遵义市艾滋病抗病毒治疗死亡病例流行病学分析

Epidemiological Analysis on AIDS Deaths of Highly Active Antiretroviral Therapy in Zunyi

目的分析遵义市艾滋病抗病毒治疗死亡病例的流行病学特征,为选择最佳抗病毒治疗时机提供科学依据。方法回顾分析遵义市2006-2013年接受抗病毒治疗后31例死亡病例流行病学资料,使用SPSS17.0软件进行相关分析。结果遵义市2006-2013年累计抗病毒治疗712例,其中男508例,女204例;累计死亡31例,男性22例(4.33%),女性9例(4.41%),男女病死率差异无统计学意义(P=0.877);已婚或同居者病死率为6.23%,离婚或分居者病死率为3.85%,丧偶患者病死率为6.52%,未婚与不详者病死率为0,病死率与患者婚姻状况有关(P=0.018);31例死亡患者中,CD4细胞≤200个/mm326例(83.87%),>200个/mm35例(16.13%);治疗前3个月患者有艾滋病相关症状者病死率为10.71%,无症状者病死率为2.60%(14/539),不详者病死率为6.06%,病死率差异与患者有无艾滋病相关症状相关(P=0.0001);3TC+AZT+NVP治疗方案的病死率(4.49%)高于3TC+AZT+EFV(1.36%),7种治疗方案的病死率差异有统计学意义(P=0.011)。结论治疗者病死率与患者婚姻状况、CD4细胞水平和治疗前是否有机会性感染密切相关,亦与治疗方案有关,及早抗病毒治疗和使用毒副作用小的药物能有效减少病死率。

Objective To analysis the epidemiological characteristics of deaths from AIDS antiviral treatment in Zu- nyi,which will provide a scientific basis for choose the optimal timing of antiviral treatment. Methods Retrospective analysis the epidemiological data of 31 AIDS dead patients after antiviral treatment in 2006 -2013. Results Total 712 patients received antiviral treatment. Five hundreds and eight cases of them are male,and the remaiming 204 cases are female. Total 31 cases of death including male 22 cases and fe- male 9 cases. Case fatality rate was 4.33% in male and 4.33% for female,there was no statistically signif- icant difference between male and female mortality （P = 0. 877 ）. Married or cohabiting case fatality rate 6.23%, divorce or separation case fatality rate was 3.85% , the case fatality rate of 6.52% , unmarried widowed patients with unknown case fatality rate of 0, the ease fatality rate is related to patients＇ marital status（ P = 0. 018 ）. Of the 31 dead cases, the CD4 cell count of 200 cells/ram3 or less in 26 cases （83.87%） ,CD4 cell count 〉 200 cells/ram~ in 5 cases （16.13%）. Three months before the treatment of symptoms in patients with HIV/AIDS related symptoms in case fatality rate was 10.71% ,no mortality was 2.60% （14/539）, an unknown case fatality rate was 6.06% , the fatality rate differences associated with patients with and without HIV symptoms （ P = 0. 0001 ）. 3TC ＋ AZT ＋ NVP treatment case fatality rate （4.49%） than 3 TC ＋ AZT ＋ EFV（ 1.36% ） ,7 kinds of treatments of case fatality rate difference was sta- tistically significant（P = 0.011 ）. Conclusion Mortality after antivirus treatment is associated with mari- tal status, CD4 cell level and complication with opportunistic infections, early antiviral treatment and use of the side effects of small drugs can effectively reduce the fatality rate.