杭州市2004-2023年HIV感染者生存状况及死亡风险的影响因素分析

陈珺芳; 许珂; 张兴亮; 吴虹; 刘克宁; 黄思超

Abstract

陈珺芳,许珂,张兴亮,吴虹,刘克宁,黄思超.杭州市2004-2023年HIV感染者生存状况及死亡风险的影响因素分析[J].Chinese journal of Epidemiology,2024,45(10):1396-1402

杭州市2004-2023年HIV感染者生存状况及死亡风险的影响因素分析

Survival status and influencing factors of death risk of HIV-infected patients in Hangzhou, 2004-2023

Received:April 29, 2024

DOI：10.3760/cma.j.cn112338-20240429-00228

KeyWord: HIV感染者生存时间影响因素抗病毒治疗

English Key Word: HIV-infected patients Survival time Influencing factors Antiviral treatment

FundProject:

Author Name	Affiliation	E-mail
Chen Junfang	Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310021, China
Xu Ke	Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310021, China
Zhang Xingliang	Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310021, China
Wu Hong	Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310021, China
Liu Kening	School of Public Health, Hangzhou Normal University, Hangzhou 311121, China
Huang Sichao	Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310021, China	huangsichao1992@163.com

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Abstract:

目的分析杭州市HIV感染者生存状况及死亡风险的影响因素，为制定艾滋病防治策略提供依据。方法资料来源于中国疾病预防控制信息系统艾滋病综合防治信息系统。采用回顾性队列研究方法，采用χ²检验比较2004-2023年杭州市HIV感染者流行病学特征，采用寿命表法计算HIV感染者生存率，采用Kaplan Meier法描述不同亚组的生存曲线，采用Cox比例风险回归模型分析HIV感染者死亡风险的影响因素。运用SPSS 26.0软件进行统计学分析。结果在9 457例HIV感染者中，总随访时间为58 004.18人年，死亡494例，全因病死率为0.85/100人年，平均生存时间为18.59（95%CI：18.40~18.78）年。恶性肿瘤和肺孢子虫肺炎分别为死亡病例的第一死因（14.37%，71/494）和第二死因（10.73%，53/494）。诊断后6个月内死亡占42.51%（210/494），自杀死亡者占4.25%（21/494）。多因素Cox比例风险回归分析发现，确诊至开始抗病毒治疗（ART）时间间隔≥3个月者和未ART者的死亡风险分别是确诊至开始ART时间间隔<3个月者的1.65（95%CI：1.25~2.19）倍和20.68（95%CI：15.80~27.06）倍；基线CD4⁺ T淋巴细胞（CD4）计数为200~、350~和≥500个/µl者的死亡风险分别是基线CD4计数<200个/µl者的0.38（95%CI：0.29~0.49）、0.26（95%CI：0.19~0.36）和0.21（95%CI：0.14~0.31）倍。确诊至开始ART时间间隔<3个月者和基线CD4计数较高者的死亡风险较低。结论 2004-2023年杭州市HIV感染者生存情况整体较好，尽早发现HIV感染者和及时动员ART是提高HIV感染者生存率的关键。应进一步加强HIV感染者抑郁/焦虑的筛查和自杀的监测，提供针对性的心理干预服务。

English Abstract:

Objective To analyze the survival status and death factors of confirmed HIV-infected patients in Hangzhou to provide a basis for the formulation of AIDS prevention and treatment strategies. Methods A retrospective cohort study was conducted. The data were from the HIV/AIDS Comprehensive Response Information Management System of the Chinese Disease Control and Prevention Information System.Epidemiological characteristics of HIV-infected patients were comparied in Hangzhou City from 2004 to 2023 by using chi-square Test. The survival rate of HIV-infected patients in Hangzhou was calculated by the life table method, the survival curves of different subgroups were described by the Kaplan-Meier method, and the Cox proportional hazard regression model was used to analyze the influencing factors of death risk. The SPSS 26.0 software was used for statistical analysis. Results Among the 9 457 subjects, the total follow-up time was 58 004.18 person-years, 494 patients died, fatality rate of all-cause cases was 0.85 per 100 person-years.The average survival time was 18.59 (95%CI:18.40-18.78) years. Malignant neoplasms and pneumocystis pneumonia were the first (14.37%,71/494) and second (10.73%, 53/494) causes of death, respectively. Death within 6 months after diagnosis accounted for 42.51% (210/494), and suicide accounted for 4.25% (21/494). Multivariate Cox regression analysis showed that compared with those who received antiviral treatment (ART) within 3 months of diagnosis, those who received ART outside 3 months and those who did not receive ART had a 1.65 (95%CI:1.25-2.19) and 20.68 (95%CI:15.80-27.06) times risk of death, respectively. The HIV-infected patients with high CD4⁺T lymphocytes (CD4) counts for the first time had a lower risk of death. The risk of death of patients with baseline CD4 counts of 200-349 cells/µl, 350-499 cells/µl, and ≥500 cells/µl was 0.38 (95%CI:0.29-0.49), 0.26 (95%CI:0.19-0.36), 0.21 (95%CI:0.14-0.31) times higher than that of baseline CD4 counts <200 cells/µl, respectively. Conclusions The overall survival of the HIV-infected patients was good in Hangzhou from 2004 to 2023. Early detection of HIV infection and timely mobilization to participate in ART was the key to improving the survival rate of patients. At the same time, given the suicide problem of HIV-infected patients, suicide surveillance and depression and anxiety screening of HIV-infected patients should be further strengthened, and targeted psychological intervention policies should be implemented.

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