云南省HIV/AIDS病人死亡危险因素分析

A case-control study on risk factors of HIV/AIDS deaths in Yunnan province

目的了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)死亡原因,分析影响病人死亡的危险因素。方法采用病例对照研究的方法,以整群抽样的方法调查400例HIV/AIDS死亡病例,将以1∶1选择同一社区、同一年发现、年龄相近、性别相同的现存活病例作为对照,利用条件Logistic回归模型分析影响因素。结果 400例死亡病例中,艾滋病相关死亡180例,无关疾病死亡127例,自杀死亡9例,意外死亡81例,无法判定3例。319例非意外死亡病例被发现感染HIV后的生存时间为0～23.4年,平均生存时间为(5.0±4.7)年;第1年、5年和10年生存率分别为(73.5±2.5)%、(42.6±2.8)%、(16.1±2.1)%。条件Logistic回归分析结果显示,在控制了年龄、性别等因素的潜在混杂作用影响后,影响HIV/AIDS病人非意外死亡的因素包括:初中及以上[比值比(OR)=0.35,P=0.033],家庭年收入≥5 000元(OR=0.54,P=0.030);知晓HIV感染后酗酒(OR=4.31,P=0.001);患其他重病(OR=12.74,P<0.001);发现感染时疾病状态为艾滋病期(OR=2.67,P=0.004);未治疗相较于开始治疗时CD4+T淋巴细胞≥350个/μL(OR=58.08,P<0.001),治疗依从性差相较于依从性好(OR=4.30,P<0.001)。结论艾滋病死亡与病人文化程度低、家庭收入少、酗酒,以及HIV感染发现晚、治疗不及时、治疗依从性差、合并其他严重疾病等相关。早发现、规范治疗,改变不良生活习惯,改善家庭经济状况有助于降低死亡。

Objective To explore the death and risk factors of HIV/AIDS cases in Yunnan province.Methods A casecontrol study was conducted with a case-control ratio of 1∶1.The case group included 319non-accidental deaths among400HIV/AIDS deaths selected by cluster sampling,and the control group included living cases selected in the same community,year,age and gender as the case group.Conditional logistic regression was utilized to determine the predictors of mortality.Results Out of the 400 deaths,180cases died of AIDS related diseases,127 died of AIDS unrelated diseases,9died of suicide,81 died of accident,and 3cases were not determined.The survival time of all respondents were 0-23.4years after they were diagnosed as HIV positive,and the mean survival time was(5.0±4.7)years.The cumulative survival rates for 1,5and 10 years were respectively(73.5±2.5)%,(42.6±2.8)%and(16.1±2.1)%.Conditional logistic regression showed that,after adjustment of age and gender,the predictors of non-accidental death among HIV/AIDS included:junior high school and above(OR=0.35,P=0.033),annual household income over RMB5000(OR=0.54,P=0.030),alcohol abuse after being diagnosed HIV positive(OR=4.31,P=0.001),suffering other serious illness(OR=12.74,P<0.001),AIDS late stage at the time of HIV diagnosis(OR=2.67,P=0.004),no antiretroviral therapy(ART)(OR=58.08,P<0.001)compared with start of ART before CD4≥350cells/!l,and poor ART compliance(OR=4.30,P<0.001).Conclusion Low educational level,low income,late detection of HIV infection,late ART,poor ART compliance and combination with other serious diseases might be the risk factors of death of HIV/AIDS patients.Early detection,standardized ART,behavior changes and increased income could reduce mortality.