摘要
目的分析山东省HIV感染者艾滋病相关死亡的影响因素, 为降低死亡风险及延长生存时间提供参考。方法研究对象为2017-2021年山东省HIV感染者, 采用Cox比例风险回归模型分析艾滋病相关死亡及确证1年内死亡的影响因素。结果 2017-2021年山东省报告的14 700例HIV感染者中, 发生艾滋病相关死亡351例, 占2.4%(351/14 700)。多因素Cox比例风险回归模型分析结果显示, HIV感染者艾滋病相关死亡的危险因素包括文化程度为初、高中/中专(aHR=1.37, 95%CI:1.01~1.84)、样本来源自医疗机构(aHR=1.61, 95%CI:1.22~2.12)、病程为艾滋病期(aHR=9.86, 95%CI:6.86~14.19)、未检测基线CD4+T淋巴细胞(CD4)(aHR=3.93, 95%CI:2.69~5.75)、抗病毒治疗(ART)时间<6个月(aHR=3.46, 95%CI:2.42~4.93)和未ART(aHR=1.45, 95%CI:1.02~2.07)、末次CD4<200个/μl(aHR=3.51, 95%CI:2.18~5.65)和末次CD4未检测(aHR=10.58, 95%CI:6.15~18.19)、末次病毒载量(VL)值为50~999拷贝数/ml、≥1 000拷贝数/ml和未检测(aHR=2.59, 95%CI:1.07~6.26;aHR=9.50, 95%CI:5.60~16.12;aHR=15.33, 95%CI:8.91~26.36);HIV感染者确证1年内发生艾滋病相关死亡风险较高的因素包括样本来源自医疗机构(aHR=1.68, 95%CI:1.19~2.36)、病程为艾滋病期(aHR=10.60, 95%CI:7.13~15.75)、基线CD4未检测(aHR=3.71, 95%CI:2.34~5.90)、ART时间<6个月(aHR=4.30, 95%CI:2.85~6.49)和未ART(aHR=2.05, 95%CI:1.35~3.13)、末次CD4<200个/μl(aHR=5.45, 95%CI:2.04~14.60)和末次CD4未检测(aHR=20.95, 95%CI:7.69~57.04)、末次VL值为50~999、≥1 000拷贝数/ml和未检测(aHR=15.21, 95%CI:2.54~91.21;aHR=42.93, 95%CI:9.64~191.20;aHR=61.35, 95%CI:13.85~271.77)。结论扩大检测覆盖面, 促进早发现和早治疗, 加强对HIV感染者的定期随访和检测, 掌握病程进展并进行精准管理和治疗, 对降低HIV感染者病死率和延长生存时间有重要作用。
Objective To explore the influencing factors of AIDS-related deaths among HIV-infected patients in Shandong Province,to help reduce the risk of death and prolong survival time.Methods The study population was HIV-infected patients in Shandong Province from 2017-2021,and Cox proportional hazards regression model was used to analyze the influencing factors of AIDS-related deaths and deaths within one year of confirmation.Results Among 14700 HIV-infected patients reported in Shandong Province in 2017-2021,351 AIDS-related deaths occurred,accounting for 2.4%(351/14700).The results of multifactorial Cox proportional hazards regression model analysis showed that the risk factors for AIDS-related deaths among HIV-infected patients included education level of junior high school,high school,and secondary school(aHR=1.37,95%CI:1.01-1.84),sample source from healthcare institutions(aHR=1.61,95%CI:1.22-2.12),duration of disease in AIDS stage(aHR=9.86,95%CI:6.86-14.19),baseline CD4+T lymphocytes(CD4)undetected(aHR=3.93,95%CI:2.69-5.75),duration of antiviral treatment(ART)<6 months(aHR=3.46,95%CI:2.42-4.93)and no ART(aHR=1.45,95%CI:1.02-2.07),final CD4<200 cells/μl(aHR=3.51,95%CI:2.18-5.65)and final CD4 undetected(aHR=10.58,95%CI:6.15-18.19),and final viral load(VL)values of 50-999 copies/ml,≥1000 copies/ml and undetected(aHR=2.59,95%CI:1.07-6.26;aHR=9.50,95%CI:5.60-16.12;aHR=15.33,95%CI:8.91-26.36).Factors with higher risk of AIDS-related deaths within one year of confirmation of HIV-infected patients included samples originating from healthcare facilities(aHR=1.68,95%CI:1.19-2.36),AIDS stage of disease(aHR=10.60,95%CI:7.13-15.75),baseline CD4 undetected(aHR=3.71,95%CI:2.34-5.90),duration of ART<6 months(aHR=4.30,95%CI:2.85-6.49)and no ART(aHR=2.05,95%CI:1.35-3.13),final CD4<200 cells/μl(aHR=5.45,95%CI:2.04-14.60)and final CD4 undetected(aHR=20.95,95%CI:7.69-57.04),and final VL values of 50-999 copies/ml,≥1000 copies/ml and undetected(aHR=15.21,95%CI:2.54-91.21;aHR=42.93,95%CI:9.64-191.20;aHR=61.35,95%CI:13.85-271.77).Conclusions Expanding the coverage of testing,promoting early detection and treatment,strengthening regular follow-up and the test of HIV-infected patients,grasping the progress of the disease to provide accurate management and treatment are important for reducing the disease mortality rate and prolonging the survival time of HIV-infected patients.
作者
赵文煜
朱晓艳
李玲
张娜
黄鹏翔
廖玫珍
李亚君
王国永
康殿民
Zhao Wenyu;Zhu Xiaoyan;Li Ling;Zhang Na;Huang Pengxiang;Liao Meizhen;Li Yajun;Wang Guoyong;Kang Dianmin(School of Public Health and Health Management,Shandong First Medical University&Shandong Academy of Medical Sciences,Ji'nan 250117,China;Institute of AIDS Control and Prevention,Shandong Center for Disease Control and Prevention,Ji'nan 250014,China)
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2023年第10期1634-1640,共7页
Chinese Journal of Epidemiology
基金
山东省人文社会科学课题(2021-ZXJK-18)。
