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安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素

戴色莺,  刘爱文,  沈月兰,  程晓莉,  张进,  吴建军,  吴家兵,  邢辉,  阮玉华

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文章导航 > 中华疾病控制杂志  > 2022 >  26(12): 1379-1383
戴色莺, 刘爱文, 沈月兰, 程晓莉, 张进, 吴建军, 吴家兵, 邢辉, 阮玉华. 安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素[J]. 中华疾病控制杂志, 2022, 26(12): 1379-1383. doi: 10.16462/j.cnki.zhjbkz.2022.12.003
引用本文: 戴色莺, 刘爱文, 沈月兰, 程晓莉, 张进, 吴建军, 吴家兵, 邢辉, 阮玉华. 安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素[J]. 中华疾病控制杂志, 2022, 26(12): 1379-1383. doi: 10.16462/j.cnki.zhjbkz.2022.12.003
shu
DAI Se-ying, LIU Ai-wen, SHEN Yue-lan, CHENG Xiao-li, ZHANG Jin, WU Jian-jun, WU Jia-bin, XING Hui, RUAN Yu-hua. Influencing factors on the death of HIV/AIDS patients receiving antiretroviral therapy in Anhui Province[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(12): 1379-1383. doi: 10.16462/j.cnki.zhjbkz.2022.12.003
Citation: DAI Se-ying, LIU Ai-wen, SHEN Yue-lan, CHENG Xiao-li, ZHANG Jin, WU Jian-jun, WU Jia-bin, XING Hui, RUAN Yu-hua. Influencing factors on the death of HIV/AIDS patients receiving antiretroviral therapy in Anhui Province[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(12): 1379-1383. doi: 10.16462/j.cnki.zhjbkz.2022.12.003
shu

安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.12.003
  • 1.

    230601 合肥，安徽省疾病预防控制中心艾滋病防治科

  • 2.

    230601 合肥，安徽省疾病预防控制中心艾滋病病毒分子与免疫学中心实验室

  • 3.

    102206 北京，中国疾病预防控制中心性病艾滋病预防控制中心

戴色莺、刘爱文、沈月兰为共同第一作者
基金项目: 

国家科技重大专项 2017ZX10201101

详细信息
    通讯作者:

    张进，E-mail: zhangjin@ahcdc.com.cn

  • 中图分类号: R512.91

Influencing factors on the death of HIV/AIDS patients receiving antiretroviral therapy in Anhui Province

  • 1.

    Department of AIDS prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China

  • 2.

    Center Laboratory of HIV Molecular and Immunology, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China

  • 3.

    National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

DAI Se-ying, LIU Ai-wen and SHEN Yue-lan contributed equally to this article
Funds: 

National Science and Technology Major Projects of China 2017ZX10201101

More Information

    摘要
  • 摘要:   目的  了解安徽省接受抗病毒治疗HIV感染者和AIDS病人(简称HIV/AIDS)死亡的影响因素。  方法  采用1∶2匹配病例对照研究方法，回顾性收集2010―2019年安徽省接受抗病毒治疗HIV/AIDS的相关信息，采用条件logistic回归分析模型分析HIV/AIDS死亡的影响因素。  结果  共调查4 347例HIV/AIDS，其中死亡组1 449例，对照组2 898例。多因素条件logistic回归分析模型分析显示，影响抗病毒治疗HIV/AIDS死亡的危险因素中，发生耐药、最近一次病毒载量≥1 000 copies/mL且未检测耐药、最近一次病毒载量无结果且未检测耐药分别是不耐药的1.75倍(95% CI: 1.22~2.52, P=0.003)、2.26倍(95% CI: 1.69~3.03, P＜0.001)、35.27倍(95% CI: 26.54~46.87, P＜0.001)；30~50岁和≥50岁分别是18~30岁的1.40倍(95% CI: 1.01~1.94, P=0.042)和4.02倍(95% CI: 2.80~5.77, P＜0.001)；男性是女性的1.37倍(95% CI: 1.08~1.74, P=0.011)；注射吸毒传播途径是异性传播途径的6.27倍(95% CI: 2.00~19.61, P=0.002)；治疗前WHO临床分期为Ⅲ期/Ⅳ期是Ⅰ期/Ⅱ期的1.41倍(95% CI: 1.12~1.76, P=0.007)；治疗前CD4+T淋巴细胞计数＜200个/μL是≥350个/μL的1.95倍(95% CI: 1.50~2.54, P＜0.001)。  结论  耐药、耐药检测、年龄、性别、传播途径、治疗前WHO临床分期、治疗前CD4+T淋巴细胞计数是安徽省接受抗病毒治疗HIV/AIDS发生死亡的影响因素。加强HIV/AIDS的耐药监测对减少艾滋病死亡具有重要意义，应对接受抗病毒治疗的HIV/AIDS及时进行病毒载量和耐药检测。
    Abstract:   Objective  To understand the influencing factors on the death of HIV/AIDS patients receiving antiretroviral therapy in Anhui Province.  Methods  A 1 to 2 matched case-control study was conducted to collect the information of HIV/AIDS patients who received antiretroviral therapy in Anhui Province from 2010 to 2019. The conditional logistic regression was used to analyze the risk factors on the death of HIV/AIDS patients.  Results  A total of 4 347 HIV/AIDS patients were investigated, with 1 449 cases in the death group and 2 898 cases in the control group. The multivariate conditional logistic regression result showed that among the death risk factors, drug resistance was 1.75 times (95% CI: 1.22-2.52, P=0.003) than that of non-drug resistance; the latest viral load ≥1 000 copies/mL and non-drug resistance tested results were 2.26 times (95% CI: 1.69-3.03, P < 0.001) than that of non-drug resistance; non-viral load and non-drug resistance tested results were 35.27 times (95% CI: 26.54-46.87, P < 0.001) than that of non-drug resistance; patients who age 30-49 years old was 1.40 times (95% CI: 1.01-1.94, P=0.042) than that of the 18-29 years old, and those age ≥ 50 years old was 4.02 times (95% CI: 2.80-5.77, P < 0.001) that of 18-29 years old; male was 1.37 times (95% CI: 1.08-1.74, P=0.011) than that of female, the transmission route of injecting drug use was 6.27 times (95% CI: 2.00-19.61, P=0.002) than that of heterosexual transmission; WHO clinical stage Ⅲ/Ⅳ before treatment was 1.41 times (95% CI: 1.12-1.76, P=0.007) than that of stage Ⅰ/Ⅱ; CD4+T lymphocyte count < 200 cells/μL before treatment was 1.95 times (95% CI: 1.50-2.54, P < 0.001) that of CD4+≥350 cells/μL before treatment.  Conclusions  Drug resistance, drug resistance test after antiretroviral therapy, age, gender, transmission route, WHO clinical stage before treatment, and CD4+T lymphocyte counts before treatment were the influencing factors of HIV/AIDS death in Anhui Province. Strengthening the monitoring of drug resistance for HIV/AIDS patients is important for reducing AIDS deaths. It is necessary to test viral load and drug resistance in time for HIV/AIDS patients receiving antiretroviral therapy.
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  • 表  1  研究对象基本信息和临床特征[n(%)]

    Table  1.   Information and clinical characteristics of the cases [n(%)]

    变量 合计(N=4 347) 病例组(n=1 449) 对照组(n=2 898) 单因素分析 多因素分析
    β值 OR(95% CI)值 P值 β值 OR(95% CI)值 P值
    年龄(岁)
      18~30 992(22.8) 149(10.3) 843(29.1) 1.00 1.00
      30~50 1 988(45.7) 578(39.9) 1 410(48.7) 0.88 2.41(1.95~2.94) ＜0.001 0.34 1.40(1.01~1.94) 0.042
      ≥50 1 367(31.4) 722(49.8) 645(22.3) 1.96 6.45(5.23~7.84) ＜0.001 1.39 4.02(2.80~5.77) ＜0.001
    性别
      男 3 443(79.2) 1 194(82.4) 2 249(77.6) 0.34 1.43(1.21~1.62) ＜0.001 0.32 1.37(1.08~1.74) 0.011
      女 904(20.8) 255(17.6) 649(22.4) 1.00 1.00
    民族
      汉族 4 290(98.8) 1 434(99.0) 2 856(98.6) 1.00 0.178
      其他 54(1.2) 13(0.9) 41(1.4) -0.48 0.71(0.41~1.24)
      缺失 3(0.0) 2(0.1) 1(0.0)
    婚姻状况
      未婚 1 179(27.1) 320(22.1) 859(29.6) -0.71 0.51(0.43~0.64) ＜0.001 -0.04 0.98(0.83~1.45) 0.931
      已婚或同居 2 243(51.6) 731(50.4) 1 512(52.2) -0.45 0.66(0.57~0.82) ＜0.001 -0.25 0.67(0.62~1.13) 0.062
      其他 925(21.3) 398(27.5) 527(18.2) 1.00 1.00
    文化程度
      初中以下 1 655(38.1) 735(50.8) 920(31.8) 1.08 2.89(2.39~3.47) ＜0.001 0.32 1.32(0.94~1.93) 0.035
      初中 1 622(37.3) 485(33.5) 1 137(39.2) 0.46 1.61(1.41~1.92) ＜0.001 0.12 1.23(0.91~1.63) 0.449
      高中或以上 1 067(24.6) 227(15.7) 840(29.0) 1.00 1.00
    职业
      农民 2 267(52.2) 876(60.5) 1 391(48.0) 0.52 1.72(1.51~1.96) ＜0.001 -0.12 0.93(0.85~1.34) 0.421
      其他 2 080(47.8) 573(39.5) 1 507(52.0) 1.00 1.00
    现住地
      农村 2 985(68.7) 992(68.5) 1 993(68.8) -0.02 1.02(0.91~1.25) 0.922
      城市 1 362(31.3) 457(31.5) 905(31.2) 1.00
    传播途径
      异性传播 2 732(62.8) 1 038(71.6) 1 694(58.5) 1.00 1.00
      男男同性传播 1 301(29.9) 282(19.5) 1 019(35.2) -0.81 0.48(0.42~0.62) ＜0.001 -0.43 0.65(0.50~0.85) 0.002
      注射吸毒传播 17(0.4) 10(0.7) 7(0.2) 0.87 2.12(0.91~5.96) 0.074 1.84 6.27(2.00~19.61) 0.002
      其他 297(6.8) 119(8.2) 178(6.1) 0.09 1.21(0.96~1.68) 0.413 0.61 1.83(1.34~2.51) ＜0.001
    治疗前WHO临床分期
      Ⅰ期/Ⅱ期 3 049(70.1) 837(57.8) 2 212(76.3) 1.00
      Ⅲ期/Ⅳ期 1 298(29.9) 612(42.2) 686(23.7) 0.92 2.13(1.96~2.85) ＜0.001 0.28 1.41(1.12~1.76) 0.007
    治疗前CD4+T计数(个/μL)
      ＜200 1 616(37.2) 714(49.3) 902(31.1) 1.26 3.25(2.71~3.98) ＜0.001 0.67 1.95(1.50~2.54) ＜0.001
      200~＜350 1 181(27.2) 256(17.7) 925(31.9) 0.09 1.23(0.91~1.58) 0.521 0.07 1.08(0.84~1.43) 0.615
      ≥350 762(17.5) 154(10.6) 608(21.0) 1.00 1.00
      缺失 788(18.1) 325(22.4) 463(16.0)
    开始抗病毒治疗时间
      2015年以前 2 051(47.2) 541(37.3) 1 510(52.1) -0.52 0.64(0.51~0.73) ＜0.001 -0.12 0.85(0.69~1.09) 0.406
      2015年及以后 2 296(52.8) 908(62.7) 1 388(47.9) 1.00 1.00
    开始抗病毒治疗方案
      含D4T 311(7.2) 69(4.8) 242(8.4) 1.00 1.00
      含AZT 1 508(34.7) 455(30.7) 1 063(36.7) 0.41 1.35(1.02~1.85) 0.009 -0.04 0.86(0.63~1.38) 0.851
      含TDF 2 235(51.4) 828(57.1) 1 407(48.6) 0.69 2.26(1.67~2.91) ＜0.001 0.05 1.12(0.82~1.72) 0.694
      含LPV/r 261(6.0) 95(6.6) 166(5.7) 0.72 2.23(1.48~3.12) ＜0.001 -0.02 0.94(0.48~1.59) 0.908
      其他 32(0.7) 12(0.8) 20(0.7) 0.78 2.26(0.94~4.32) 0.067 -0.06 0.91(0.28~2.84) 0.910
    最近一次抗病毒治疗方案
      含D4T 0(0.0) 0(0.0) 0(0.0)
      含AZT 1 645(37.8) 535(36.9) 1 110(38.3) 1.00 1.00
      含TDF 1 485(34.2) 505(34.9) 980(33.8) 0.08 1.21(0.89~1.41) 0.416 0.11 1.18(0.89~1.43) 0.405
      含LPV/r 953(21.9) 303(20.9) 650(22.4) -0.02 0.88(0.76~1.34) 0.756 -0.03 0.85(0.69~1.18) 0.743
      其他 264(6.1) 106(7.3) 158(5.5) 0.36 1.57(1.19~2.21) 0.032 0.01 1.02(0.71~1.62) 0.991
    抗病毒治疗后停药或失访
      否 3 703(85.2) 1 242(85.7) 2 461(84.9) 1.00
      是 644(14.8) 207(14.3) 437(15.1) -0.07 0.82(0.65~1.23) 0.534
    耐药结果
      不耐药 2 859(65.8) 448(30.9) 2 411(83.2) 1.00 1.00
      耐药 211(4.9) 59(4.1) 152(5.2) 0.78 2.14(1.62~3.15) ＜0.001 0.56 1.75(1.22~2.52) 0.003
    最近一次病毒载量≥1 000 copies/mL且未检测耐药 328(7.5) 107(7.4) 221(7.6) 0.98 2.72(2.14~3.46) ＜0.001 0.81 2.26(1.69~3.03) ＜0.001
    最近一次病毒载量无结果且未检测耐药 949(21.8) 835(57.6) 114(3.9) 3.72 39.68(31.59~49.37) ＜0.001 3.56 35.27(26.54~46.87) ＜0.001
    注：司他夫定(stavudine, D4T)；齐多夫定(zidovudine, AZT)；替诺福韦(tenefovir disoproxil fumarate, TDF)；克立芝(ritonavir boosted lopinavir, LPV/r)。
    下载: 导出CSV
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  • 收稿日期:  2021-09-24
  • 修回日期:  2022-01-22
  • 网络出版日期:  2022-12-30
  • 刊出日期:  2022-12-10

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