南非克里斯·哈尼巴罗坎纳思医院医疗病房中与艾滋病毒相关的死亡原因。

HIV-attributable causes of death in the medical ward at the Chris Hani Baragwanath Hospital, South Africa.

机构信息

Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.

Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.

出版信息

PLoS One. 2019 May 6;14(5):e0215591. doi: 10.1371/journal.pone.0215591. eCollection 2019.

DOI:10.1371/journal.pone.0215591

PMID:31059528

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6502348/

Abstract

INTRODUCTION

Data on the association between HIV infection and deaths from underlying medical conditions are needed to understand and assess the impact of HIV on mortality. We present data on mortality in the Chris Hani Baragwanath Hospital (CHBH) South Africa and analyse the relationship between each cause of death and HIV.

METHODS

From 2006 to 2009 data were collected on 15,725 deaths including age, sex, day of admittance and of death, HIV status, ART initiation and CD4+ cell counts. Causes of death associated with HIV were cases, causes of death not associated with HIV were controls. We calculate the odds-ratios (ORs) for being HIV-positive and for each AIDS related condition the disease-attributable fraction (DAF) and the population-attributable fraction (PAF) due to HIV for cases relative to controls.

RESULTS

Among those that died, the prevalence of HIV was 61% and of acquired immune deficiency syndrome (AIDS) related conditions was 69%. The HIV-attributable fraction was 36% in the whole sample and 60% in those that were HIV-positive. Cryptococcosis, Kaposi's sarcoma and Pneumocystis jirovecii, TB, gastroenteritis and anaemia were highly predictive of HIV with odds ratios for being HIV-positive ranging from 8 to 124, while genito-urinary conditions, meningitis, other respiratory conditions and sepsis, lymphoma and conditions of skin and bone were significantly associated with HIV with odds ratios for being HIV-positive ranging from 3 to 8. Most of the deaths attributable to HIV were among those dying of TB or of other respiratory conditions.

CONCLUSIONS

The high prevalence of HIV among those that died, peaking at 70% in those aged 30 years but still 7% in those aged 80 years, demonstrates the impact of the HIV epidemic on adult mortality and on hospital services and the extent to which early anti-retroviral treatment would have reduced the burden of both. These data make it possible to better assess mortality and morbidity due to HIV in this still high prevalence setting and, in particular, to identify those causes of death that are most strongly associated with HIV.

摘要

引言

了解和评估 HIV 对死亡率的影响，需要有关于 HIV 感染与基础医学疾病死亡之间关联的数据。我们报告了南非克里斯·哈尼巴哈纳医院（CHBH）的死亡率数据，并分析了每种死因与 HIV 之间的关系。

方法

2006 年至 2009 年期间，收集了 15725 例死亡病例的数据，包括年龄、性别、入院日和死亡日、HIV 状态、ART 起始和 CD4+细胞计数。与 HIV 相关的死因是病例，与 HIV 不相关的死因是对照。我们计算了 HIV 阳性的优势比（OR），以及每种艾滋病相关疾病的疾病归因分数（DAF）和人群归因分数（PAF），病例相对于对照。

结果

在死亡者中，HIV 流行率为 61%，艾滋病相关疾病的流行率为 69%。HIV 归因分数在全样本中为 36%，在 HIV 阳性者中为 60%。隐球菌病、卡波西肉瘤和肺囊虫肺炎、结核病、胃肠炎和贫血是 HIV 的高度预测指标，其 HIV 阳性的优势比范围为 8 至 124，而泌尿生殖系统疾病、脑膜炎、其他呼吸系统疾病和败血症、淋巴瘤以及皮肤和骨骼疾病与 HIV 显著相关，其 HIV 阳性的优势比范围为 3 至 8。大多数归因于 HIV 的死亡发生在死于结核病或其他呼吸系统疾病的人群中。

结论

在死亡者中 HIV 的高流行率，在 30 岁年龄组达到 70%，但在 80 岁年龄组仍为 7%，表明 HIV 流行对成人死亡率和医院服务的影响，以及早期抗逆转录病毒治疗将在多大程度上减轻两者的负担。这些数据使我们能够更好地评估该地区 HIV 相关死亡率和发病率，特别是确定与 HIV 关联最密切的死因。