婚/同居者的死亡风险较低;相比于基线CD4计数≥201个/μl组、其他感染途径和单纯HIV感染者,基线CD4计数≤200个/μl组、注射吸毒途径和合并HBV感染者的死亡风险较高。结论 江苏省需要在HIV/AIDS抗病毒治疗工作中加强合并HBV感染的检测、管理和精准治疗,加强乙型肝炎疫苗接种对单纯HIV感染者的保护,减少HIV/AIDS死亡风险。
English Abstract:
      Objective To analyze the incidence of co-infection of HIV and HBV and death in HIV/AIDS cases who newly received antiretroviral therapy (ART) from 2005-2020 in Jiangsu Province. Methods According to the baseline and follow-up data of HIV/AIDS cases on ART enrolled between January 2005 and December 2020, the last follow-up clinical visit was up until December 31, 2022, the national information system was retrospectively collected for HIV/AIDS cases from Chinese System Disease for Control and Prevention. Excel database was established, and statistical analysis was performed using the SPSS 16.0 software. Kaplan-Meier method was used to draw the survival curves, the log rank test was used to compare the survival curves, and Cox proportional hazards modeling was used to assess the mortality and potential risk factors. Results There were 33 322 HIV/AIDS cases that newly received ART during 2005-2020.The rate of HBsAg test was 57.3%(19 098/33 322). Among HIV/AIDS cases tested HBsAg, the ratio of male to female was 7.1∶1 (16 745∶2 353), the average age was (39.4±14.0) years old, 49.5% (9 446/19 098) of the HIV/AIDS cases were married, 57.8% (11 048/19 098) were infected with HIV through homosexual contact and 36.6% (6 990/19 098) were through heterosexual contact. The M (Q1, Q3) of CD4+T lymphocytes (CD4) counts at ART initiation was 297 (166, 445) cells/μl. A total of 8.2% (1 566/19 098, 95%CI:7.8%-8.6%) were HBsAg positive. There were 1 062 HIV/AIDS died by December 31, 2022. The log rank test showed that there were differences in survival curves between HIV/AIDS co-infected with HBV or not (χ2=28.07, P<0.001). Multivariate analysis of the Cox proportional risk regression model showed that enrollment year, age, marital status, route of HIV infection, baseline CD4 counts before ART, and co-HBV infection were the influencing factors for HIV/AIDS death (all P<0.05), compared with those enrolled in 2015 and before, age ≥45 years, and those who were unmarried. Those enrolled in treatment from 2016 to 2020, those younger than 45 years, and married/cohabitation had a lower risk of death. Compared with baseline CD4 counts ≥201 cells/μl, other routes of infection, and HIV infection alone, baseline CD4 counts ≤200 cells/μl, injecting drug use, and co-HBV infection were associated with a higher risk of death. Conclusion Effective treatment for coinfection with HBV and HBV vaccination for HBV-negative people with HIV should be integrated into HIV treatment programs to reduce HIV-related mortality in Jiangsu Province, 2005-2020.
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