[山西省南部地区艾滋病相关死亡率及其危险因素]

[HIV/AIDS related mortality in southern Shanxi province and its risk factors].

作者信息

Ning Shaoping, Xue Zidong, Wei Jun, Mu Shengcai, Xu Yajuan, Jia Shaoxian, Qiu Chao, Xu Jianqing

机构信息

Yuncheng Center for Disease Control and Prevention, Yuncheng 044000, China.

Shanxi Provincial Center for Disease Control and Prevention.

出版信息

Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Mar;36(3):245-9.

PMID:25975402

Abstract

OBJECTIVE

To explore factors influencing mortality rate of HIV/AIDS and to improve the effectiveness of antiretroviral therapy (ART).

METHODS

By means of retrospective cohort study and the AIDS control information system, HIV/AIDS case reports and antiviral treatment information of 4 cities in southern Shanxi province up to end of December 2012 were selected, to calculate the mortality rate and treatment coverage based on further data collected, along with analysis using the Cox proportional hazards survival regression.

RESULTS

4 040 cases confirmed of HIV/AIDS were included in this study. The average age was (36.0 ± 12.9) years, with 65.3% being male, 56.5% being married, 73.5% having junior high school education or lower, 58.4% being peasants, 54.3% with sexually transmitted infection (40.1% were heterosexual, 14.2% were homosexual), and 38.9% were infected via blood transmission (20.2% were former plasma donors, 16.2% blood transfusion or products recipients, 2.4% were injection drug users). Overall mortality decreased from 40.2 per 100 person/year in 2004 to 6.3 per 100 person/year in 2012, with treatment coverage concomitantly increasing from almost 14.8% to 63.4%. Cox proportional hazards survival regression was used on 4 040 qualified cases, demonstrating the top mortality risk factor was without antiretroviral therapy (RR = 14.9, 95% CI: 12.7-17.4). Cox proportional hazards survival regression was made on 1 938 cases of antiviral treatment, demonstrating that the mortality risk of underweight or obese before treatment was higher than those of normal and overweight cases (RR = 2.7, 95% CI: 1.6-4.5), and the mortality of those having a CD4(+) T-lymphocyte count ≤ 50 cells per µl before treatment was more than 50 cases (RR = 2.6, 95% CI: 1.5-4.5); Cox proportional hazards survival regression was made on 2 102 cases of untreated cases, demonstrating the mortality risk of those initially diagnosed as AIDS was higher than those initially diagnosed as HIV (RR = 3.4, 95% CI: 2.9-4.0).

CONCLUSION

The ART could successfully make lower HIV/AIDS mortality rate, indicating effective ART can further decrease mortality.

摘要

目的

探讨影响艾滋病病毒/艾滋病（HIV/AIDS）死亡率的因素，提高抗逆转录病毒治疗（ART）的效果。

方法

采用回顾性队列研究方法，通过艾滋病防治信息系统，选取截至2012年12月底山西省南部4个市的HIV/AIDS病例报告及抗病毒治疗信息，在进一步收集数据的基础上计算死亡率和治疗覆盖率，并采用Cox比例风险生存回归分析。

结果

本研究纳入4040例确诊的HIV/AIDS患者。平均年龄为（36.0±12.9）岁，男性占65.3%，已婚者占56.5%，初中及以下文化程度者占73.5%，农民占58.4%，性传播感染途径者占54.3%（异性传播占40.1%，同性传播占14.2%），血液传播途径感染者占38.9%（既往血浆供血者占20.2%，输血或使用血制品者占16.2%，注射吸毒者占2.4%）。总体死亡率从2004年的每100人年40.2例降至2012年的每100人年6.3例，治疗覆盖率则从近14.8%增至63.4%。对4040例符合条件的病例进行Cox比例风险生存回归分析，结果显示死亡风险最高的因素是未接受抗逆转录病毒治疗（RR=14.9，95%CI：12.7-17.4）。对1938例接受抗病毒治疗的病例进行Cox比例风险生存回归分析，结果显示治疗前体重过轻或肥胖者的死亡风险高于体重正常和超重者（RR=2.7，95%CI：1.6-4.5），治疗前CD4(+)T淋巴细胞计数≤50个/μl者的死亡率超过50例（RR=2.6，95%CI：1.5-4.5）；对2102例未治疗的病例进行Cox比例风险生存回归分析，结果显示初诊为艾滋病者的死亡风险高于初诊为HIV者（RR=3.4，95%CI：2.9-4.0）。