Yang C-H, Huang Y-F, Hsiao C-F, Yeh Y-L, Liou H-R, Hung C-C, Yang S-Y
Third Division, Centers for Disease Control, Department of Health, Taipei, Taiwan.
HIV Med. 2008 Aug;9(7):535-43. doi: 10.1111/j.1468-1293.2008.00600.x. Epub 2008 Jun 28.
The aim of this study was to analyse the trends of mortality and causes of death among HIV-infected patients in Taiwan from 1984 to 2005.
Registered data and death certificates for HIV-infected patients from Taiwan Centers for Disease Control were reviewed. Mortality rate and causes of deaths were compared among patients whose HIV diagnosis was made in three different study periods: before the introduction of highly active antiretroviral therapy (HAART) (pre-HAART: from 1 January 1984 to 31 March 1997), in the early HAART period (from 1 April 1997 to 31 December 2001), and in the late HAART period (from 1 January 2002 to 31 December 2005). A subgroup of 1161 HIV-infected patients (11.4%) followed at a university hospital were analysed to investigate the trends of and risk factors for mortality.
For 10 162 HIV-infected patients with a mean follow-up of 1.97 years, the mortality rate of HIV-infected patients declined from 10.2 deaths per 100 person-years (PY) in the pre-HAART period to 6.5 deaths and 3.7 deaths per 100 PY in the early and late HAART periods, respectively (P<0.0001). For the 1161 patients followed at a university hospital (66.8% with CD4 count <200 cells/microL), HAART reduced mortality by 89% in multivariate analysis, and the adjusted hazard ratio for death was 0.28 (95% confidence interval 0.24, 0.33) in patients enrolled in the late HAART period compared with those in the pre-HAART period. Seventy-six per cent of the deaths in the pre-HAART period were attributable to AIDS-defining conditions, compared with 36% in the late HAART period (P<0.0001). The leading causes of non-AIDS-related deaths were sepsis (14.7%) and accidental death (8.3%), both of which increased significantly throughout the three study periods. Compared with patients acquiring HIV infection through sexual contact, injecting drug users were more likely to die from non-AIDS-related causes.
The mortality of HIV-infected patients declined significantly after the introduction of HAART in Taiwan. In the HAART era, AIDS-related deaths decreased significantly while deaths from non-AIDS-related conditions increased.
本研究旨在分析1984年至2005年台湾地区HIV感染患者的死亡率趋势及死亡原因。
回顾了台湾疾病控制中心登记的HIV感染患者数据和死亡证明。比较了在三个不同研究时期确诊HIV的患者的死亡率和死亡原因：在高效抗逆转录病毒治疗（HAART）引入之前（HAART前：1984年1月1日至1997年3月31日）、HAART早期（1997年4月1日至2001年12月31日）以及HAART晚期（2002年1月1日至2005年12月31日）。对一所大学医院随访的1161例HIV感染患者亚组（占11.4%）进行分析，以研究死亡率趋势及危险因素。
对于10162例平均随访1.97年的HIV感染患者，HIV感染患者的死亡率从HAART前时期的每100人年10.2例死亡降至HAART早期的每100人年6.5例死亡和HAART晚期的每100人年3.7例死亡（P<0.0001）。对于在一所大学医院随访的1161例患者（66.8%的患者CD4细胞计数<200个/微升），多因素分析显示HAART使死亡率降低了89%，与HAART前时期入组的患者相比，HAART晚期入组患者的校正死亡风险比为0.28（95%置信区间0.24, 0.33）。HAART前时期76%的死亡归因于艾滋病界定疾病，而HAART晚期这一比例为36%（P<0.0001）。非艾滋病相关死亡的主要原因是败血症（14.7%）和意外死亡（8.3%），在整个三个研究时期均显著增加。与通过性接触感染HIV的患者相比，注射吸毒者更可能死于非艾滋病相关原因。
在台湾地区引入HAART后，HIV感染患者的死亡率显著下降。在HAART时代，艾滋病相关死亡显著减少，而非艾滋病相关疾病导致的死亡增加。
