1990-2012年云南省保山市HIV/AIDS病例全因死亡率及其影响因素研究

Study on the All-cause Mortality and Risk Factors among the HIV /AIDS Patients between 1990 and 2012

目的研究1990—2012年云南省保山市人类免疫缺陷病毒（human Immunodeficiency Virus，HIV，艾滋病病毒）／获得性免疫缺陷综合症（acquired immunodeficiency syndrome，AIDS，艾滋病）病例全因死亡率及其影响因素。方法采用哨点监测、重点人群筛查、自愿咨询检测、常规筛查方法等获得1990—2012年现住址为保山市的HIV／AIDS病例相关资料，收集其全因死亡相关信息，计算全因死亡率和累积生存率，应用Cox比例风险回归模型分析其全因死亡的影响因素。结果共有4275例HIV／AIDS病例纳入分析，男性占58．62％，30～44年龄段占41．94％，汉族占91．58％，农民占74．27％，已婚有配偶占66．69％，初中文化程度占41．36％。研究对象累计观察14054．21人年，全因死亡987人，死亡率为7．02／100人年。死亡率在1990—2004年间总体呈上升趋势，自2005年起开始持续下降。研究对象自从报告为HIV感染至研究结束时平均生存时间为10．57年，中位生存时间为11．11年，其中，曾接受或正在接受抗病毒治疗者的平均生存时间为17．02年，未接受过抗病毒治疗者的平均生存时间为6．41年，中位生存时间为5．58年。多因素分析显示性别、发病时年龄、首次检测报告HIV阳性的第1次CD4计数、可能感染HIV的途径、抗病毒治疗、病程处于HIV阶段样本来源对HIV／AIDS病例的死亡和生存状态具有统计学意义。结论抗病毒治疗有效地降低了保山市HIV／AIDS病例的全因死亡率，今后需进一步扩大抗病毒治疗人群覆盖面，但应基于HIV／AIDS病例的人口学特征加以分类治疗管理，最终减少HI、yAIDS病例的死亡。

Objective To determine the all-cause mortality and risk factors among human immunodeficiency vrus （HIV）/acquired immunodeficiency syndrome （AIDS） patients from 1990 to 2012 in Baoshan prefecture, Yunnan province. Methods Data of HIV/AIDS patients who had local residence in Baoshan prefecture was collected by performing the testing for HIV as follows ： sentinel surveillance, screening for high risk population, voluntary counseling testing, regular screening, et al. All the HIV/AIDS patients were involved from 1990 to 2012. Descriptive epidemiological study was used to summarize the allcause mortality rates and cumulative survival rates. Multivariable Cox regression was used for determining risk factors associated with all-cause death. Results There were 4275 eligible HIV/AIDS patients between 1990 and 2012. Patients included 58.62% men,41.94% aged 30 ~44 years,and 91.58% Han ethnicity,74. 27% farmers,and 66. 69% married,41.36% attended education at junior level. The accumulative person-year was 14054.21 years, all-cause death of 987 patients, and the all-cause mortality rate was 7.02 perl00 person-year. The all-cause mortality rate during 1990 -2004 showed an upward trend. However, since 2005 it showed a downward trend. The mean survival time within all patients was 10. 57 years, medians for survival time was 11.11 years,the mean survival time among patients under antiretroviral treatment（ART） was 17.12 years, the mean survival time among patients who were not receiving ART was 6. 4l years, and median for survival time was 5.58 years. The results of multivariable Cox regression showed age, the first CD4 cells count after confirming HIV, and possible HIV infection route, ART, and HIV staging, source of samples were risk factors for HIV/AIDS patients＇ all cause mortality. Conclusion ART greatly contributed to reducing the all-cause mortality rate among HIV/AIDS patients, there is an urgent need to scale-up ART coverage, and at the same time, tailor to the treatment and management of patients based on their demographic characteristics, finally decreasing the death rate.