Garriga César, García de Olalla Patricia, Miró Josep M, Ocaña Inma, Knobel Hernando, Barberá Maria Jesús, Humet Victoria, Domingo Pere, Gatell Josep M, Ribera Esteve, Gurguí Mercè, Marco Andrés, Caylà Joan A
Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
Spanish Field Epidemiology Training Programme, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
PLoS One. 2015 Dec 30;10(12):e0145701. doi: 10.1371/journal.pone.0145701. eCollection 2015.
Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013.
We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models.
182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)].
Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5-7.0) and <200 CD4 at diagnosis (sHR:2.7; CI:1.3-5.7) versus ≥500 CD4. Factors associated with non-HIV-related causes of death include: ageing (sHR:1.5; CI:1.4-1.7) and heterosexual female (sHR:2.8; CI:1.1-7.3) versus MSM. Factors associated with external causes of death were IDU male (sHR:28.7; CI:6.7-123.2) and heterosexual male (sHR:11.8; CI:2.5-56.4) versus MSM.
There are important differences in survival among transmission groups. Improved treatment is especially necessary in IDUs and heterosexual males.
抗逆转录病毒疗法已使与艾滋病相关的死亡率有所下降，并且出现了非艾滋病定义疾病成为相互竞争的死亡原因。本研究估计了2001年1月至2013年6月期间一个大城市中不同病因的艾滋病死亡率及其危险因素。
我们对3137例新诊断的艾滋病非艾滋病病例进行了随访。死亡原因分为与艾滋病相关、与艾滋病无关和外部原因。我们使用死亡率、Kaplan-Meier曲线和Cox模型研究了危险因素对生存的影响。最后，我们通过Fine和Gray模型估计了每个主要死亡原因组的生存率。
共发现182例死亡[14.0/1000人年随访（py）；95%置信区间（CI）：12.0 - 16.1/1000 py]，其中81.3%有已知的死亡原因。与艾滋病相关原因和与艾滋病无关原因的死亡率相同（4.9/1000 py；CI：3.7 - 6.1/1000 py），外部原因较低[1.7/1000 py；（1.0 - 2.4/1000 py）]。
Kaplan-Meier估计显示，静脉吸毒者（IDU）和异性恋者的生存率低于男男性行为者（MSM）。与艾滋病相关死亡原因相关的因素包括：IDU男性（亚危险比（sHR）：3.2；CI：1.5 - 7.0）以及诊断时CD4<200（sHR：2.7；CI：1.3 - 5.7）与CD4≥500相比。与艾滋病无关死亡原因相关的因素包括：年龄增长（sHR：1.5；CI：1.4 - 1.7）以及异性恋女性（sHR：2.8；CI：1.1 - 7.3）与MSM相比。与外部原因死亡相关的因素是IDU男性（sHR：28.7；CI：6.7 - 123.2）和异性恋男性（sHR：1`1.8；CI：2.5 - 56.4）与MSM相比。
不同传播组之间的生存率存在重要差异。对IDU和异性恋男性尤其需要改善治疗。
