Chelli Jihène, Bellazreg Foued, Aouem Abir, Hattab Zouhour, Mesmia Hèla, Lasfar Nadia Ben, Hachfi Wissem, Masmoudi Tasnim, Chakroun Mohamed, Letaief Amel
Service de Maladies Infectieuses, CHU Farhat Hached, Sousse 4000, Tunisie.
Service de Maladies Infectieuses, CHU Fattouma Bourguiba, Monastir 5000, Tunisie.
Pan Afr Med J. 2016 Oct 21;25:105. doi: 10.11604/pamj.2016.25.105.9748. eCollection 2016.
Antiretroviral tritherapy has contributed to a considerable reduction in HIV-related mortality. The causes of death are dominated by opportunistic infections in developing countries and by cardiovascular diseases and cancer in developed countries. To determine the causes and risk factors associated with death in HIV-infected patients in two Tunisian medical centers. cross-sectional study of HIV-infected patients over 15 years treated at Sousse and Monastir medical centers between 2000 and 2014. Death was considered related to HIV if its primary cause was AIDS-defining illness or if it was due to an opportunistic infection of unknown etiology with CD4 < 50 cells/mm; it was considered unrelated to HIV if its primary cause wasn't an AIDS defining illness or if it was due to an unknown cause if no information was available. Two hundred thirteen patients, 130 men (61%) and 83 women (39%), average age 40 ± 11 years were enrolled in the study. Fifty four patients died, the mortality rate was 5.4/100 patients/year. Annual mortality rate decreased from 5.8% in 2000-2003 to 2.3% in 2012-2014. Survival was 72% at 5 years and 67% at 10 years. Death events were associated with HIV in 70.4% of cases. The leading causes of death were pneumocystis carinii pneumonia and cryptococcal meningitis in 6 cases (11%) each. Mortality risk factors were a personal history of opportunistic infections, duration of antiretroviral therapy < 12 months and smoking. Strengthening screening, early initiation of antiretroviral therapy and fight against tobacco are needed to reduce mortality in patients infected with HIV in Tunisia.
抗逆转录病毒三联疗法已使与艾滋病相关的死亡率大幅下降。在发展中国家，死亡原因主要是机会性感染；在发达国家，则主要是心血管疾病和癌症。为确定突尼斯两个医疗中心感染艾滋病毒患者的死亡原因及相关风险因素，对2000年至2014年期间在苏塞和莫纳斯提尔医疗中心接受治疗的15岁以上艾滋病毒感染患者进行了横断面研究。如果死亡的主要原因是艾滋病界定疾病，或者是病因不明且CD4细胞计数<50个/mm³的机会性感染，则认为死亡与艾滋病毒有关；如果主要原因不是艾滋病界定疾病，或者病因不明且无相关信息，则认为死亡与艾滋病毒无关。共有213名患者纳入研究，其中男性130名（61%），女性83名（39%），平均年龄40±11岁。54名患者死亡，死亡率为5.4/100患者/年。年死亡率从2000 - 2003年的5.8%降至2012 - 2014年的2.3%。5年生存率为72%，10年生存率为67%。70.4%的死亡事件与艾滋病毒有关。主要死亡原因是卡氏肺孢子虫肺炎和隐球菌性脑膜炎，各有6例（11%）。死亡风险因素包括机会性感染个人史、抗逆转录病毒治疗时间<12个月以及吸烟。突尼斯需要加强筛查、尽早开始抗逆转录病毒治疗并开展控烟工作，以降低艾滋病毒感染患者的死亡率。
