Division of Treatment and Care, National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China.
Lancet Infect Dis. 2011 Jul;11(7):516-24. doi: 10.1016/S1473-3099(11)70097-4.
Overall HIV mortality rates in China have not been reported. In this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality.
We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009. Mortality rates were calculated in terms of person-years, with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment, with risk factors for not receiving treatment identified by use of logistic regression.
Of 323,252 people reported as having HIV in China by the end of 2009, 145,484 (45%) were identified as treatment-eligible and included in this analysis. Median CD4 count was 201 cells per μL (IQR 71-315) at HIV diagnosis and 194 cells per μL (73-293) when first declared eligible for treatment. Overall mortality decreased from 39·3 per 100 person-years in 2002 to 14·2 per 100 person-years in 2009, with treatment coverage concomitantly increasing from almost zero to 63·4%. By 2009, mortality was higher and treatment coverage lower in injecting drug users (15·9 deaths per 100 person-years; 42·7% coverage) and those infected sexually (17·5 deaths per 100 person-years; 61·7% coverage), compared with those infected through plasma donation or blood transfusion (6·7 deaths per 100 person-years; 80·2% coverage). The two strongest risk factors for HIV-related mortality were not receiving highly active antiretroviral therapy (adjusted hazard ratio 4·35, 95% CI 4·10-4·62) and having a CD4 count of less than 50 cells per μL when first declared eligible for treatment (7·92, 7·33-8.57).
An urgent need exists for earlier HIV diagnosis and better access to treatment for injecting drug users and patients infected with HIV sexually, especially before they become severely immunosuppressed.
The National Centre for AIDS/STD Control and Prevention of the Chinese Centre for Disease Control and Prevention.
目前尚未报道中国的整体艾滋病毒死亡率。本分析评估了符合治疗条件的艾滋病毒成年患者的总体死亡率，并尝试确定与艾滋病毒相关的死亡风险因素。
我们使用国家艾滋病毒流行病学和治疗数据库的数据，确定了 1985 年至 2009 年间年龄在 15 岁及以上、有资格接受高效抗逆转录病毒治疗的艾滋病毒感染者。死亡率按人年计算，使用 Cox 比例风险回归确定风险因素。将患者接受治疗的时间比例定义为治疗覆盖率，使用逻辑回归确定未接受治疗的风险因素。
截至 2009 年底，中国报告的艾滋病毒感染者为 323252 人，其中 145484 人（45%）被确定为符合治疗条件，并纳入本分析。诊断时的中位 CD4 计数为 201 个细胞/μL（IQR 71-315），首次宣布有资格接受治疗时为 194 个细胞/μL（73-293）。总体死亡率从 2002 年的 39.3/100 人年降至 2009 年的 14.2/100 人年，同时治疗覆盖率从几乎为零增至 63.4%。到 2009 年，与通过血浆捐献或输血感染的患者（6.7/100 人年；80.2%的覆盖率）相比，注射吸毒者（15.9/100 人年；42.7%的覆盖率）和性传播感染者（17.5/100 人年；61.7%的覆盖率）的死亡率更高，治疗覆盖率更低。与艾滋病毒相关的死亡率的两个最强风险因素是未接受高效抗逆转录病毒治疗（调整后的危险比 4.35，95%CI 4.10-4.62）和首次宣布有资格接受治疗时 CD4 计数小于 50 个细胞/μL（7.92，7.33-8.57）。
迫切需要更早地发现艾滋病毒并为注射吸毒者和性传播感染者提供更好的治疗机会，尤其是在他们严重免疫抑制之前。
中国疾病预防控制中心国家艾滋病/性病预防控制中心。
