Albuquerque M F P M, Alves D N, Bresani Salvi C C, Batista J D L, Ximenes R A A, Miranda-Filho D B, Melo H R L, Maruza M, Montarroyos U R
Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz,Pernambuco,Brazil.
Universidade Federal da Fronteira Sul,Santa Catarina,Brazil.
Epidemiol Infect. 2017 Apr;145(5):914-924. doi: 10.1017/S0950268816003149. Epub 2017 Jan 9.
We conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3 (SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.
我们进行了一项带有竞争风险的生存分析，以估计巴西东北部艾滋病毒/艾滋病感染者（PLWH）免疫缺陷相关死亡的死亡率和预测因素。2007年7月至2010年6月期间招募了一个由2372名PLWH组成的队列，并在两个医疗中心对其进行监测，直至2012年12月31日。感兴趣的事件是免疫缺陷相关死亡，其根据《艾滋病毒协议中的死亡原因编码》（CoDe）进行定义。预测变量包括：社会人口学特征、非法药物、烟草、酒精、营养状况、抗逆转录病毒疗法、基线时的贫血和CD4细胞计数；以及随访期间的结核病（TB）治疗或化学预防。由于我们将与免疫缺陷无关的死亡视为竞争事件，因此我们使用Fine & Gray模型进行带有竞争风险的生存分析，并估计了调整后的亚分布风险比（SHRs）。在10012.6人年的观察期内，每100人年有3.1例死亡（2.3例与免疫缺陷相关，0.8例与免疫缺陷无关）。结核病（SHR 4.0I）、贫血（SHR 3.58）、CD4<200个细胞/mm3（SHR 3.33）和失业（SHR 1.56）是免疫缺陷相关死亡的风险因素。本研究揭示了我们州高效抗逆转录病毒疗法（HAART）的覆盖率为13%，并补充说，无论HAART和CD4情况如何，基线时的贫血或结核病发病率可能会增加因艾滋病毒免疫缺陷而死亡的特定风险。
