巴西里约热内卢感染艾滋病毒的女性、异性恋男性和男男性接触者的死亡率：一项观察性队列研究。
Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study.
机构信息
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
出版信息
Lancet HIV. 2016 Oct;3(10):e490-8. doi: 10.1016/S2352-3018(16)30052-2. Epub 2016 Aug 17.
BACKGROUND
Mortality in HIV-infected individuals might differ by sex and mode of HIV acquisition. We aimed to study mortality in HIV-infected women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil.
METHODS
In this observational cohort study, we included HIV-infected women, heterosexual men, and MSM (aged ≥18 years) from the Instituto Nacional de Infectologia Evandro Chagas database who were enrolled between Jan 1, 2000, and Oct 30, 2011, and who had at least 60 days of follow-up. Causes of deaths, defined with the Coding of Death in HIV protocol, were documented. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS-related and non-AIDS-related deaths.
FINDINGS
We had 10 142 person-years of follow-up from 2224 individuals: 817 (37%) women, 554 (25%) heterosexual men, and 853 (38%) MSM. Of 103 deaths occurred, 64 were AIDS related, 31 were non-AIDS related, and eight were of unknown causes. In unadjusted analyses, compared with women, the hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% CI 1·30-9·08; p=0·009) and for MSM (2·30, 0·89-5·94; p=0·084). After adjustment for age, CD4 cell counts, last HIV viral load, antiretroviral therapy use, and AIDS-defining infection, AIDS-defining malignant disease, and hospital admission during follow-up, the excess risk of AIDS-related death decreased for heterosexual men (adjusted HR 1·99, 0·75-5·25; p=0·163) but was unchanged for MSM (2·24, 0·82-6·11; p=0·114). Non-AIDS-related mortality did not differ by group.
INTERPRETATION
Compared with women, increased risk of AIDS-related death in heterosexual men was partly mitigated by risk factors for AIDS mortality, whereas the excess risk in MSM was unchanged. Further study of reasons for disparity in AIDS-related mortality by mode of transmission is needed.
FUNDING
US National Institutes of Health, Brazilian National Council of Technological and Scientific Development (CNPq), and Research Funding Agency of the State of Rio de Janeiro (FAPERJ).
背景
HIV 感染者的死亡率可能因性别和 HIV 感染途径而有所不同。我们旨在研究巴西里约热内卢队列中 HIV 感染的女性、异性恋男性和男男性接触者（MSM）的死亡率。
方法
在这项观察性队列研究中，我们纳入了 2000 年 1 月 1 日至 2011 年 10 月 30 日期间在巴西国立传染病学伊瓦德罗·查加斯研究所数据库中登记的年龄≥18 岁的 HIV 感染女性、异性恋男性和 MSM（至少随访 60 天）。使用 HIV 死亡编码方案记录死因。使用考虑竞争风险的 Cox 比例风险模型来探讨 AIDS 相关和非 AIDS 相关死亡的危险因素。
结果
我们从 2224 名个体中获得了 103142 人年的随访数据：817 名（37%）女性、554 名（25%）异性恋男性和 853 名（38%）MSM。103 例死亡中，64 例与 AIDS 相关，31 例与非 AIDS 相关，8 例死因不明。在未调整分析中，与女性相比，异性恋男性 AIDS 相关死亡的风险更高（危险比[HR]3.52，95%CI 1.30-9.08；p=0.009），MSM 也更高（2.30，0.89-5.94；p=0.084）。在调整年龄、CD4 细胞计数、末次 HIV 病毒载量、抗逆转录病毒治疗的使用以及随访期间 AIDS 定义性感染、AIDS 定义性恶性疾病和住院治疗后，异性恋男性的 AIDS 相关死亡风险增加幅度降低（调整后的 HR 为 1.99，0.75-5.25；p=0.163），而 MSM 则保持不变（2.24，0.82-6.11；p=0.114）。非 AIDS 相关死亡率在各组之间没有差异。
解释
与女性相比，异性恋男性 AIDS 相关死亡的风险增加，部分原因是 AIDS 死亡率的危险因素得到了缓解，而 MSM 的超额风险则保持不变。需要进一步研究传播模式不同导致 AIDS 相关死亡率差异的原因。
资金来源
美国国立卫生研究院、巴西国家技术和科学发展理事会（CNPq）和里约热内卢州研究经费机构（FAPERJ）。
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