我国15岁及以上注射吸毒HIV感染者确证后的生存分析

Survival analysis since diagnosis of HIV-positive injecting drug users aged 15 years and above in China

目的了解我国报告注射吸毒HIV感染者的死亡情况及危险因素,为制定相关防治策略提供依据。方法资料来源于艾滋病综合防治信息系统注射吸毒HIV感染者,采用回顾性队列研究方法进行分析,计算死亡密度,并采用Cox比例风险回归模型分析死亡的风险因素,采用Excel 2019和SPSS 22.0软件进行数据整理和统计学分析。结果2001-2020年,我国累计报告≥15岁注射吸毒HIV感染者119209例,其中死亡59094例,全死因死亡密度为6.96/100人年,艾滋病相关死亡密度为1.91/100人年,总死亡密度呈下降趋势。多因素Cox比例风险回归模型分析结果显示,注射吸毒HIV感染者全死因死亡风险,相比于首次CD4+T淋巴细胞(CD4)计数>500个/µl者,未检测CD4计数、0~、200~和350~个/µl的HR值(95%CI)分别为2.85(2.78~2.93)、2.47(2.40~2.54)、1.58(1.53~1.62)和1.24(1.21~1.28);相比于抗病毒治疗者,未抗病毒治疗者的HR值(95%CI)为7.13(6.99~7.27);相比于美沙酮维持治疗者,未美沙酮维持治疗者的HR值(95%CI)为1.07(1.04~1.10)。注射吸毒HIV感染者艾滋病相关死亡风险,相比于首次CD4计数>500个/µl者,未检测CD4计数、0~、200~和350~个/µl的HR值(95%CI)分别为3.26(3.08~3.46)、5.54(5.24~5.85)、2.35(2.21~2.50)和1.41(1.32~1.50);相比于抗病毒治疗者,未抗病毒治疗者的HR值(95%CI)为5.96(5.74~6.18)。结论应促进注射吸毒人群HIV感染者的早诊断和早治疗,坚持参加美沙酮维持治疗等降低危害项目,提高其依从性,进而降低其死亡风险。

Objective To understand death's mortality and risk factors among HIV-positive injecting drug users(IDU)aged 15 or above in China and provide further reference to future prevention and treatment policies.Method Retrospective cohort study was conducted to calculate the mortality rate of HIV-positive IDU based on HIV/AIDS Comprehensive Response Information Management System.Cox proportion hazards regression model was performed to assess the risk factors for deaths.The Excel 2019 and SPSS 22.0 software was used for data cleaning and statistical analysis.Results Between 2001 and 2020,119209 HIV-positive IDU were reported with 59094 deaths.The all-cause mortality rate was 6.96 per 100 person-years(py),and the AIDS-related mortality rate was 1.91 per 100 py,with a decreasing trend over the years.Multivariate Cox regression indicated for all-cause death risks of HIV-positive IDU,compared with those baseline T+lymphocyte cells(CD4)counts above 500 cells/μl,the HR(95%CI)of those CD4 counts untested,between 0-199,200-349,350-500 cells/μl was 2.85(2.78-2.93),2.47(2.40-2.54),1.58(1.53-1.62)and 1.24(1.21-1.28)respectively.The HR(95%CI)of antiretroviral treatment(ART)naïve was 7.13(6.99-7.27)compared with those under ART.The HR(95%CI)of methadone maintenance treatment(MMT)naïve was 1.07(1.04-1.10)compared to those receiving MMT.As for AIDS-related death risks,compared with baseline T+lymphocyte cell CD4 counts>500 cells/μl,the HR(95%CI)of those CD4 counts untested,between 0-199,200-349,350-500 cells/μl was 3.26(3.08-3.46),5.54(5.24-5.85),2.35(2.21-2.50)and 1.41(1.32-1.50).HR(95%CI)of ART naïve was 5.96(5.74-6.18)compared to those under ART.Conclusions Further efforts should be made timely on diagnosis,treatment,and harm reduction programs such as MMT for improvement compliance to reduce mortality risks of HIV-positive IDU.