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2008年至2021年加入泰国国家艾滋病项目后开始接受抗逆转录病毒治疗的艾滋病毒感染者的死因。

Cause of death in people living with HIV who initiated antiretroviral therapy after enrolling to the Thai National AIDS Program from 2008 to 2021.

作者信息

Lertpiriyasuwat Cheewanan, Kerr Stephen J, Noknoy Sairat, Namahoot Patiphak, Punsuwan Niramon, Apornpong Tanakorn, Sophonphan Jiratchaya, Hiranburana Napon, Chetchotisakd Ploenchan, Putcharoen Opass, Ruxrungtham Kiat, Avihingsanon Anchalee

机构信息

Division of AIDS and STIs, Ministry of Public Health, Nonthaburi 11000 Thailand.

HIV-NAT, Thai Red Cross AIDS and Infectious Diseases Research Centre (formerly Known as the Thai Red Cross AIDS Research Centre (TRCARC)), Bangkok 10330 Thailand.

出版信息

Lancet Reg Health Southeast Asia. 2025 Apr 23;36:100576. doi: 10.1016/j.lansea.2025.100576. eCollection 2025 May.

DOI:10.1016/j.lansea.2025.100576
PMID:40330708
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12051708/
Abstract

BACKGROUND

Widespread access to antiretroviral therapy (ART) has led to near-normal life expectancies for people living with HIV (PLHIV), shifting the leading cause of death (COD) from AIDS-related to non-AIDS-related mortality. We assessed trends in COD among PLHIV who initiated ART in Thai National AIDS Program (NAP).

METHODS

We analysed NAP data from PLHIV aged ≥15 at ART initiation, who started ART under Thailand's universal health coverage from 2008 to 2021. Individual data was linked with the National Death Registration system, and a rule-based algorithm applied text mining to classify COD as AIDS-related, non-AIDS-related and uncertain. Competing risk models examined associations between demographic and clinical characteristics and COD. Standardized mortality ratios (SMR) were calculated using mortality rate from the general Thai population.

FINDINGS

Among 398,182 PLHIV (37.1% females) enrolled, the median (IQR) age was 35 (28-43) years, 43.6% commenced ART with CD4 counts <200 cells/mm3. Over 2,631,435 person years of follow-up, 73,768 (18.5%) deaths occurred: 56% AIDS-related, 40% non-AIDS-related and 4% uncertain. The cumulative incidence of AIDS-related mortality at 14 years was 14.74%, non-AIDS-related 12.04% and all-cause mortality 27.93%. AIDS-related deaths declined from 60% to 50% over the study period. Low CD4 counts, permanently loss to care and treatment at non-capital city were significantly associated with higher AIDS-related mortality. The SMR was higher in females [9.08 (95% CI 8.97-9.20] compared to males [5.83 (95% CI 5.78-5.88).

INTERPRETATION

AIDS-related mortality decreased over time, but continued efforts are needed to improve earlier diagnosis, and equitable outcomes for women and those residing outside major cities.

FUNDING

Supported by National Institute of Health (IeDEA:U01AI069907).

摘要

背景

广泛使用抗逆转录病毒疗法（ART）已使艾滋病毒感染者（PLHIV）的预期寿命接近正常水平，导致主要死因（COD）从与艾滋病相关的死亡率转变为与非艾滋病相关的死亡率。我们评估了在泰国国家艾滋病项目（NAP）中开始接受ART治疗的PLHIV的死因趋势。

方法

我们分析了2008年至2021年在泰国全民健康覆盖计划下开始接受ART治疗的年龄≥15岁的PLHIV的NAP数据。个体数据与国家死亡登记系统相关联，并使用基于规则的算法应用文本挖掘将死因分类为与艾滋病相关、与非艾滋病相关和不确定。竞争风险模型研究了人口统计学和临床特征与死因之间的关联。使用泰国普通人群的死亡率计算标准化死亡率（SMR）。

结果

在纳入的398,182名PLHIV（37.1%为女性）中，年龄中位数（IQR）为35（28-43）岁，43.6%的人在CD4细胞计数<200个/mm³时开始接受ART治疗。在超过2,631,435人年的随访中，发生了73,768例（18.5%）死亡：56%与艾滋病相关，40%与非艾滋病相关，4%不确定。14年时与艾滋病相关的死亡率累积发生率为14.74%，与非艾滋病相关的为12.04%，全因死亡率为27.93%。在研究期间，与艾滋病相关的死亡从60%下降到50%。低CD4细胞计数、在非首都城市永久失去护理和治疗与较高的与艾滋病相关的死亡率显著相关。女性的SMR[9.08（95%CI 8.97-9.20）]高于男性[5.83（95%CI 5.78-5.88）]。

解读

与艾滋病相关的死亡率随时间下降，但仍需继续努力改善早期诊断，并为女性和居住在大城市以外的人群实现公平的结果。

资金

由美国国立卫生研究院（IeDEA：U01AI069907）资助。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6488/12051708/11a7c6a0f492/figs17.jpg
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