1989-2010年云南省德宏州艾滋病病毒感染者死因分析

Causes of death among HIV-infected patients in Dehong prefecture, Yunnan province： 1989-2010

目的了解1989—2010年云南省德宏州艾滋病病毒感染者／艾滋病患者（HIWAIDS）20年病死率及死因变化。方法在“艾滋病综合防治数据信息管理系统”中，下载1989—2010年的历史卡片，对相关数据进行调查核实和统计分析。结果1989--2010年共报告现住址及户籍地为德宏州的HIV／AIDS13493例，其中HIV8569例，死亡2036例；AIDS4924例，死亡2251例。少数病例已存活达15—20年。2004年以前报告的发病病例中，死亡病例数高于存活病例数，而此后历年报告的发病病例中，存活病例数则高于死亡病例数。HIV／AIDS当年发病当年死亡的病例数占当年发病总病例数的比例在1989--2010年的20年间则表现出由低到高再到低的变化趋势，其中2001--2003年该比例均高于10．0％，2003年达到最高的18．9％，此后逐年稳步下降，2010年该比例为5．8％；而年初存活当年死亡的比例则自2007年起逐年下降。HIV／AIDS死亡病例中，因艾滋病而死亡的比例逐年上升而因吸毒过量而死亡的比例下降，其中，曾接受过CD4＋T淋巴细胞计数检测和抗病毒治疗的比例也逐年上升，至2010年时分别达到89．9％和25．5％。结论德宏州HIV／AIDS病死率近年来呈下降趋势，扩大CD4＋T淋巴细胞计数检测和抗病毒治疗、降低病死率仍是今后一个时期艾滋病防治工作重点。农村地区应加强AIDS死因监测。

Objectives To analyze the fatality and causes of death related to comprehensive prevention and care programs among HIV-infected patients in Dehong prefecture of Yunnan province, from 1989 to 2010. Methods Data on HIV/AIDS death cases in Dehong prefecture were extracted from the ＂Chinese National Comprehensive HIV/AIDS Prevention and Care Information System＂ and were analyzed. Results From 1989 to the end of 2010, a total of 13 493 HIV/AIDS cases registered as local residents or currently living in Dehong, had been reported. Among them, 8569 were reported as HIV cases with 2036 deaths and the other 4924 were reported as AIDS cases with 2251 deaths. A few of the cases had survived for 15-20 years. By the end of 2010, the number of deaths was higher than the number of survivors among HIV/AIDS cases reported before 2004, whereas the number of survivors was higher than the number of deaths among HIV/AIDS cases reported in 2004 and there after. During the twenty years＇ period, the proportion of reported HIV/AIDS cases died in the same year showed a secular trend of being low-highest-low, rising up to 〉 10.0% in 2001, peaking at 18.9% in 2003 and then continuously going down to 5.8% in 2010. The proportion of HIV/AIDS cases who survived at the beginning but died later in the year was going down since 2007. The proportion of HIV/ AIDS deaths died directly from AIDS was increasing whereas the proportion of HIV/AIDS deaths dying directly from overuse of drugs was decreasing in the recent years. Among HIV/AIDS deaths, the proportion of ever received CD4 ＋ T-cell testing and the proportion of ever having received antiretroviral treatment were also increasing in the past years, reaching to 89.9% and 25.5% in 2010, respectively, Conclusion The case fatality of HIV/AIDS was decreasing in the past years in Dehong prefecture. More efforts were needed to scale up the CD4 ＋ T-cell count testing and antiretroviral treatment in order to further reduce both morbidity and mortality among HIV/AIDS patients in Dehong prefecture. It is critical to improve surveillance program on HIV/AIDS deaths in the rural areas.