湖北省荆州市1996-2021年HIV/AIDS病死率及其影响因素回顾性队列研究

A retrospective cohort study of case fatality rate of HIV/AIDS cases and influencing factors in Jingzhou,Hubei Province,1996-2021

目的分析荆州市HIV/AIDS病死率及其影响因素。方法资料来源于中国疾病预防控制信息系统的艾滋病综合防治信息系统,选取现住址为荆州市、确诊时年龄≥15岁、确诊时间为1996-2021年的HIV/AIDS作为研究对象。采用乘积极限法绘制死亡曲线,Cox比例风险回归模型识别死亡的影响因素。结果 HIV/AIDS共3 304例,随访16 091.5人年,死亡893例,病死率为5.5/100人年。HIV/AIDS确诊后1、5和10年的累积死亡概率分别为15.4%、25.0%和34.6%,参加抗病毒治疗者1、5和10年的累积死亡概率为6.9%、14.4%和23.7%,未参加抗病毒治疗者1、5和10年的累积死亡概率为68.0%、90.1%和98.7%。Cox比例风险回归模型分析结果显示,未参加抗病毒治疗者的死亡风险高于参加抗病毒治疗者(aHR=9.85,95%CI:8.19~11.85);参加抗病毒治疗者死亡的危险因素包括男性(aHR=1.64,95%CI:1.29~2.08)、确诊时年龄≥60岁(aHR=3.52,95%CI:2.38~5.20)、注射吸毒/其他途径感染(aHR=2.38,95%CI:1.30~4.34)、医疗机构发现(aHR=1.53,95%CI:1.11~2.11)和首次CD4+T淋巴细胞(CD4)计数<50个/μl(aHR=2.58,95%CI:1.87~3.58),死亡的保护因素是较高文化程度(高中/中专:aHR=0.64,95%CI:0.46~0.90;大专及以上:aHR=0.42,95%CI:0.24~0.73)。未参加抗病毒治疗者死亡的危险因素包括确诊时年龄较大(30~岁:aHR=2.32,95%CI:1.40~3.84;45~岁:aHR=2.61:95%CI:1.59~4.27;≥60岁:aHR=3.31,95%CI:2.01~5.47)、首次CD4计数较低(<50个/μl:aHR=10.47,95%CI:6.47~16.56;50~199个/μl:aHR=2.31,95%CI:1.08~4.94;200~349个/μl:aHR=2.35,95%CI:1.46~3.79)。结论 1996-2021年荆州市HIV/AIDS病死率较高,首次CD4计数、抗病毒治疗和确诊时年龄是影响HIV/AIDS死亡的主要因素,应进一步坚持扩大检测和"发现即治疗"政策,提升抗病毒治疗效果和HIV/AIDS生存率。

Objective To analyze the case fatality rate of HIV/AIDS cases and influencing factors in Jingzhou.Methods The data were retrieved from HIV/AIDS Comprehensive Response Information System and the cases diagnosed with HIV/AIDS in Jingzhou during 1996-2021 and aged 15 years or older were selected for the study.The death curve was drawn with Kaplan-Meier method,and Cox proportional-hazards model was used to identify influencing factors for death.Results A total of 3304 HIV/AIDS cases were followed up for 16091.5 person-years,and 893 cases died,with a case fatality rate of 5.5/100 person-years.The cumulative case fatality rates of 1,5 and 10 years were 15.4%,25.0%and 34.6%respectively,the cumulative case fatality rates of 1,5 and 10 years were 6.9%,14.4%and 23.7%in the cases with access to antiretroviral therapy(ART),and 68.0%,90.1%and 98.7%in the cases without access to ART.The results of Cox proportional hazards regression model showed that the risk for death was higher in those without access to ART than in those with access to ART(aHR=9.85,95%CI:8.19-11.85).The risk factors for death in those with access to ART included being men(aHR=1.64,95%CI:1.29-2.08),age≥60 years old at diagnosis(aHR=3.52,95%CI:2.38-5.20),being infected by injecting drug use/others(aHR=2.38,95%CI:1.30-4.34),being detected by medical institution(aHR=1.53,95%CI:1.11-2.11),CD4+T lymphocytes(CD4)counts<50 cells/μl(aHR=2.58,95%CI:1.87-3.58).The protective factor for death was high education level(high school and technical secondary school:aHR=0.64,95%CI:0.46-0.90;college and above:aHR=0.42,95%CI:0.24-0.73).The risk factors for HIV/AIDS death in those without access to ART included older age at diagnosis(30-44 years old:aHR=2.32,95%CI:1.40-3.84;45-59 years old:aHR=2.61,95%CI:1.59-4.27;≥60 years old:aHR=3.31,95%CI:2.01-5.47),lower CD4 counts(<50 cells/μl:aHR=10.47,95%CI:6.47-16.56;50-199 cells/μl:aHR=2.31,95%CI:1.08-4.94;200-349 cells/μl:aHR=2.35,95%CI:1.46-3.79).Conclusions The case fatality rate of HIV/AIDS was relatively high in Jingzhou from 1996 to 2021,the first CD4 counts,ART and age at diagnosis were the major factors affecting HIV/AIDS death,"Expanding testing"and"prompt treatment upon diagnosis"should be continued and enhanced to improve the efficacy of ART and HIV/AIDS case survival.