2010-2021年我国男男性行为HIV/AIDS患者生存分析

Survival analysis of MSM with HIV/AIDS in China from 2010 to 2021

目的了解我国2010-2021年男男性行为(men who have sex with men,MSM)HIV/AIDS患者的生存情况及影响因素,为有效开展MSM人群的AIDS防控工作提供依据。方法资料来源于中国疾病预防控制信息系统,采用回顾性队列研究方法,分析患者的累积生存率,采用Cox比例风险回归模型分析患者死亡的影响因素。结果2010-2021年我国共报告≥15岁MSM HIV/AIDS患者309964例,死亡20371例,全死因死亡密度为1.47/100人年,患者平均生存时间为10.21年(95%CI:10.204~10.225),第1、5、10年的累积生存率分别为96.56%、93.06%、88.73%。多因素Cox比例风险回归模型分析显示,确证时年龄≥60岁的患者是15~<30岁患者死亡风险的4.022倍(95%CI:3.792~4.266);与首次CD4^(+)T淋巴细胞计数>500个/μL的患者相比,未检测CD4^(+)T淋巴细胞和首次CD4^(+)T淋巴细胞计数<200个/μL患者的死亡风险分别是7.072倍(95%CI:6.696~7.470)和3.842倍(95%CI:3.657~4.036);未接受抗病毒治疗(antiretroviral therapy,ART)患者的死亡风险是接受ART的14.400倍(95%CI:13.881~14.939)。结论确证时年龄较大、首次CD4^(+)T淋巴细胞未检测或首次CD4^(+)T淋巴细胞计数<200个/μL、未接受ART是我国MSM HIV/AIDS患者死亡的主要危险因素,需加强MSM的早发现、早诊断、早治疗,同时需重点关注老年MSM的检测治疗,进一步降低MSM HIV/AIDS患者的死亡风险。

Objective To understand the survival and influencing factors of MSM(men who have sex with men)with HIV/AIDS in China from 2010 to 2021,in order to provide reference for effective AIDS prevention and control in the MSM population.Methods The data were obtained from the China disease control and prevention information system.Retrospective cohort study was used to calculate the mortality density of the patients.Cumulative survival of patients was analyzed,and Cox proportion hazards regression model was performed to assess the risk factors for patient deaths.Results Between 2010 and 2021,309964 MSM with HIV/AIDS were reported with 20371 deaths,and the all-cause mortality density was 1.47 per 100 person-years.The mean survival time of the patients was 10.21(95%CI:10.204-10.225)years,and the cumulative survival rates in 1,5,and 10 years were 96.56%,93.06%,and 88.73%.The results of multivariate Cox proportional risk regression model showed that patients with confirmed age≥60 years were 4.022(95%CI:3.792-4.266)times the risk of death of patients aged 15-<30 years.Compared with patients with first CD4^(+)T-lymphocytes>500 copies/μL,the risk of death for patients with first CD4^(+)T-lymphocytes undetected and first CD4^(+)T-lymphocytes<200 copies/μL was 7.072(95%CI:6.696-7.470)times and 3.842(95%CI:3.657-4.036)times respectively.Patients who did not receive ART had a 14.400(95%CI:13.881-14.939)times greater risk of death than those who did receive ART.Conclusions Older age at confirmation,first CD4^(+)T-lymphocytes undetected or first CD4^(+)T-lymphocytes<200 copies/μL,and not receiving ART are the main risk factors for death of MSM with HIV/AIDS in China,and early detection,diagnosis,and treatment of MSM need to be strengthened.At the same time,focus needs to be placed on the detection and treatment of elderly MSM,to further reduce the risk of death of MSM with HIV/AIDS.