[伊犁哈萨克自治州接受美沙酮维持治疗的艾滋病毒感染患者的死亡率]

[Mortality of HIV infected clients treated with methadone maintenance treatment in Yili Kazakh autonomous prefecture].

作者信息

Liu En-wu, Wang Shu-jiang, Liu Yan, Liu Wei, Chen Zhi-sheng, Li Xiu-ying, A Li-ya, Wu Zun-you

机构信息

National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2011 Nov;45(11):979-84.

PMID:22336271

Abstract

OBJECTIVE

To investigate the mortality of HIV infected clients from methadone maintenance treatment (MMT) clinics in Yili Kazakh autonomous prefecture as well as the factors associated with mortality of HIV infected clients.

METHODS

A retrospective cohort study was performed. Data of 860 cases were collected from National Methadone Maintenance Treatment database, National AIDS/HIV database and antiretroviral therapy (ART) treatment database for adults. Information collected included demographic information of HIV infected clients, methadone daily treatment information, CD4 testing information, ART treatment information and death information. Recruiting began from August, 2005 through May, 2011. Cox proportional regression was used to identify factors associated with mortality. The proportional hazard assumption was assessed using Schoenfeld's residuals test. Missing values were imputed using the multiple linear regression method. R software (version 2.13.0) was used to perform data analysis.

RESULTS

A total of 860 HIV positive MMT clients were analyzed. The methadone dose for study subjects was (38.2 ± 20.7) mg/d. 27.8% (239/860) of study subjects participated in ART treatment, 38.7% (333/860) had never tested for CD4 count. The age for study subjects was (32.9 ± 6.4) years old. Among all these subjects, 67.3% (579/860) were married. During the observation period, 151 deaths were observed in 2192.9 person years. The average observation time was 2.6 year for each subject. The all-cause mortality rate was 68.9‰. Cox proportion model showed that ART treatment (HR = 0.53, 95%CI: 0.32 - 0.88), baseline CD4 count at 200 - 350 cells/µl (HR = 0.35, 95%CI: 0.20 - 0.60), baseline CD4 count more than 350 cells/µl (HR = 0.16, 95%CI: 0.09 - 0.29), and marriage (HR = 0.55, 95%CI: 0.37 - 0.82) were associated with less mortality compared with control group. Age (more than 45 years old) (HR = 5.20, 95%CI: 2.60 - 10.20) and sharing needles (HR = 1.40, 95%CI: 1.02 - 2.00) were risk factors associated with death.

CONCLUSION

High mortality rate was observed among HIV infected clients. Methadone clinic should provide ART treatment or ART referral services.

摘要

目的

调查伊犁哈萨克自治州美沙酮维持治疗（MMT）门诊中HIV感染患者的死亡率以及与HIV感染患者死亡率相关的因素。

方法

进行一项回顾性队列研究。从国家美沙酮维持治疗数据库、国家艾滋病/HIV数据库和成人抗逆转录病毒治疗（ART）数据库收集了860例患者的数据。收集的信息包括HIV感染患者的人口统计学信息、美沙酮每日治疗信息、CD4检测信息、ART治疗信息和死亡信息。招募时间从2005年8月至2011年5月。采用Cox比例回归分析确定与死亡率相关的因素。使用Schoenfeld残差检验评估比例风险假设。采用多重线性回归方法对缺失值进行插补。使用R软件（版本2.13.0）进行数据分析。

结果

共分析了860例HIV阳性的MMT患者。研究对象的美沙酮剂量为（38.2±20.7）mg/d。27.8%（239/860）的研究对象接受了ART治疗，38.7%（333/860）从未检测过CD4细胞计数。研究对象的年龄为（32.9±6.4）岁。在所有这些受试者中，67.3%（579/860）已婚。在观察期内，2192.9人年中共观察到151例死亡。每位受试者的平均观察时间为2.6年。全因死亡率为68.9‰。Cox比例模型显示，与对照组相比，ART治疗（HR = 0.53，95%CI：0.32 - 0.88）、基线CD4细胞计数在200 - 350个/μl（HR = 0.35，95%CI：0.20 - 0.60）、基线CD4细胞计数超过350个/μl（HR = 0.16，95%CI：0.09 - 0.29）以及已婚（HR = 0.55，95%CI：0.37 - 0.82）与较低死亡率相关。年龄（超过45岁）（HR = 5.20，95%CI：2.60 - 10.20）和共用针头（HR = 1.40，95%CI：1.02 - 2.00）是与死亡相关的危险因素。