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Article(id=1240633238385906494, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310286, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1697644800000, receivedDateStr=2023-10-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773719613881, onlineDateStr=2026-03-17, pubDate=1716566400000, pubDateStr=2024-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773719613881, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773719613881, creator=13701087609, updateTime=1773719613881, updator=13701087609, issue=Issue{id=1240633237542851387, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773719613680, creator=13701087609, updateTime=1773720039302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240635022806405370, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240635022806405371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1729, endPage=1735, ext={EN=ArticleExt(id=1240633238616593215, articleId=1240633238385906494, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trends of cumulative mortality and risk factors of AIDS-related and non-AIDS-related deaths among HIV/AIDS patients in Fangchenggang City, 2005-2022, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

This study aims to investigate the mortality among HIV/AIDS patients receiving antiretroviral therapy (ART) in Fangchenggang City, Guangxi Province, and to identify associated factors with AIDS-related and non-AIDS-related deaths, providing scientific evidence for reducing AIDS mortality.

Methods

We collected data from the National Comprehensive AIDS Prevention and Control Information System. These data included socio-demographic and follow-up records of 2 728 HIV-1 infected individuals receiving Antiretroviral Therapy (ART) treatment in Fangchenggang City from January 1, 2005 to July 5, 2022. This dataset included socio-demographic and follow-up records during the specified period, providing a comprehensive insight into the therapeutic responses, survival rates, and potential associated complications among ART-treated HIV/AIDS patients within Fangchenggang City. Socio-demographic and follow-up data were analyzed using the cumulative incidence function (CIF) under a competing risk framework and the Fine-Gray subdistribution hazard regression model to assess the associated factors with both AIDS-related and non-AIDS-related deaths.

Results

With an average follow-up period of 6.7 person-years, 295 cases experienced AIDS-related death with a mortality rate of 1.06/100 person-years, while 227 cases died from non-AIDS-related causes, with a mortality rate of 1.2/100 person-years. Under consideration of competing risks, the cumulative incidence of AIDS-related death at 1 year, 5 years, and 13 years post-diagnosis was 2.5%, 8.5%, and 15.0%, respectively. The factors associated with a higher risk of AIDS-related death included: age 60 years or older (aHR=1.5, 95%CI: 1.05~2.15), current spouse’s infection status unknown/not investigated (aHR=1.39, 95%CI:1.03~1.90), history of prophylactic treatment for opportunistic infections (aHR=1.4, 95%CI:1.06~1.84), and occurrence of opportunistic infections or tumors (aHR=1.65, 95%CI: 1.12~2.45). On the contrary, factors associated with a lower risk of AIDS-related death included: being female (aHR=0.67, 95%CI: 0.49~0.90), initial treatment regimen containing EFV (aHR=0.41, 95%CI: 0.25~0.68), having changed the treatment regimen (aHR=0.19, 95%CI: 0.12~0.29), first CD4 cell count ≥ 200 cells/μL (aHR=0.30, 95%CI: 0.20~0.45), initial viral load (VL) between 50 to 1000 copies/ml (aHR=0.31, 95%CI: 0.18~0.54), and VL < 50 copies/ml (aHR=0.61, 95%CI: 0.44~0.84). Regarding non-AIDS related deaths, passive detection (aHR=1.41, 95%CI: 1.0~1.98), uninvestigated/unknown spouse’s infection status (aHR=1.40, 95%CI: 1.01~1.95), and first CD4 cell count ≥200 cells/μL (aHR=1.68, 95%CI:1.27~2.22) were found to be associated with increased risk. In contrast, lower risk factors included being female (aHR=0.55, 95%CI: 0.37~0.81), having experienced a change in antiviral treatment regimen post-initiation (aHR=0.33, 95%CI:0.21~0.50), initial treatment regimens containing EFV (aHR=0.55, 95%CI: 0.34~0.88), and NVP (aHR=0.50, 95%CI: 0.3~0.83).

Conclusion

The mortality rate among HIV/AIDS patients receiving ART in Fangchenggang City is relatively low. This study underscores the importance of preventing and treating opportunistic infections or tumors for improving the survival of HIV/AIDS patients. HIV/AIDS care clinics should particularly focus on monitoring and following up on female patients, older patients, and those detected passively, enhancing medication adherence, expanding HIV testing among key populations, and thereby striving to reduce the mortality rate among AIDS patients.

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目的

了解广西防城港市抗病毒治疗艾滋病病毒感染者和艾滋病患(HIV/AIDS)的死亡情况及艾滋病死亡的影响因素，为减少艾滋病死亡提供科学依据。

方法

通过全国艾滋病综合防治信息系统收集2005年1月1日至2022年7月5日期间在防城港市接受抗逆转录病毒治疗(Antiretroviral Therapy, ART)治疗的2 728例HIV/AIDS的基本情况和随访资料。采用竞争风险累积发生率(CIF)和部分分布比例风险回归模型(F-G模型)，分析影响艾滋病相关和非艾滋病相关死亡的影响因素。

结果

本研究纳入了2 728例HIV/AIDS，平均随访人年为6.7人年。295例发生艾滋病相关死亡，病死率为1.06/100人年；227例发生艾滋病无关死亡，病死率为1.2/100 人年。考虑竞争风险的情况下，HIV/AIDS患者确诊后1年、5年和13年的艾滋病相关死亡累积发生率分别为2.5%、8.5%和15.0%。多因素分析结果显示，60岁及以上（adjusted Hazard Ratio, aHR=1.50, 95% Confidence Interval(CI):1.05~2.15）、当前配偶的HIV感染状态未查或不详(aHR=1.39, 95%CI:1.03~1.90)、曾接受预防机会性感染治疗(aHR=1.40，95%CI:1.06~1.84)和出现机会性感染或肿瘤(aHR=1.65, 95%CI:1.12~2.45)的患者发生艾滋病相关死亡风险较高。女性(aHR=0.67, 95%CI:0.49~0.90)、初始治疗方案为依非韦伦(EFV) (aHR=0.41,95%CI:0.25~0.68)、有变更治疗方案(aHR=0.19,95%CI:0.12~0.29)、首次CD4细胞计数≥200个/μL(aHR=0.3,95%CI:0.20~0.45)、初始病毒载量(viral load, VL)为50~1000 copies/ml(aHR=0.31,95%CI:0.18~0.54)和<50 copies/ml (aHR=0.61,95%CI:0.44~0.84)的患者发生艾滋病相关死亡风险较低。60岁及以上(aHR=2.82,95%CI:1.80~4.43)，被动检测(aHR=1.41, 95%CI:1~1.98)、配偶的HIV感染状态未查或不详(aHR=1.40,95%CI:1.01~1.95)、首次CD4细胞计数≥200个/μL(aHR=1.68,95%CI:1.27~2.22)，发生艾滋病无关死亡风险较高。女性(aHR=0.55,95%CI:0.37~0.81)、接受抗病毒治疗后有变更过治疗方案(aHR=0.33,95%CI:0.21~0.50)、初始治疗方案含EFV(aHR=0.55,95%CI:0.34~0.88)和奈韦拉平(NVP) (aHR=0.50,95%CI:0.30~0.83)的患者发生艾滋病无关死亡风险较低。

结论

防城港市HIV/AIDS抗病毒治疗患者的死亡发生率较低。本研究强调了预防和治疗机会性感染或肿瘤对HIV/AIDS患者生存的重要性。艾滋病护理门诊应重点关注男性、年龄较大的患者、被动检测发现的HIV/AIDS的监测和随访，提高患者的服药依从性，扩大重点人群的HIV检测，以降低艾滋病患者的死亡率。

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梁冰玉，E-mail:;
马平，E-mail:
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严芝蔓（1989—），女，本科，主治医师，研究方向：传染病学；林志峰（1998—），男，硕士在读，研究方向：公共卫生

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严芝蔓（1989—），女，本科，主治医师，研究方向：传染病学；林志峰（1998—），男，硕士在读，研究方向：公共卫生

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严芝蔓（1989—），女，本科，主治医师，研究方向：传染病学；林志峰（1998—），男，硕士在读，研究方向：公共卫生

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Demographic characteristics of HIV/AIDS patients receiving antiviral therapy in Fangchenggang City from 2005 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
变量观察人数n(%)艾滋病相关死亡
死亡例数(%)		艾滋病无关死亡
死亡例数(%)
性别
男性1 854(68.0)237(12.8)178(9.6)
女性874(32.0)58(6.6)49(5.6)
年龄组（岁）
<39540(19.8)41(7.6)24(4.4)
40~591 167(42.8)113(9.7)58(5.0)
≥601 021(37.4)141(13.8)145(14.2)
职业
固定职业250(9.2)21(8.4)33(13.2)
非固定职业2 218(81.3)250(11.3)179(8.1)
其他260(9.5)24(9.2)15(5.8)
民族
汉族1 728(63.3)187(10.8)147(8.5)
壮族819(30.0)90(11.0)60(7.3)
其他181(6.7)18(9.9)20(11.0)
性接触方式
非婚商业异性性接触史567(20.8)67(11.8)42(7.4)
配偶/固定性伴阳性464(17.0)31(6.7)35(7.5)
非婚异性性接触史/非婚非商业异性性接触史1 491(54.7)183(12.3)130(8.7)
其他/不详206(7.5)14(6.8)20(9.7)
样本来源
主动检测723(26.5)57(7.9)42(5.8)
被动检测1 704(62.5)209(12.3)161(9.4)
其他301(11.0)29(9.6)24(8)
最可能的感染途径
异性性传播2 505(91.8)279(11.1)207(8.3)
非异性性传播223(8.2)16(7.2)20(9.0)
当前配偶感染状况
阴性590(21.6)53(9.0)46(7.8)
阳性537(19.7)42(7.8)32(6.0)
未查/不详1 601(58.7)200(12.5)149(9.3)
确诊~开始ART的时间（周）
<2931(34.1)105(11.3)76(8.2)
2~4794(29.1)86(10.8)64(8.1)
>41 003(36.8)104(10.4)87(8.7)
是否接受预防机会性感染治疗
否2 013(73.8)172(8.5)180(8.9)
是715(26.2)123(17.2)47(6.6)
初始治疗方案
洛匹那韦/利托那韦（LPV/r）126(4.6)20(15.9)22(17.5)
依非韦伦（EFV）1 282(47.0)85(6.6)90(7)
奈韦拉平（NVP）1 312(48.1)189(14.4)114(8.7)
其他8(0.3)1(12.5)1(12.5)
是否变更治疗方案
否1 979(72.5)272(13.7)203(10.3)
是749(27.5)23(3.1)24(3.2)
是否出现机会性感染或肿瘤
否2 545(93.3)260(10.2)211(8.3)
是183(6.7)35(19.1)16(8.7)
首次CD4细胞计数 (个/μL)
0~1991 630(59.7)257(15.8)122(7.5)
≥2001 098(40.3)38(3.5)105(9.6)
初始VL（copies/ml）
>1 000291(10.7)45(15.5)25(8.6)
50~1 000303(11.1)18(5.9)26(8.6)
<502 134(78.2)232(10.9)176(8.2)
是否出现艾滋病相关症状和体征
否1 922(70.5)182(9.5)158(8.2)
是806(29.5)113(14.0)69(8.6)
), ArticleFig(id=1240633246782902377, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238385906494, language=CN, label=表1, caption=

2005—2022年防城港市抗病毒治疗HIV/AIDS 病例人口学特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量观察人数n(%)艾滋病相关死亡
死亡例数(%)		艾滋病无关死亡
死亡例数(%)
性别
男性1 854(68.0)237(12.8)178(9.6)
女性874(32.0)58(6.6)49(5.6)
年龄组（岁）
<39540(19.8)41(7.6)24(4.4)
40~591 167(42.8)113(9.7)58(5.0)
≥601 021(37.4)141(13.8)145(14.2)
职业
固定职业250(9.2)21(8.4)33(13.2)
非固定职业2 218(81.3)250(11.3)179(8.1)
其他260(9.5)24(9.2)15(5.8)
民族
汉族1 728(63.3)187(10.8)147(8.5)
壮族819(30.0)90(11.0)60(7.3)
其他181(6.7)18(9.9)20(11.0)
性接触方式
非婚商业异性性接触史567(20.8)67(11.8)42(7.4)
配偶/固定性伴阳性464(17.0)31(6.7)35(7.5)
非婚异性性接触史/非婚非商业异性性接触史1 491(54.7)183(12.3)130(8.7)
其他/不详206(7.5)14(6.8)20(9.7)
样本来源
主动检测723(26.5)57(7.9)42(5.8)
被动检测1 704(62.5)209(12.3)161(9.4)
其他301(11.0)29(9.6)24(8)
最可能的感染途径
异性性传播2 505(91.8)279(11.1)207(8.3)
非异性性传播223(8.2)16(7.2)20(9.0)
当前配偶感染状况
阴性590(21.6)53(9.0)46(7.8)
阳性537(19.7)42(7.8)32(6.0)
未查/不详1 601(58.7)200(12.5)149(9.3)
确诊~开始ART的时间（周）
<2931(34.1)105(11.3)76(8.2)
2~4794(29.1)86(10.8)64(8.1)
>41 003(36.8)104(10.4)87(8.7)
是否接受预防机会性感染治疗
否2 013(73.8)172(8.5)180(8.9)
是715(26.2)123(17.2)47(6.6)
初始治疗方案
洛匹那韦/利托那韦（LPV/r）126(4.6)20(15.9)22(17.5)
依非韦伦（EFV）1 282(47.0)85(6.6)90(7)
奈韦拉平（NVP）1 312(48.1)189(14.4)114(8.7)
其他8(0.3)1(12.5)1(12.5)
是否变更治疗方案
否1 979(72.5)272(13.7)203(10.3)
是749(27.5)23(3.1)24(3.2)
是否出现机会性感染或肿瘤
否2 545(93.3)260(10.2)211(8.3)
是183(6.7)35(19.1)16(8.7)
首次CD4细胞计数 (个/μL)
0~1991 630(59.7)257(15.8)122(7.5)
≥2001 098(40.3)38(3.5)105(9.6)
初始VL（copies/ml）
>1 000291(10.7)45(15.5)25(8.6)
50~1 000303(11.1)18(5.9)26(8.6)
<502 134(78.2)232(10.9)176(8.2)
是否出现艾滋病相关症状和体征
否1 922(70.5)182(9.5)158(8.2)
是806(29.5)113(14.0)69(8.6)
), ArticleFig(id=1240633246904537205, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238385906494, language=EN, label=Table 2, caption=

Risk factors of AIDS-related mortality and Non-AIDS-related mortality among HIV-infected patients receiving ART in Fangchenggang City from 2005 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n艾滋病相关死亡非艾滋病相关死亡
aHR值(95%CI)P值aHR值(95%CI)P值
性别
男1 8541.01.0
女8740.67(0.49~0.90)0.0080.55(0.37~0.81)0.002
年龄组(岁)
0~395401.01.0
40~591 1671.12(0.78~1.62)0.5001.10(0.68~1.79)0.700
≥601 0211.50(1.05~2.15)0.0242.82(1.80~4.43)<0.001
职业
固定职业2501.0
非固定职业2 2180.76(0.52~1.10)0.200
其他2600.54(0.28~1.01)0.055
样本来源
主动检测7231.0
被动检测1 7041.41(1.0~1.98)0.047
其他3011.27(0.74~2.17)0.400
接触方式
非婚商业异性性接触史5671.0
配偶/固定性伴阳性4641.17(0.67~2.03)0.600
非婚异性性接触史/非婚非商业异性性接触史1 4910.96(0.66~1.42)0.900
其他2061.70(0.92~3.12)0.088
当前配偶感染状况
阴性5901.01.0
阳性5371.06(0.71~1.59)0.8000.82(0.52~1.29)0.400
未查/不详1 6011.39(1.03~1.90)0.0341.40(1.01~1.95)0.045
初始治疗方案
洛匹那韦/利托那韦（LPV/r）1261.01.0
依非韦伦（EFV）1 2820.41(0.25~0.68)<0.0010.55(0.34~0.88)0.013
奈韦拉平（NVP）1 3120.76(0.46~1.24)0.3000.50(0.30~0.83)0.007
其他81.21(0.13~11.5)0.9000.95(0.11~7.93)>0.900
是否变更治疗方案
否1 9791.01.0
是7490.19(0.12~0.29)<0.0010.33(0.21~0.5)<0.001
首次CD4检测值 (个/μL)
0~1991 6301.01.0
≥2001 0980.30(0.20~0.45)<0.0011.68(1.27~2.22)<0.001
初始VL（copies/ml）
>1 0002911.0
50~1 0003030.31(0.18~0.54)<0.001
<502 1340.61(0.44~0.84)0.002
是否接受预防机会性感染治疗
否2 0131.0
是7151.40(1.06~1.84)0.017
是否出现机会性感染或肿瘤
否2 5451.0
是1831.65(1.12~2.45)0.012
), ArticleFig(id=1240633247072309376, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633238385906494, language=CN, label=表2, caption=

2005—2022年防城港市接受抗病毒治疗HIV/AIDS艾滋病和非艾滋病相关死亡的危险因素

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n艾滋病相关死亡非艾滋病相关死亡
aHR值(95%CI)P值aHR值(95%CI)P值
性别
男1 8541.01.0
女8740.67(0.49~0.90)0.0080.55(0.37~0.81)0.002
年龄组(岁)
0~395401.01.0
40~591 1671.12(0.78~1.62)0.5001.10(0.68~1.79)0.700
≥601 0211.50(1.05~2.15)0.0242.82(1.80~4.43)<0.001
职业
固定职业2501.0
非固定职业2 2180.76(0.52~1.10)0.200
其他2600.54(0.28~1.01)0.055
样本来源
主动检测7231.0
被动检测1 7041.41(1.0~1.98)0.047
其他3011.27(0.74~2.17)0.400
接触方式
非婚商业异性性接触史5671.0
配偶/固定性伴阳性4641.17(0.67~2.03)0.600
非婚异性性接触史/非婚非商业异性性接触史1 4910.96(0.66~1.42)0.900
其他2061.70(0.92~3.12)0.088
当前配偶感染状况
阴性5901.01.0
阳性5371.06(0.71~1.59)0.8000.82(0.52~1.29)0.400
未查/不详1 6011.39(1.03~1.90)0.0341.40(1.01~1.95)0.045
初始治疗方案
洛匹那韦/利托那韦（LPV/r）1261.01.0
依非韦伦（EFV）1 2820.41(0.25~0.68)<0.0010.55(0.34~0.88)0.013
奈韦拉平（NVP）1 3120.76(0.46~1.24)0.3000.50(0.30~0.83)0.007
其他81.21(0.13~11.5)0.9000.95(0.11~7.93)>0.900
是否变更治疗方案
否1 9791.01.0
是7490.19(0.12~0.29)<0.0010.33(0.21~0.5)<0.001
首次CD4检测值 (个/μL)
0~1991 6301.01.0
≥2001 0980.30(0.20~0.45)<0.0011.68(1.27~2.22)<0.001
初始VL（copies/ml）
>1 0002911.0
50~1 0003030.31(0.18~0.54)<0.001
<502 1340.61(0.44~0.84)0.002
是否接受预防机会性感染治疗
否2 0131.0
是7151.40(1.06~1.84)0.017
是否出现机会性感染或肿瘤
否2 5451.0
是1831.65(1.12~2.45)0.012
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2005—2022年防城港市艾滋病患者累积死亡率趋势及艾滋病相关和无关死亡危险因素分析
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严芝蔓 1 , 林志峰 2 , 黄雪刚 1 , 卢平 1 , 黄祖龙 1 , 吴叶舟 2 , 莫实德 3 , 林燕 3 , 马平 1 , 梁冰玉 2
现代预防医学 | 流行病与统计方法 2024,51(10): 1729-1735
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现代预防医学 | 流行病与统计方法 2024, 51(10): 1729-1735
2005—2022年防城港市艾滋病患者累积死亡率趋势及艾滋病相关和无关死亡危险因素分析
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严芝蔓1, 林志峰2, 黄雪刚1, 卢平1, 黄祖龙1, 吴叶舟2, 莫实德3, 林燕3, 马平1 , 梁冰玉2
作者信息
  • 1.防城港市第一人民医院 感染性疾病科；档案管理科 538001
  • 2.广西医科大学 广西艾滋病防治研究重点实验室
  • 3.防城港市疾病预防控制中心

    • 严芝蔓（1989—），女，本科，主治医师，研究方向：传染病学；林志峰（1998—），男，硕士在读，研究方向：公共卫生

通讯作者:

梁冰玉，E-mail:;
马平，E-mail:
Trends of cumulative mortality and risk factors of AIDS-related and non-AIDS-related deaths among HIV/AIDS patients in Fangchenggang City, 2005-2022
Zhi-man YAN1, Zhi-feng LIN2, Xue-gang HUANG1, Ping LU1, Zu-long HUANG1, Ye-zhou WU2, Shi-de MO3, Yan LIN3, Ping MA1 , Bing-yu LIANG2
Affiliations
  • Department of Infectious Diseases, Fangchenggang First People’s Hospital, Fangchenggang, Guangxi 538000, China
出版时间: 2024-05-25 doi: 10.20043/j.cnki.MPM.202310286
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摘要
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目的

了解广西防城港市抗病毒治疗艾滋病病毒感染者和艾滋病患(HIV/AIDS)的死亡情况及艾滋病死亡的影响因素，为减少艾滋病死亡提供科学依据。

方法

通过全国艾滋病综合防治信息系统收集2005年1月1日至2022年7月5日期间在防城港市接受抗逆转录病毒治疗(Antiretroviral Therapy, ART)治疗的2 728例HIV/AIDS的基本情况和随访资料。采用竞争风险累积发生率(CIF)和部分分布比例风险回归模型(F-G模型)，分析影响艾滋病相关和非艾滋病相关死亡的影响因素。

结果

本研究纳入了2 728例HIV/AIDS，平均随访人年为6.7人年。295例发生艾滋病相关死亡，病死率为1.06/100人年；227例发生艾滋病无关死亡，病死率为1.2/100 人年。考虑竞争风险的情况下，HIV/AIDS患者确诊后1年、5年和13年的艾滋病相关死亡累积发生率分别为2.5%、8.5%和15.0%。多因素分析结果显示，60岁及以上（adjusted Hazard Ratio, aHR=1.50, 95% Confidence Interval(CI):1.05~2.15）、当前配偶的HIV感染状态未查或不详(aHR=1.39, 95%CI:1.03~1.90)、曾接受预防机会性感染治疗(aHR=1.40，95%CI:1.06~1.84)和出现机会性感染或肿瘤(aHR=1.65, 95%CI:1.12~2.45)的患者发生艾滋病相关死亡风险较高。女性(aHR=0.67, 95%CI:0.49~0.90)、初始治疗方案为依非韦伦(EFV) (aHR=0.41,95%CI:0.25~0.68)、有变更治疗方案(aHR=0.19,95%CI:0.12~0.29)、首次CD4细胞计数≥200个/μL(aHR=0.3,95%CI:0.20~0.45)、初始病毒载量(viral load, VL)为50~1000 copies/ml(aHR=0.31,95%CI:0.18~0.54)和<50 copies/ml (aHR=0.61,95%CI:0.44~0.84)的患者发生艾滋病相关死亡风险较低。60岁及以上(aHR=2.82,95%CI:1.80~4.43)，被动检测(aHR=1.41, 95%CI:1~1.98)、配偶的HIV感染状态未查或不详(aHR=1.40,95%CI:1.01~1.95)、首次CD4细胞计数≥200个/μL(aHR=1.68,95%CI:1.27~2.22)，发生艾滋病无关死亡风险较高。女性(aHR=0.55,95%CI:0.37~0.81)、接受抗病毒治疗后有变更过治疗方案(aHR=0.33,95%CI:0.21~0.50)、初始治疗方案含EFV(aHR=0.55,95%CI:0.34~0.88)和奈韦拉平(NVP) (aHR=0.50,95%CI:0.30~0.83)的患者发生艾滋病无关死亡风险较低。

结论

防城港市HIV/AIDS抗病毒治疗患者的死亡发生率较低。本研究强调了预防和治疗机会性感染或肿瘤对HIV/AIDS患者生存的重要性。艾滋病护理门诊应重点关注男性、年龄较大的患者、被动检测发现的HIV/AIDS的监测和随访，提高患者的服药依从性，扩大重点人群的HIV检测，以降低艾滋病患者的死亡率。

艾滋病病毒感染者/艾滋病患者  /  生存分析  /  竞争风险模型
Objective

This study aims to investigate the mortality among HIV/AIDS patients receiving antiretroviral therapy (ART) in Fangchenggang City, Guangxi Province, and to identify associated factors with AIDS-related and non-AIDS-related deaths, providing scientific evidence for reducing AIDS mortality.

Methods

We collected data from the National Comprehensive AIDS Prevention and Control Information System. These data included socio-demographic and follow-up records of 2 728 HIV-1 infected individuals receiving Antiretroviral Therapy (ART) treatment in Fangchenggang City from January 1, 2005 to July 5, 2022. This dataset included socio-demographic and follow-up records during the specified period, providing a comprehensive insight into the therapeutic responses, survival rates, and potential associated complications among ART-treated HIV/AIDS patients within Fangchenggang City. Socio-demographic and follow-up data were analyzed using the cumulative incidence function (CIF) under a competing risk framework and the Fine-Gray subdistribution hazard regression model to assess the associated factors with both AIDS-related and non-AIDS-related deaths.

Results

With an average follow-up period of 6.7 person-years, 295 cases experienced AIDS-related death with a mortality rate of 1.06/100 person-years, while 227 cases died from non-AIDS-related causes, with a mortality rate of 1.2/100 person-years. Under consideration of competing risks, the cumulative incidence of AIDS-related death at 1 year, 5 years, and 13 years post-diagnosis was 2.5%, 8.5%, and 15.0%, respectively. The factors associated with a higher risk of AIDS-related death included: age 60 years or older (aHR=1.5, 95%CI: 1.05~2.15), current spouse’s infection status unknown/not investigated (aHR=1.39, 95%CI:1.03~1.90), history of prophylactic treatment for opportunistic infections (aHR=1.4, 95%CI:1.06~1.84), and occurrence of opportunistic infections or tumors (aHR=1.65, 95%CI: 1.12~2.45). On the contrary, factors associated with a lower risk of AIDS-related death included: being female (aHR=0.67, 95%CI: 0.49~0.90), initial treatment regimen containing EFV (aHR=0.41, 95%CI: 0.25~0.68), having changed the treatment regimen (aHR=0.19, 95%CI: 0.12~0.29), first CD4 cell count ≥ 200 cells/μL (aHR=0.30, 95%CI: 0.20~0.45), initial viral load (VL) between 50 to 1000 copies/ml (aHR=0.31, 95%CI: 0.18~0.54), and VL < 50 copies/ml (aHR=0.61, 95%CI: 0.44~0.84). Regarding non-AIDS related deaths, passive detection (aHR=1.41, 95%CI: 1.0~1.98), uninvestigated/unknown spouse’s infection status (aHR=1.40, 95%CI: 1.01~1.95), and first CD4 cell count ≥200 cells/μL (aHR=1.68, 95%CI:1.27~2.22) were found to be associated with increased risk. In contrast, lower risk factors included being female (aHR=0.55, 95%CI: 0.37~0.81), having experienced a change in antiviral treatment regimen post-initiation (aHR=0.33, 95%CI:0.21~0.50), initial treatment regimens containing EFV (aHR=0.55, 95%CI: 0.34~0.88), and NVP (aHR=0.50, 95%CI: 0.3~0.83).

Conclusion

The mortality rate among HIV/AIDS patients receiving ART in Fangchenggang City is relatively low. This study underscores the importance of preventing and treating opportunistic infections or tumors for improving the survival of HIV/AIDS patients. HIV/AIDS care clinics should particularly focus on monitoring and following up on female patients, older patients, and those detected passively, enhancing medication adherence, expanding HIV testing among key populations, and thereby striving to reduce the mortality rate among AIDS patients.

HIV/AIDS patients  /  Survival analysis  /  Competing risk model
严芝蔓, 林志峰, 黄雪刚, 卢平, 黄祖龙, 吴叶舟, 莫实德, 林燕, 马平, 梁冰玉. 2005—2022年防城港市艾滋病患者累积死亡率趋势及艾滋病相关和无关死亡危险因素分析. 现代预防医学, 2024 , 51 (10) : 1729 -1735 . DOI: 10.20043/j.cnki.MPM.202310286
Zhi-man YAN, Zhi-feng LIN, Xue-gang HUANG, Ping LU, Zu-long HUANG, Ye-zhou WU, Shi-de MO, Yan LIN, Ping MA, Bing-yu LIANG. Trends of cumulative mortality and risk factors of AIDS-related and non-AIDS-related deaths among HIV/AIDS patients in Fangchenggang City, 2005-2022[J]. Modern Preventive Medicine, 2024 , 51 (10) : 1729 -1735 . DOI: 10.20043/j.cnki.MPM.202310286
正文
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1　前言
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艾滋病是一种由人免疫缺陷病毒(HIV)引起的慢性疾病，可导致免疫系统受损并最终导致死亡。据联合国艾滋病规划署报告，2020年全球新增艾滋病病毒感染者/艾滋病患者(HIV感染者/AIDS患者)共计150万，与艾滋病相关的死亡人数高达68万人[1]。2009至2020年，我国AIDS累计发病例数约105.82万人，累计死亡例数约22.28万人，全国AIDS发病率和死亡率逐年增长后逐渐趋于平缓[2]。多年来，我国艾滋病的死亡率一直居乙类传染病首位[3]。既往研究表明机会性感染和艾滋病相关肿瘤是HIV/AIDS患者主要的死因，艾滋病患者死亡的主要影响因素包括年龄、首次CD4细胞计数、确诊到启动抗病毒治疗的时间间隔、样本来源等[4]。自1996年以来，我国一直在改善艾滋病毒感染者的治疗和管理，包括促进治疗和积极预防机会性感染、管理合并症、加强重症监护管理、提升疾病筛查和健康促进等。这些改进措施大大提高了艾滋病患者的生存率，并且使艾滋病的死亡原因发生变化。近年来，与艾滋病相关的死亡人数大大减少，而与艾滋病无关的死亡人数逐渐增加[5]。因此，有必要研究艾滋病相关死亡和无关死亡的主要影响因素，以为艾滋病的抗病毒治疗策略和措施的调整和优化提供科学依据，降低艾滋病患者的死亡率。
本研究通过回顾性收集2005—2022年防城港市HIV/AIDS病例信息，分析艾滋病患者接受抗病毒治疗后不同时间的死亡累计发生率，以及艾滋病相关和无关死亡的影响因素，为相关部门制定科学、合理的艾滋病护理措施提供理论依据。
2　资料与方法
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2.1　资料来源
数据来源于“艾滋病防治工作信息系统”中HIV/AIDS患者的疫情数据库、随访数据库和抗病毒治疗数据库。以2005年1月1日―2022年7月5日在广西壮族自治区防城港市接受抗逆转录酶(ART)治疗的HIV/AIDS患者为研究对象，收集研究对象的社会人口学信息和随访的临床信息，ART治疗方案，初始和首次CD4+ T 细胞计数，病毒载量(viral load, VL)等信息。研究对象纳入标准：(1)确诊HIV抗体阳性；(2)在2005年1月1日—2022年7月5日期间确诊的患者。(3)确诊HIV时年龄≥18岁。排除标准：关键信息缺失的病例，如首次CD4细胞计数、病毒载量和感染途径等。本项目经过广西医科大学伦理委员会审批（2019-SB-102）。
2.2　定义
(1)样本来源：主动检测包括医疗机构检测、其他就诊者检测、婚前检测、孕产期检查。被动检测包括术前/性病门诊、配偶或性伴阳性检测、其他包括出入境人员体检、羁押人员体检、强制/劳教戒毒人员检测、受血(制品)前检测、无偿献血人员检测、娱乐场所人员检测以及婚前检查等。(2)死因分类：依据随访表中填写的死亡原因，归类为艾滋病相关死亡、艾滋病无关死亡与死亡原因不确定三类[6]。死亡原因是艾滋病相关疾病引起的定义为“艾滋病相关死亡”。死亡原因是艾滋病无关疾病、意外死亡、自杀、艾滋病抗病毒治疗药物毒副反应和其他原因的死亡定义为“艾滋病无关死亡”。未填写死亡原因或死因无法明确，归类为“死亡原因不确定”。(2)数据删失：抗病毒治疗随访中因不明原因失访、停药、转出及截至2022年7月5日仍存活者。
2.3　统计学方法
采用回顾性队列研究方法，研究起始时间为HIV的确诊时间，终点时间为2022年7月5日。采用R 4.3.1软件分析数据。使用“cmprsk”包和“riskRegression”包计算艾滋病相关死亡与艾滋病无关死亡的竞争风险累计发生率(CIF)，构建部分分布比例风险回归模型(F-G模型)分析其影响因素分析。手动逐步法筛选变量，最终选择最优模型。共线性诊断结果显示所有的变量的膨胀因子(variance inflation factor, VIF)均<10。通过“timeROC”包分别构建艾滋病相关死亡和艾滋病无关死亡的时间依赖AUC曲线，AUC值均保持在0.6以上。双侧检验，检验水准α=0.05。
3　结果
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3.1　基线特征
本研究共纳入2 728例HIV/AIDS病例，男性1 854例(68%)，年龄≥60岁1 021例(37.4%)，职业是农民/民工/家务2 218例(81.3%)，病例样本主要来自于被动检测1 704例(62.5%)，异性传播2 505例(91.8%)，其他情况详见表1。
3.2　死亡累积发生率趋势
截至2022年7月5日，累计665例(24.4%)死亡，其中死亡原因不明有143例(5.2%)。2 728例 HIV/AIDS 患者共计随访18 182.4人年，平均随访 6.7人年。随访中发生艾滋病相关死亡和无关死亡分别为295例(10.8%)和227例(8.3%)，死亡率分别为1.6/100 人年和1.2/100 人年。CIF结果显示治疗第1、3、5、9、13年艾滋病相关死亡和艾滋病无关死亡的累积死亡率分别为2.5%，6.1%，8.5%，13.0%，15.0%和1.5%，3.7%，6.2%，10.0%，12.0%。患者治疗第12年后，累积死亡率趋于平缓，见图1。
3.3　艾滋病相关死亡和非艾滋病相关死亡的多因素分析
在艾滋病相关死亡中，60岁及以上（adjusted Hazard Ratio, aHR=1.50, 95% Confidence Interval, CI: 1.05~2.15）相较于0~39岁年龄组，发生艾滋病相关死亡风险较高；当前配偶感染状态未查/不详(aHR=1.39, 95%CI:1.03~1.90)相较于配偶阴性，发生艾滋病相关死亡风险较高；曾接受预防机会性感染治疗(aHR=1.40,95%CI:1.06~1.84)和出现机会性感染或肿瘤(aHR=1.65,95%CI:1.12~2.45)发生艾滋病相关死亡风险较高。女性(aHR=0.67,95%CI:0.49~0.90)相对于于男性，发生艾滋病相关死亡风险较低；与初始治疗方案是洛匹那韦/利托那韦（LPV/r）相比，初始治疗方案是依非韦伦（EFV）发生艾滋病相关死亡风险较低(aHR=0.41,95%CI:0.25~0.68)；接受抗病毒治疗期间变更治疗方案(aHR=0.19,95%CI:0.12~0.29)、首次CD4细胞计数≥200(aHR=0.30,95%CI:0.20~0.45)，发生艾滋病相关死亡风险较低；与初始VL>1 000 copies/ml相比，初始VL在50~1 000 copies/ml (aHR=0.31,95%CI:0.18~0.54) 和初始VL<50 copies/ml(aHR=0.61, 95%CI:0.44~0.84)的感染者发生艾滋病相关死亡风险较低。
在艾滋病无关死亡中，样本来源是被动检测(aHR=1.41,95%CI:1.0~1.98)相较于主动检测，发生艾滋病无关死亡风险较高；与配偶HIV感染状态是阴性相比，配偶感染状态是未查或不详的感染者发生艾滋病无关死亡风险更高(aHR=1.40,95%CI:1.01~1.95)；首次CD4细胞计数≥200 (aHR=1.68,95%CI:1.27~2.22)，女性(aHR=0.55,95%CI:0.37~0.81)，接受抗病毒治疗后曾变更治疗方案(aHR=0.33,95%CI:0.21~0.50)发生艾滋病无关死亡风险较低；初始治疗方案含EFV (aHR=0.55,95%CI:0.34~0.88)和含NVP (aHR=0.50,95%CI:0.30~0.83)相较于含LPV/r的治疗方案，发生艾滋病无关死亡风险较低，见表2。
4　讨论
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本次回顾性研究中随访时间长达17年且发生非艾滋病相关死亡的比例较高，因此，本研究采用CIF和F-G模型分析防城港市艾滋病患者的累积发生率、艾滋病相关死亡和艾滋病无关死亡的影响因素。研究发现，防城港市HIV/AIDS患者治疗第3、5、9、13年发生艾滋病相关和无关死亡的累积死亡率分别为6.1%，8.5%，13.0%，15.0%和3.7%，6.2%，10.0%，12.0%，低于广西其他地区艾滋病相关死亡的死亡率[7]，也低于广东、云南等地[8-9]。随着我国免费ART的不断完善和覆盖率的增加，艾滋病病死率显著降低，呈现由艾滋病相关死亡向非艾滋病相关死亡转移的趋势[10]。在本研究中，我们观察到了多个与死亡风险相关的因素，其中包括性别、年龄≥60岁、配偶感染状况、发生机会性感染或肿瘤、被动检测等。与此相反，女性、治疗方案变更显示出降低艾滋病相关死亡风险的趋势。
我们的研究观察到初始治疗方案含EFV和含NVP的病人与初始治疗方案含LPV/r发生艾滋病无关死亡风险较低。目前，我国艾滋病免费抗病毒药物以含NVP的方案最为常用[11]。此外，EFV和NVP可能具有相对较低的心血管或其他系统副作用，或者这些药物引发的严重不良反应较少，从而间接降低了因非艾滋病相关原因导致的死亡风险[12]。我们还发现那些曾经变更治疗方案的患者的死亡风险较低，这与广东省的一项研究结果相一致[13]。治疗方案的调整通常基于患者对药物的耐受性和出现的艾滋病相关症状，包括更换药物或调整剂量以减少副作用。新接受ART治疗的患者更有可能经历方案调整，从而获得更好的治疗效果和更低的副作用风险[14]。因此，临床医生有必要针对患者对药物的反应以及患者的临床体征，及时调整抗病毒治疗方案，以优化治疗效果[15]。通过定期随访检查，及时调整ART药物治疗方案，实施个案管理模式可以有效降低死亡的风险，提高患者的生活质量。
本研究发现，出现机会性感染或肿瘤并且曾接受预防机会性感染治疗的患者发生艾滋病相关死亡的风险越高。艾滋病合并机会性感染的种类和数量严重威胁生命，尤其是在免疫系统受损的情况下[16]。出现机会性感染或肿瘤往往是晚发现的患者，免疫系统严重受损，更容易发生免疫学失败和病毒学失败最终导致死亡。对于首次CD4细胞计数低于200个/ml或已出现机会性感染（如结核、肺孢子肺炎、弓形虫感染等）的患者，预防性治疗至关重要。尽管预防性治疗有助于控制机会性感染，但对于那些晚发现或已存在感染的患者，死亡风险依旧较高[17-18]。因此，密切关注晚发现和出现机会性感染病例的治疗，及时并积极处理机会性感染，减少机会性感染或肿瘤对患者生存的负面影响。
社会经济和人口统计因素也可能对HIV患者的生存产生重要影响。女性，50岁及以上年龄段，职业为农民/民工/家务，发生死亡风险较低。这可能与女性更倾向于寻求医疗帮助、遵守医嘱以及更早进行检测和治疗有关[17-18]。因此，采取包括社会支持和提升高危人群自我检测意识的综合干预措施，可以有效降低艾滋病无关死亡的风险。
我们发现，与通过主动检测被确诊HIV的艾滋病患者相比，通过被动检测确诊的艾滋病患者具有更高的艾滋病无关死亡风险。被动检测群体往往在出现艾滋病相关症状或机会性感染后才寻求医疗帮助并得到确诊，这表明他们的HIV感染可能已经持续较长时间，导致治疗的延迟和生存率的降低。因此，加强HIV检测的推广至关重要，包括鼓励自我检测和医疗机构检测，从而减少晚发现、减少传播，并延缓艾滋病进展[20]。
本研究也存在一定的局限性。第一，本研究仅纳入了接受ART治疗的HIV/AIDS患者，未能分析未治疗患者的死亡原因，研究结果不能推广到未治疗患者人群。第二，由于研究时间跨度较大，早期抗病毒治疗数据库的管理不够完善，部分病例死亡信息不准确或死亡原因不清楚，可能会影响研究结果的准确性；第三，本研究未获得患者服药的依从性、耐药性和非艾滋病相关并发症等可能影响抗病毒治疗效果的信息，可能会对研究结果产生影响。
综上所述，防城港市HIV/AIDS抗病毒治疗患者的死亡率相对较低。艾滋病相关死亡主要与年龄、初始治疗方案、是否发生机会性感染或肿瘤、是否晚发现等因素有关。临床医生应根据患者的年龄、机会性感染和免疫状况制定治疗方案，且应根据临床体重或治疗效果及时调整治疗方案，并积极预防和治疗机会性感染或肿瘤，管理并发症，提高患者的服药依从性。卫生部门还应加大力度促进艾滋病主动检测，尤其是促进农村地区的老年人检测，减少艾滋病的晚发现，进而减少艾滋病相关死亡。
基金
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  • 国家自然科学基金(82060610)
文献
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参考文献 引证文献
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2024年第51卷第10期
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doi: 10.20043/j.cnki.MPM.202310286
  • 接收时间：2023-10-19
  • 首发时间：2026-03-17
  • 出版时间：2024-05-25
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  • 收稿日期：2023-10-19
基金
国家自然科学基金(82060610)
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    1.防城港市第一人民医院 感染性疾病科；档案管理科 538001
    2.广西医科大学 广西艾滋病防治研究重点实验室
    3.防城港市疾病预防控制中心

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