2005—2022年防城港市艾滋病患者累积死亡率趋势及艾滋病相关和无关死亡危险因素分析  

Trends of cumulative mortality and risk factors of AIDS-related and non-AIDS-related deaths among HIV/AIDS patients in Fangchenggang City,2005-2022

作　　者：严芝蔓 林志峰 黄雪刚 卢平 黄祖龙 吴叶舟 莫实德[3] 林燕[3] 马平 梁冰玉[2] YAN Zhi-man;LIN Zhi-feng;HUANG Xue-gang;LU Ping;HUANG Zu-long;WU Ye-zhou;MO Shi-de;LIN Yan;MA Ping;LIANG Bing-yu(Department of Infectious Diseases,Fangchenggang First People’s Hospital,Fangchenggang,Guangxi 538000,China)

机构地区：[1]防城港市第一人民医院感染性疾病科档案管理科,538001 [2]广西医科大学广西艾滋病防治研究重点实验室 [3]防城港市疾病预防控制中心

出　　处：《现代预防医学》2024年第10期1729-1735,1765,共8页Modern Preventive Medicine

基　　金：国家自然科学基金(82060610)。

摘　　要：目的了解广西防城港市抗病毒治疗艾滋病病毒感染者和艾滋病患(HIV/AIDS)的死亡情况及艾滋病死亡的影响因素,为减少艾滋病死亡提供科学依据。方法通过全国艾滋病综合防治信息系统收集2005年1月1日至2022年7月5日期间在防城港市接受抗逆转录病毒治疗(Antiretroviral Therapy,ART)治疗的2728例HIV/AIDS的基本情况和随访资料。采用竞争风险累积发生率(CIF)和部分分布比例风险回归模型(F-G模型),分析影响艾滋病相关和非艾滋病相关死亡的影响因素。结果本研究纳入了2728例HIV/AIDS,平均随访人年为6.7人年。295例发生艾滋病相关死亡,病死率为1.06/100人年;227例发生艾滋病无关死亡,病死率为1.2/100人年。考虑竞争风险的情况下,HIV/AIDS患者确诊后1年、5年和13年的艾滋病相关死亡累积发生率分别为2.5%、8.5%和15.0%。多因素分析结果显示,60岁及以上(adjusted Hazard Ratio,aHR=1.50,95%Confidence Interval(CI):1.05~2.15)、当前配偶的HIV感染状态未查或不详(aHR=1.39,95%CI:1.03~1.90)、曾接受预防机会性感染治疗(aHR=1.40,95%CI:1.06~1.84)和出现机会性感染或肿瘤(aHR=1.65,95%CI:1.12~2.45)的患者发生艾滋病相关死亡风险较高。女性(aHR=0.67,95%CI:0.49~0.90)、初始治疗方案为依非韦伦(EFV)(aHR=0.41,95%CI:0.25~0.68)、有变更治疗方案(aHR=0.19,95%CI:0.12~0.29)、首次CD4细胞计数≥200个/μL(aHR=0.3,95%CI:0.20~0.45)、初始病毒载量(viral load,VL)为50~1000 copies/ml(aHR=0.31,95%CI:0.18~0.54)和<50 copies/ml(aHR=0.61,95%CI:0.44~0.84)的患者发生艾滋病相关死亡风险较低。60岁及以上(aHR=2.82,95%CI:1.80~4.43),被动检测(aHR=1.41,95%CI:1~1.98)、配偶的HIV感染状态未查或不详(aHR=1.40,95%CI:1.01~1.95)、首次CD4细胞计数≥200个/μL(aHR=1.68,95%CI:1.27~2.22),发生艾滋病无关死亡风险较高。女性(aHR=0.55,95%CI:0.37~0.81)、接受抗病毒治疗后有变更过治疗方案(aHR=0.33,95%CI:0.21~0.50)、初始治疗方案含EFV(aObjective This study aims to investigate the mortality among HIV/AIDS patients receiving antiretroviral therapy(ART)in Fangchenggang City,Guangxi Province,and to identify associated factors with AIDS-related and non-AIDS-related deaths,providing scientific evidence for reducing AIDS mortality.Methods We collected data from the National Comprehensive AIDS Prevention and Control Information System.These data included socio-demographic and follow-up records of 2728 HIV-1 infected individuals receiving Antiretroviral Therapy(ART)treatment in Fangchenggang City from January 1,2005 to July 5,2022.This dataset included socio-demographic and follow-up records during the specified period,providing a comprehensive insight into the therapeutic responses,survival rates,and potential associated complications among ART-treated HIV/AIDS patients within Fangchenggang City.Socio-demographic and follow-up data were analyzed using the cumulative incidence function(CIF)under a competing risk framework and the Fine-Gray subdistribution hazard regression model to assess the associated factors with both AIDS-related and non-AIDS-related deaths.Results With an average follow-up period of 6.7 person-years,295 cases experienced AIDS-related death with a mortality rate of 1.06/100 person-years,while 227 cases died from non-AIDS-related causes,with a mortality rate of 1.2/100 person-years.Under consideration of competing risks,the cumulative incidence of AIDS-related death at 1 year,5 years,and 13 years post-diagnosis was 2.5%,8.5%,and 15.0%,respectively.The factors associated with a higher risk of AIDS-related death included:age 60 years or older(aHR=1.5,95%CI:1.05~2.15),current spouse’s infection status unknown/not investigated(aHR=1.39,95%CI:1.03~1.90),history of prophylactic treatment for opportunistic infections(aHR=1.4,95%CI:1.06~1.84),and occurrence of opportunistic infections or tumors(aHR=1.65,95%CI:1.12~2.45).On the contrary,factors associated with a lower risk of AIDS-related death included:being female(aHR=0.67,95%CI:0.49~0.90

关 键 词：艾滋病病毒感染者/艾滋病患者 生存分析 竞争风险模型 

分 类 号：R512.91[医药卫生—内科学]