Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan.
Clinical Academic Department of Internal Medicine, CF "University Medical Center", Astana, Kazakhstan.
Front Public Health. 2023 Jun 20;11:1138604. doi: 10.3389/fpubh.2023.1138604. eCollection 2023.
Although global HIV pandemic has stabilized, it continues to rise in Eastern Europe and Central Asia due to exponential growth of newly acquired cases. Based on UNAIDS, there are currently 35,000 people living with HIV (PLWH) in Kazakhstan. This alarming HIV epidemiologic situation mandates urgent investigation of causes, routes of transmission and other characteristics in order to halt the epidemic. We aimed to analyze the data of all hospitalized patients for the period of 2014-2019 who tested positive for HIV from the Unified National Electronic Health System (UNEHS) of Kazakhstan.
This cohort study extracted data for all HIV positive patients during 2014-2019 from UNEHS of Kazakhstan to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Crosscheck of the target population data was conducted with tuberculosis, viral hepatitis, alcohol abuse and intravenous drug user (IDU) cohorts in order to create a comprehensive database. All survival functions and factors associated with mortality were tested for significance.
The cohort population ( = 2,213) mean age was 33.3 ± 13.3 years with 1,375 males (62.1%) and 838 females (37.9%). Incidence rate decreased from 2.05 in 2014 to 1.88 in 2019, however, prevalence and mortality continues to escalate every year, the mortality raised significantly from 0.39 in 2014 to 0.97 in 2019. People aged >50 years, males, retired people, patients from tuberculosis hospital profile had much lower survival probabilities than the corresponding groups. Adjusted Cox regression model death hazard showed strong association of HIV patients with tuberculosis coinfection (HR 1.4, 95% CI 1.1; 1.7, < 0.001).
The results of this study demonstrate high rates of HIV mortality, strong association of HIV with TB coinfection, regional, age specific, gender, hospital profile and social status differences that significantly affect HIV prevalence. Since the prevalence of HIV is continuing to increase, more information is necessary for evaluation and implementation of prevention procedures.
尽管全球艾滋病疫情已趋于稳定，但东欧和中亚地区的艾滋病疫情仍在持续上升，新发病例呈指数级增长。根据联合国艾滋病规划署的数据，目前哈萨克斯坦有 3.5 万名艾滋病毒感染者。这种令人震惊的艾滋病流行病学状况要求紧急调查原因、传播途径和其他特征，以阻止疫情蔓延。我们旨在分析 2014 年至 2019 年期间从哈萨克斯坦统一国家电子健康系统（UNEHS）检测出 HIV 阳性的所有住院患者的数据。
本队列研究从哈萨克斯坦 UNEHS 中提取 2014 年至 2019 年期间所有 HIV 阳性患者的数据，应用描述性、Kaplan-Meier 估计和 Cox 比例风险回归模型进行分析。对结核病、病毒性肝炎、酒精滥用和静脉吸毒者（IDU）队列的目标人群数据进行交叉核对，以创建一个综合数据库。所有生存函数和与死亡率相关的因素均进行了显著性检验。
队列人群（ = 2213）的平均年龄为 33.3 ± 13.3 岁，其中男性 1375 人（62.1%），女性 838 人（37.9%）。发病率从 2014 年的 2.05 降至 2019 年的 1.88，但患病率和死亡率仍逐年上升，死亡率从 2014 年的 0.39 显著上升至 2019 年的 0.97。年龄>50 岁、男性、退休人员、来自结核病医院的患者的生存概率明显低于相应人群。调整后的 Cox 回归模型死亡风险显示，HIV 患者与结核病合并感染具有很强的相关性（HR 1.4，95%CI 1.1；1.7， < 0.001）。
本研究结果表明，HIV 死亡率较高，HIV 与结核病合并感染密切相关，区域、年龄、性别、医院特征和社会地位差异对 HIV 流行率有显著影响。由于 HIV 感染率持续上升，需要更多信息来评估和实施预防措施。
