2019年广西两区县报告死亡HIV/AIDS患者的死因调查

Causes of Death in HIV-infected Patients from Two Districts in Guangxi in 2019

目的了解广西壮族自治区(简称广西)2019年报告死亡HIV/AIDS患者的死因构成,并探讨死因相关影响因素,为进一步减少死亡策略提供参考。方法选取广西两区县基于艾滋病防治基本信息系统报告的2019年HIV/AIDS死亡患者,通过查阅医疗资料及随访信息、开展入户调查获取患者死亡相关信息,对患者的根本死因进行判断。分人群计算艾滋病相关死亡的比例,并探讨艾滋病相关死亡的影响因素,采用Cox比例风险模型分析患者死亡的危险因素。结果广西两区县2019年共报告386例HIV/AIDS死亡患者,其中64.5%(249/386)被判别为艾滋病相关死亡,死于机会性感染和艾滋病相关肿瘤的患者分别占52.6%(203/386)和4.1%(16/386)。多因素Logistic回归分析显示:性途径感染(OR=18.087,95%CI:3.594~91.018)和死亡时病程为艾滋病阶段(OR=2.542,95%CI:1.225~5.273)的患者死于艾滋病相关疾病风险较高,65岁及以上的患者死于艾滋病相关疾病的风险是49岁及以下患者的0.530倍(95%CI:0.290~0.969)。多因素Cox比例风险模型分析显示,生前未接受过ART(HR=4.262,95%CI:3.254~5.582)或ART时长不足3个月(HR=4.314,95%CI:2.647~7.031)、首次CD4细胞计数低于200个/mm3(HR=4.033,95%CI:2.564~6.345)的患者5年内死亡风险较高。结论艾滋病相关疾病仍是广西调查地区HIV/AIDS患者主要死因,早发现和早治疗策略对减少艾滋病相关死亡具有重要意义。

Objective This study aimed to understand causes of death and associated risk factors among HIVinfected patients from two designated districts in Guangxi who deceased in 2019.The results will provide reference for future policies-making regarding prevention of death among HIV-infected patients.Methods Deceased HIV-infected patients were selected from Chinese HIV/AIDS Comprehensive Response Information Management System(CRIMS).Detailed information was supplemented by medical records,follow-up records and household survey to further determine the causes of death.Influencing factors of AIDS-related deaths were analyzed.Cox proportional hazard model was performed to explore the risk factors of deaths.Results A total of 386 HIV-infected patients were reported dead during2019 in these two districts,among whom 64.5%(249/386)died of AIDS-related causes,such as opportunistic infection(52.6%,203/386)and AIDS-related cancer(4.1%,16/386).Multivariate logistic analysis revealed that sexually transmission(OR=18.087,95%CI:3.594-91.018)and development to AIDS stage(OR=2.542,95%CI:1.225-5.273)before death was associated with AIDS-related deaths.Patients aged over 65 years old were less likely to die of AIDS-related diseases compared with those aged under 49 years old(OR=0.530,95%CI:0.290-0.969).Multivariate Cox proportional hazard model showed that patients who never initiated ART(HR=4.262,95%CI:3.254-5.582),or received ART less than 3 months(HR=4.314,95%CI:2.647-7.031),or had baseline CD4 cell count lower than 200/mm3(HR=4.033,95%CI:2.564-6.345)were at higher risk of death within 5 years after diagnosis.Conclusions AIDS-related diseases are still the prime causes of death of HIV-infected patients.Policies on early detection and early treatment are of great significance in preventing deaths of HIV-infected individuals.