Lahey Timothy, Lin Michelle, Marsh Bryan, Curtin Jim, Wood Kim, Eccles Betsy, von Reyn C Fordham
Department of Microbiology and Immunology, Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
AIDS Res Hum Retroviruses. 2007 May;23(5):693-8. doi: 10.1089/aid.2006.0206.
Although patients with human immunodeficiency virus (HIV) infection who live in the rural United States receive less expert care and less antiretroviral treatment, the impact of living in rural areas on mortality from HIV infection is unstudied. We compared mortality rates in 327 rural and 317 urban patients with HIV infection in a retrospective cohort study using a multivariate logistic regression model. Rural patients with HIV infection were older at the end of follow-up (43.4 vs. 41.4 years, p = 0.002), and more likely white (93.0% vs. 77.9%, p < 0.001), and a greater proportion were men who have sex with men (55.5% vs. 36.1%, p < 0.001). While the mean year of diagnosis was 1994 in rural patients and 1995 in urban patients (p < 0.001), the mean CD4(+) T cell count at presentation was similar in the two groups: 376 vs. 351 cells/mul (p = 0.298). Rural patients in our cohort were more likely to receive antiretroviral medications at any CD4 count (73.7 vs. 62.1%, p =0.0016), and received PCP prophylaxis at comparable rates (23.5% vs. 25.6%,p =0.555). Mortality was higher in rural patients (10.4% vs. 6.0%, p = 0.028). The risk of mortality remained higher in rural patients when adjusting for age, sex, race, HIV risk factors, year of diagnosis, travel time, lack of insurance, and receipt of antiretroviral treatment or PCP prophylaxis in a logistic regression model (OR 2.11, 1.064 to 4.218, p = 0.047). Patients with HIV who live in rural areas have higher mortality rates than urban patients with HIV.
尽管生活在美国农村地区的人类免疫缺陷病毒（HIV）感染者接受的专业护理和抗逆转录病毒治疗较少，但农村地区生活对HIV感染死亡率的影响尚未得到研究。在一项回顾性队列研究中，我们使用多变量逻辑回归模型比较了327名农村HIV感染者和317名城市HIV感染者的死亡率。随访结束时，农村HIV感染者年龄更大（43.4岁对41.4岁，p = 0.002），更可能是白人（93.0%对77.9%，p < 0.001），且男男性行为者比例更高（55.5%对36.1%，p < 0.001）。虽然农村患者的诊断平均年份为1994年，城市患者为1995年（p < 0.001），但两组初诊时的平均CD4(+) T细胞计数相似：376对351个细胞/微升（p = 0.298）。我们队列中的农村患者在任何CD4计数时更可能接受抗逆转录病毒药物治疗（73.7%对62.1%，p = 0.0016），接受肺孢子菌肺炎（PCP）预防的比例相当（23.5%对25.6%，p = 0.555）。农村患者的死亡率更高（10.4%对6.0%，p = 0.028）。在逻辑回归模型中，调整年龄、性别、种族、HIV风险因素、诊断年份、出行时间、缺乏保险以及接受抗逆转录病毒治疗或PCP预防后，农村患者的死亡风险仍然更高（比值比2.11，1.064至4.218，p = 0.047）。生活在农村地区的HIV感染者的死亡率高于城市HIV感染者。
