*Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; †Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‡Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; and §Division of Infectious Diseases, Beijing Ditan Hospital Capital Medical University, Beijing, China.
J Acquir Immune Defic Syndr. 2013 Aug 15;63(5):e150-7. doi: 10.1097/QAI.0b013e3182948d82.
OBJECTIVE: To evaluate excess mortality across calendar time comparing HIV-infected patients receiving combination antiretroviral therapy (cART) with the general Chinese population. METHODS: Patients receiving free cART through the National Free Antiretroviral Therapy Program (NFATP) between January 1, 2003, and December 31, 2009, were included. Observed mortality rates, excess mortality rates, and standardized mortality ratios were calculated by calendar periods. Factors associated with excess mortality across calendar time were evaluated in multivariable Poisson regression models. RESULTS: Among 64,836 HIV-infected patients, the observed and excess mortality rates in 2003-2004 were 9.5 deaths per 100 person-years [95% confidence interval (CI): 8.8 to 10.2] and 9.1 (95% CI: 8.5 to 9.8); in 2008-2009, these decreased to 5.6 (95% CI: 5.4 to 5.8) and 5.2 (95% CI: 5.0 to 5.4), respectively. The adjusted excess hazard ratio (eHR) for 2003-2004 in comparison to 2008-2009 was 1.27 (95% CI: 1.11 to 1.45). Patients initiating cART at CD4 cell counts <50 cells per microliter in comparison with ≥350 cells per microliter had an adjusted eHR of 9.92 (95% CI: 8.59 to 11.44). Patients starting cART at older ages also had greater excess mortality with an eHR of 1.63 (95% CI: 1.47 to 1.82) comparing ages ≥45 to 18-29 years. Standardized mortality ratio results were consistent with those for excess mortality. CONCLUSIONS: Substantial decreases in excess mortality were observed from 2003 to 2009 in China among HIV-infected patients receiving free cART. However, mortality among HIV-infected patients remained higher than the general Chinese population. As more efficacious first- and second-line cART regimens become increasingly available to Chinese HIV-infected patients, further reductions in overall and excess mortality are likely.
目的：通过比较接受联合抗逆转录病毒疗法（cART）的 HIV 感染者和普通中国人群的日历时间，评估超额死亡率。
方法：纳入 2003 年 1 月 1 日至 2009 年 12 月 31 日期间通过国家免费抗逆转录病毒治疗计划（NFATP）接受免费 cART 的患者。按日历时间计算观察死亡率、超额死亡率和标准化死亡率比。采用多变量泊松回归模型评估与日历时间相关的超额死亡相关因素。
结果：在 64836 名 HIV 感染者中，2003-2004 年的观察死亡率和超额死亡率分别为每 100 人年 9.5 例（95%置信区间[CI]：8.8 至 10.2）和 9.1（95%CI：8.5 至 9.8）；2008-2009 年分别降至 5.6（95%CI：5.4 至 5.8）和 5.2（95%CI：5.0 至 5.4）。与 2008-2009 年相比，2003-2004 年调整后的超额危险比（eHR）为 1.27（95%CI：1.11 至 1.45）。与 CD4 细胞计数≥350 个/微升相比，CD4 细胞计数<50 个/微升的患者开始 cART 治疗的调整后 eHR 为 9.92（95%CI：8.59 至 11.44）。年龄较大的患者开始 cART 治疗的超额死亡率也更高，年龄≥45 岁与 18-29 岁比较的 eHR 为 1.63（95%CI：1.47 至 1.82）。标准化死亡率比的结果与超额死亡率的结果一致。
结论：在中国，接受免费 cART 的 HIV 感染者的超额死亡率从 2003 年到 2009 年显著下降。然而，HIV 感染者的死亡率仍然高于普通中国人群。随着更有效、一线和二线 cART 方案越来越多地应用于中国 HIV 感染者，总死亡率和超额死亡率可能会进一步降低。
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