1985-2016年温州市HIV感染者和病人死亡情况分析

Status of HIV infectors and AIDS deaths in Wenzhou City,1985-2016

目的了解1985-2016年温州市新报告艾滋病病毒(human immunodeficiency virus,HIV)感染者和病人死亡状况,为制定防控措施提供科学依据。方法以1985-2016年报告的所有现住址为温州市的HIV感染者和病人死亡病例为研究对象,对其一般人口学特征、存活时间、死亡原因、抗病毒治疗等情况进行统计分析。结果 1985-2016年累计报告现住址为温州市的HIV/AIDS病例3 512例,其中死亡516例,病死率为14.69%。在所有死亡病例中男性占83.72%,50岁及以上年龄组占56.01%,已婚有配偶占57.75%,小学及以下占54.85%,农民占35.85%,医疗机构发现占79.46%,异性传播占80.62%。死于艾滋病及其相关疾病者占51.74%,2010-2016年历年因艾滋病及其相关疾病死亡的比例呈下降趋势,非艾滋病相关死亡的比例呈上升趋势(χ_(趋势)~2=5.81,P=0.016)。死亡病例确诊阳性后中位存活时间为173 d,1年内死亡的占60.66%。接受过艾滋病抗病毒治疗者占33.53%,随着存活时间的延长艾滋病及其相关疾病死亡者中接受抗病毒治疗所占比例整体呈上升趋势(χ_(趋势)~2=29.43,P=0.000)。死前做过CD4^+T淋巴细胞检测者占56.01%,最近一次CD4^+T淋巴细胞<200/μl者占58.82%。结论最近几年温州市非艾滋病相关死亡成为HIV/AIDS病例的主要死因,死亡病例的晚发现比例高,CD4^+T淋巴细胞检测和抗病毒治疗比例低,今后需扩大检测覆盖面,及时发现HIV感染者,加强随访管理,以减少HIV感染者死亡,延长患者存活时间。

Objective To investigate the situation of new reported HIV infectors and AIDS deaths in Wenzhou City from 1985 to 2016 so as to provide a scientific basis for developing prevention and control measures. Methods All reported HIV infectors and AIDS death cases with current residence address in Wenzhou City from 1985 to 2016 were selected as the research objects, and their demographic characteristics, survival time, causes of death, antiviral therapy and other situation were analyzed. Results There were 3,512 cumulatively reported HIV/AIDS cases with current residence address in Wenzhou City during 1985-2016, with the mortality rate being 14.69% （516/3,512）. Among all the deaths, the males, the group aged 50 years and above, the married, the group with educational background of elementary school and below, farmers, the group discovered by medical institution, and the group with heterosexual transmission accounted for 83.72%, 56.01%, 57.75%, 54.85%, 35.85%, 79.46% and 80.62% respectively. The deaths caused by AIDS and its related diseases accounted for 51.74%. The proportion of deaths due to AIDS and its related diseases during 2010-2016 showed a downward trend, while the proportion of non-AIDS-related deaths an upward trend（χ^2trend=5.81, P=0.016）. The death cases’ median survival time after confirmed HIV positive was 173 days, and 60.66% died in one year. The proportion of cases receiving antiviral therapy was 33.53%, and it was on the rise with the extension of survival time in the deaths owe to AIDS and its related diseases（χ^2trend=29.43, P=0.000）. The cases receiving CD4＋ T lymphocyte detection before death and the cases with the latest CD4＋ T lymphocyte 〈 200/ul accounted for 56.01% and 58.82% respectively. Conclusions The non-AIDS-related death has become the main cause of death in HIV/AIDS cases in Wenzhou in recent years. The proportion of late diagnosis in the deaths is high, while CD4＋ T lymphocyte detection and antiviral therapy are both low. It is necessary to expand the coverage of detection services, timely identify HIV positive cases and strengthen follow-up management so as to reduce the number of HIV/AIDS death cases and prolong survival time of patients at the same time.