2004-2021年我国HIV阳性MSM超额死亡率及其影响因素分析

Excess mortality and influencing factors among HIV-positive men who have sex with men in China,2004-2021

目的了解2004-2021年中国新报告HIV阳性MSM的超额死亡率及其影响因素。方法通过中国疾病预防控制信息系统选取2004-2020年新报告、年龄≥18岁、经男男性行为感染的HIV/AIDS患者。以男性一般人群死亡率为参照,计算HIV阳性MSM的超额死亡率。采用多变量Poisson回归模型并基于相对生存率估计法,进行HIV阳性MSM超额死亡率的影响因素分析。结果2004-2021年HIV阳性MSM的粗死亡率为1.33/100人年,超额死亡率为1.10/100人年。诊断到启动cART时间≤30天和未治疗人群的超额死亡率分别为0.65/100人年和13.85/100人年。随着随访时间的延长,HIV阳性MSM超额死亡率呈现下降趋势。多变量Poisson回归显示,年龄越大、文化程度越低、首次CD4细胞计数水平越低的感染者超额死亡风险越高。此外,居住在中西部省份、未婚/离异/丧偶、医疗机构检测发现、诊断到启动cART时间>30天及未治疗感染者的超额死亡风险较高。结论HIV阳性MSM的死亡风险高于男性一般人群,启动cART治疗可有助于缩小这一死亡率差距。应持续扩大HIV检测范围,尽早发现并及时启动抗病毒治疗,同时提高对老年及文化程度较低MSM的随访服务质量,并加强依从性教育,以全面降低HIV阳性MSM的死亡率。

Objective This study aims to evaluate the excess mortality rates and their influencing factors among newly reported HIV-positive men who have sex with men(MSM)in China from 2004 to 2021.Methods Data of MSM aged≥18 years,diagnosed as HIV positive,infected through male-to-male sexual behavior,and newly reported between 2004 and 2020 were obtained from the China Information System for Disease Control and Prevention.The excess mortality rates for HIV-positive MSM were calculated using the mortality rates of the general male population as a reference.The factors influencing the excess mortality rates among HIV-positive MSM were analyzed using a multivariable Poisson regression model based on the relative survival estimation method.Results From 2004 to 2021,the crude mortality rate for HIV-positive MSM was 1.33/100 person-years and the excess mortality rate was 1.10/100 person-years.The excess mortality rate was 0.65/100 person-years for diagnosed MSM who initiated combination antiretroviral therapy(cART)within 30 days,and 13.85/100 person-years for the untreated population.Subsequently,there was a decreasing trend in the excess mortality rates among HIV-positive MSM with the increasing follow-up period.Multivariable Poisson regression indicated that higher excess mortality risk among HIV-positive MSM was associated with older age,lower educational level,and lower initial CD4+cell count.In addition,HIV-positive MSM residing in central or western provinces,with marital status of unmarried/divorced/widowed,detected by medical institutions,with time from diagnosis to cART initiation>30 days or untreated had a higher risk of excess mortality.Conclusions The mortality risk of HIV-positive MSM is higher than that of the general male population.Initiation of cART may help to narrow the mortality gap.It is of the utmost importance to continuously expand the scope of HIV testing,detect infections earlier,and initiate antiretroviral treatment without delay.Furthermore,it is essential to improve the quality of follow-up services for older individuals.