Medical School of Chinese PLA, Beijing 100853, China; National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China; Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China.
National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China; Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China; Department of liver disease, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen Third People's Hospital, Shenzhen, China.
J Infect. 2022 Mar;84(3):400-409. doi: 10.1016/j.jinf.2021.12.034. Epub 2021 Dec 29.
High HIV-related mortality is mainly associated with severe immunosuppression (CD4 count < 50 cells/μL) in people living with HIV (PLWH). This study intended to explore the trends in epidemic and early mortality among PLWH with severe immunosuppression for further targeted intervention.
We extracted the data of treatment-naïve PLWH with severe immunosuppression from China's National Free Antiretroviral Treatment (ART) Program database. Early mortality (within 6 or 12 months after initiating ART) and spatial, temporal, and population distribution were analyzed during 2005-2018.
Of 748,066 treatment-naïve PLWH, 105,785 (14.1%) were severely immunosuppressed PLWH aged more than 15-year-old. The proportion of severely immunosuppressed PLWH peaked at 31.4% and then decreased with time, leveling off at approximately 11-12% from 2015 onward. Early mortality rates of these PLWH declined significantly (from 17.0% to 8.1% after 6 months of initiating ART; 20.4% to 10.6% after 12 months; both p values < 0.01) from 2005-2007 to 2016-2018. In the South-central and Southwest, the number of these PLWH was larger than that in the other regions during 2005-2018, and it increased to 4780 (37.1%) and 3370 (26.2%) in 2018. The proportion of PLWH aged 30-44 years among all treatment-naïve severely immunosuppressed PLWH in each region was higher than that of other age groups during 2005-2018. After the proportion decreased during 2005-2007, the proportion of PLWH aged 45-59 years in Southwest and South-central were increased steadily from 11% (69/626) and 16.7% (358/2140) in 2007 to 33.8% (1138/3370) and 34.0% (1626/4780) in 2018, respectively; the proportion of PLWH aged ≥60 years showed an increasing trend during 2005-2018; while changes in the proportion of those age groups were less pronounced in North and Northeast. The proportion of PLWH infected by heterosexual contact was high at 83% (2798/3370) in Southwest, and 75.1% (3588/4780) in South-central in 2018; conversely, proportion of PLWH infected by homosexual contacts was largest in North (57.8% [500/865]) and Northeast (59.9% [561/936]).
The persistent burden of treatment-naïve PLWH with severe immunosuppression remains challenging. Our results provide evidence for policy-makers to allocate resources and establish targeting strategies to identify early infection of PLWH.
在艾滋病毒感染者（PLWH）中，高 HIV 相关死亡率主要与严重免疫抑制（CD4 计数<50 个/μL）有关。本研究旨在探讨严重免疫抑制的 PLWH 中流行和早期死亡率的趋势，以便进一步进行有针对性的干预。
我们从中国国家免费抗逆转录病毒治疗（ART）计划数据库中提取了治疗初治严重免疫抑制的 PLWH 数据。分析了 2005-2018 年期间的早期死亡率（ART 开始后 6 或 12 个月内）以及空间、时间和人口分布。
在 748066 名治疗初治的 PLWH 中，有 105785 名（14.1%）为年龄大于 15 岁的严重免疫抑制 PLWH。严重免疫抑制 PLWH 的比例在 2005-2007 年达到 31.4%的峰值，然后随时间下降，从 2015 年开始稳定在 11-12%左右。这些 PLWH 的早期死亡率显著下降（ART 开始后 6 个月从 17.0%降至 8.1%；12 个月从 20.4%降至 10.6%；均<0.01）。在 2005-2018 年期间，中南和西南地区的这些 PLWH 数量大于其他地区，2018 年分别增加到 4780（37.1%）和 3370（26.2%）。在每个地区，所有治疗初治严重免疫抑制 PLWH 中，年龄在 30-44 岁的 PLWH 比例在 2005-2018 年期间均高于其他年龄组。在 2005-2007 年期间该比例下降后，西南和中南地区 45-59 岁 PLWH 的比例从 2007 年的 11%（69/626）和 16.7%（358/2140）稳步增加到 33.8%（1138/3370）和 34.0%（1626/4780），60 岁及以上 PLWH 的比例呈上升趋势；而在 2005-2018 年期间，其他年龄组的比例变化不明显。在西南地区（2798/3370，83%）和中南地区（3588/4780，75.1%），异性接触感染的 PLWH 比例较高，2018 年分别为 83%（2798/3370）和 75.1%（3588/4780）；相反，同性接触感染的 PLWH 比例在北方（57.8%[500/865]）和东北（59.9%[561/936]）最高。
治疗初治严重免疫抑制的 PLWH 的持续负担仍然具有挑战性。我们的研究结果为决策者提供了证据，以分配资源并制定有针对性的策略，以确定 PLWH 的早期感染。
