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柳州市2005-2020年新发HIV感染者疾病进展及其影响因素

储琴书,  梁佳佳,  韦陶,  蓝建国,  张思晨,  王婷,  符院生,  谢昌平,  范引光

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文章导航 > 中华疾病控制杂志  > 2022 >  26(4): 386-391
储琴书, 梁佳佳, 韦陶, 蓝建国, 张思晨, 王婷, 符院生, 谢昌平, 范引光. 柳州市2005-2020年新发HIV感染者疾病进展及其影响因素[J]. 中华疾病控制杂志, 2022, 26(4): 386-391. doi: 10.16462/j.cnki.zhjbkz.2022.04.004
引用本文: 储琴书, 梁佳佳, 韦陶, 蓝建国, 张思晨, 王婷, 符院生, 谢昌平, 范引光. 柳州市2005-2020年新发HIV感染者疾病进展及其影响因素[J]. 中华疾病控制杂志, 2022, 26(4): 386-391. doi: 10.16462/j.cnki.zhjbkz.2022.04.004
shu
CHU Qin-shu, LIANG Jia-jia, WEI Tao, LAN Jian-guo, ZHANG Si-chen, WANG Ting, FU Yuan-sheng, XIE Chang-ping, FAN Yin-guang. Disease progression and influencing factors of newly HIV-infected patients in Liuzhou City from 2005 to 2020[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(4): 386-391. doi: 10.16462/j.cnki.zhjbkz.2022.04.004
Citation: CHU Qin-shu, LIANG Jia-jia, WEI Tao, LAN Jian-guo, ZHANG Si-chen, WANG Ting, FU Yuan-sheng, XIE Chang-ping, FAN Yin-guang. Disease progression and influencing factors of newly HIV-infected patients in Liuzhou City from 2005 to 2020[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(4): 386-391. doi: 10.16462/j.cnki.zhjbkz.2022.04.004
shu

柳州市2005-2020年新发HIV感染者疾病进展及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.04.004
  • 1.

    230032 合肥，安徽医科大学公共卫生学院流行病与卫生统计学系

  • 2.

    545005 柳州，柳州市疾病预防控制中心办公室

  • 3.

    545005 柳州，柳州市疾病预防控制中心艾滋病防制所

储琴书和梁佳佳为共同第一作者
基金项目: 

2020年中国疾病预防控制中心艾滋病防治现场技术支持项目 K2020043

安徽省教育厅自然科学重点项目 900206

详细信息
    通讯作者:

    谢昌平，E-mail: ping164007@126.com

    范引光，E-mail: fanyinguang@163.com

  • 中图分类号: R183.7

Disease progression and influencing factors of newly HIV-infected patients in Liuzhou City from 2005 to 2020

  • 1.

    Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China

  • 2.

    Liuzhou Center for Disease Control and Prevention Office, Liuzhou 545005, China

  • 3.

    Department of AIDS Prevention and Control, Liuzhou Center for Disease Control and Prevention, Liuzhou 545005, China

CHU Qin-shu and LIANG Jia-jia contributed equally to this work
Funds: 

Program of Technical Support Authorized by the Chinese National Center for AIDS/STD Control and Prevention K2020043

Key Project of Natural Science Research in Universities of Anhui Province 900206

More Information

    摘要
  • 摘要:   目的  了解柳州市新发HIV感染者进展为AIDS的进程，探讨可能影响疾病进展的因素。  方法  采用回顾性队列研究方法，从艾滋病综合防治信息系统查询柳州市2005年1月1日-2020年12月31日新报告且接受高效抗逆转录病毒治疗(highly active anti-retroviral therapy, HAART)的HIV感染者信息。通过Kaplan-Meier法计算平均潜伏期，寿命表法计算艾滋病的进展率和累积未进展率，采用多因素Cox比例风险模型分析HIV进展为AIDS的影响因素。  结果  9 905例HIV感染者的平均潜伏期为6.01(95% CI: 5.86~6.16)年，第1、3、5、10年累积未进展率分别为57.03%、46.64%、39.45%和27.39%。多因素Cox回归分析显示：男性(HR=1.10, 95% CI: 1.03~1.17, P=0.003)、确诊时年龄≥40岁(40~ < 60岁：HR=1.50, 95% CI: 1.20~1.88, P < 0.001;≥60岁：HR=1.57, 95% CI: 1.24~1.98, P < 0.001)、首次诊断时CD4+T淋巴细胞计数 < 200个/μl(HR=5.51, 95% CI: 5.10~5.95, P < 0.001)、已婚有配偶(HR=1.10, 95% CI: 1.02~1.18, P=0.010)和异性性接触传播(HR=1.84, 95% CI: 1.47~2.31, P < 0.001)者AIDS发病风险增加。  结论  柳州市新发HIV感染者进展为AIDS的速度较快，应针对危险因素改善相应的公共卫生和医疗服务，以减缓疾病进展。
    Abstract:   Objective  To understand the progress of newly HIV infected people into AIDS in Liuzhou City, and to explore factors that may have effects on the progress of the disease.  Methods  A retrospective cohort study was conducted. Newly reported HIV-infected patients with highly active anti-retroviral therapy (HAART) in Liuzhou City from January 1, 2005 to December 31, 2020 were selected from the National Comprehensive AIDS Prevention and Control Information System, and relative data were obtained. The mean incubation period was calculated by Kaplan-Meier. Life table method was used to calculate the incidence and cumulative non-incidence of AIDS. Furthermore, multivariate Cox proportional-hazards model was performed on the influencing factors of HIV disease progression.  Results  The mean incubation period of 9 905 HIV-infected cases was 6.01(95% CI: 5.86-6.16) years. The cumulative non-incidence of AIDS in 1, 3, 5, 10 years were 57.03%, 46.64%, 39.45% and 27.39%, respectively. Multivariate Cox proportional-hazards model analysis showed that male (HR=1.10, 95% CI: 1.03-1.17, P=0.003), age of onset ≥40 years (40-<60 years old: HR=1.50, 95% CI: 1.20-1.88, ≥ 60 years old: HR=1.57, 95% CI: 1.24-1.98, all P < 0.05), CD4+T lymphocyte count at first diagnosis < 200 cells/μl (HR=5.51, 95% CI: 5.10-5.95, P < 0.001), married (HR=1.10, 95% CI: 1.02-1.18, P=0.010) and heterosexual transmission (HR=1.84, 95% CI: 1.47-2.31, P < 0.001) increased the risk of AIDS.  Conclusions  Newly HIV-infected patients in Liuzhou develop into AIDS rapidly. Therefore, corresponding public health and medical services should be improved to slow down the disease progression.
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  • 表  1  2005-2020年柳州市进行HAART的HIV患者人口学特征[n(%)]

    Table  1.   Demographic characteristics of HIV patients with HAART in Liuzhou, 2005-2020 [n(%)]

    变量 未进展者 进展者 χ2值 P值 变量 未进展者 进展者 χ2值 P值
    性别 48.658 < 0.001 婚姻状况 16.002 < 0.001
      男 2 425(24.48) 3 963(40.01)   未婚 1 036(10.46) 1 317(13.30)
      女 1 588(16.03) 1 929(19.48)   已婚有配偶 2 271(22.93) 3 510(35.44)
    确诊时年龄(岁) 19.610 < 0.001   离异或丧偶 706(7.13) 1 065(10.75)
       < 20 115(1.16) 96(0.97) 民族 36.657 < 0.001
      20~ < 40 1 589(16.04) 2 418(24.41)   汉族 2 089(21.09) 3 258(32.89)
      40~ < 60 1 454(14.68) 2 078(20.98)   壮族 1 550(15.65) 2 271(22.93)
      ≥60 855(8.63) 1 300(13.12)   其他少数民族 374(3.78) 363(3.66)
    职业 12.996 0.023 文化程度 94.938 < 0.001
      家政、家务及待业 799(8.07) 1 155(11.66)   文盲 218(2.20) 308(3.11)
      农民及民工 2 250(22.72) 3 314(33.46)   小学 1 384(13.97) 2 143(21.64)
      工人 188(1.90) 293(2.96)   初中 1 626(16.42) 2 595(26.20)
      商业服务 176(1.78) 195(1.97)   高中或中专 474(4.79) 641(6.47)
      离退人员 176(1.78) 319(3.22)   大专及以上 311(3.14) 205(2.07)
      其他及不详 424(4.28) 616(6.22) 非婚异性性接触史 21.289 < 0.001
    首次诊断时CD4+T淋巴细胞计数(个/μl) 2 163.086 < 0.001   无 1 079(10.89) 1 345(13.58)
       < 200 7(0.07) 1 948(19.67)   有 2 934(29.62) 4 547(45.91)
      200~ < 350 852(8.60) 1 614(16.29) 感染途径 348.793 < 0.001
      350~<500 1 108(11.19) 1 215(12.27)   异性性接触传播 3 532(35.66) 5 175(52.25)
      ≥500 2 046(20.66) 1 115(11.26)   同性性接触传播 312(3.15) 94(0.95)
      注射毒品 107(1.08) 463(4.67)
      其他感染途径 62(0.63) 160(1.62)
    下载: 导出CSV

    表  2  2005-2020年柳州市进行HAART的HIV感染者进展为AIDS情况

    Table  2.   Progress of AIDS among HIV-infected patients with HAART in Liuzhou, 2005-2020

    确诊后时间(年) 期间观察数 期间失访数 AIDS进展人数 AIDS进展率(%) 未进展率(%) 累积未进展率(%) 累积未进展率标准误
    0~ < 1 9 905 427 3 442 35.52 64.48 64.48 0.00
    1~ < 2 6 036 381 676 11.56 88.44 57.03 0.01
    2~ < 3 4 979 409 454 9.51 90.49 51.60 0.01
    3~ < 4 4 116 332 380 9.62 90.38 46.64 0.01
    4~ < 5 3 404 362 301 9.34 90.66 42.28 0.01
    5~ < 6 2 741 377 171 6.70 93.30 39.45 0.01
    6~ < 7 2 193 343 132 6.53 93.47 36.88 0.01
    7~ < 8 1 718 314 102 6.53 93.47 34.47 0.01
    8~ < 9 1 302 297 78 6.76 93.24 32.14 0.01
    9~ < 10 927 280 63 8.01 91.99 29.56 0.01
    10~ < 11 584 190 36 7.36 92.64 27.39 0.01
    11~ < 12 358 112 27 8.94 91.06 24.94 0.01
    12~ < 13 219 81 20 11.20 88.80 22.14 0.01
    13~ < 14 118 47 3 3.17 96.83 21.44 0.01
    14~ < 15 68 36 5 10.00 90.00 19.30 0.01
    ≥15 27 25 2 13.79 86.21 16.64 0.02
    下载: 导出CSV

    表  3  不同时间段进行HAART的HIV感染者进展为AIDS情况比较

    Table  3.   Comparison of AIDS incidence in HIV-infected patients with HAART at different time periods

    不同时间段确诊后时间(年) 期间观察人数 期间失访人数 AIDS进展人数 AIDS进展率(%) 未进展率(%) 累积未进展率(%) 累积未进展率标准误
    2005-2010
      0~ < 1 2 661 548 500 20.95 79.05 79.05 0.01
      1~ < 2 1 613 311 224 15.37 84.63 66.90 0.01
      2~ < 3 1 078 233 162 16.85 83.15 55.63 0.01
      ≥3 683 447 236 51.36 48.64 27.06 0.01
    2011-2015
      0~ < 1 4 023 482 1 570 41.51 58.49 58.49 0.01
      1~ < 2 1 971 445 210 12.01 87.99 51.46 0.01
      2~ < 3 1 316 441 69 6.30 93.70 48.22 0.01
      ≥3 806 751 55 12.78 87.22 42.06 0.01
    2016-2020
      0~ < 1 3 221 408 1 279 42.39 57.61 57.61 0.01
      1~ < 2 1 534 350 97 7.14 92.86 53.50 0.01
      2~ < 3 1 087 379 44 4.90 95.10 50.87 0.01
      ≥3 664 630 34 9.74 90.26 45.92 0.01
    下载: 导出CSV

    表  4  HIV疾病进展影响因素的Cox回归分析

    Table  4.   Cox proportional hazard regression analyses for HIV progress in patients

    变量 单因素Cox回归分析 多因素Cox回归分析 变量 单因素Cox回归分析 多因素Cox回归分析
    HR(95%CI)值 P值 HR(95%CI)值 P值 HR(95%CI)值 P值 HR(95%CI)值 P值
    性别 婚姻状况
      女 1.00 1.00   未婚 1.00 1.00
      男 1.33(1.26~1.41) < 0.001 1.10(1.03~1.17) 0.003   已婚有配偶 1.19(1.12~1.27) < 0.001 1.10(1.02~1.18) 0.010
    确诊时年龄(岁)   离异或丧偶 1.33(1.23~1.44) < 0.001 1.15(1.05~1.26) 0.002
       < 20 1.00 1.00 民族
      20~ < 40 1.48(1.21~1.82) < 0.001 1.34(1.08~1.68) 0.009   其他少数民族 1.00 1.00
      40~ < 60 1.90(1.54~2.33) < 0.001 1.50(1.20~1.88) < 0.001   汉族 1.20(1.07~1.33) 0.001 1.00(0.95~1.06) 0.966
      ≥60 2.33(1.89~2.86) < 0.001 1.57(1.24~1.98) < 0.001   壮族 1.18(1.06~1.32) 0.004 0.93(0.84~1.04) 0.217
    地区类别 文化程度
      柳州市疾病预防控制中心所在县区 1.00 1.00   大专及以上 1.00 1.00
      柳州市其他县区 0.99(0.94~1.05) 0.792 1.01(0.96~1.07) 0.649   文盲 1.66(1.39~1.98) < 0.001 1.18(0.98~1.43) 0.086
      广西壮族自治区其他地市 0.81(0.73~0.90) < 0.001 0.89(0.80~0.98) 0.023   小学 1.72(1.49~1.98) < 0.001 1.10(0.94~1.29) 0.223
      其他省 0.83(0.73~0.95) 0.008 0.91(0.79~1.04) 0.178   初中 1.52(1.32~1.75) < 0.001 1.10(0.95~1.28) 0.211
    职业   高中或中专 1.47(1.26~1.72) < 0.001 1.18(1.00~1.39) 0.044
      家政、家务及待业 1.00 1.00 非婚异性性接触史
      农民及民工 1.16(1.09~1.24) < 0.001 1.02(0.95~1.10) 0.556   无 1.00 1.00
      工人 1.12(0.99~1.27) 0.082 1.17(1.03~1.34) 0.018   有 1.30(1.23~1.39) < 0.001 1.10(1.01~1.18) 0.020
      商业服务 0.83(0.71~0.96) 0.013 1.01(0.86~1.17) 0.938 感染途径
      离退人员 1.44(1.27~1.63) < 0.001 0.99(0.87~1.14) 0.926   同性性接触传播 1.00 1.00
      其他及不详 0.97(0.88~1.07) 0.505 0.98(0.89~1.09) 0.751   异性性接触传播 2.83(2.31~3.47) < 0.001 1.84(1.47~2.31) < 0.001
    首次诊断时CD4+T淋巴细胞计数(个/μl)   注射毒品 2.86(2.29~3.57) < 0.001 1.59(1.26~2.00) < 0.001
      ≥500 1.00 1.00   其他感染途径 2.80(2.17~3.61) < 0.001 2.30(1.76~3.01) < 0.001
       < 200 5.72(5.31~6.16) < 0.001 5.51(5.10~5.95) < 0.001
      200~ < 350 2.81(2.61~3.04) < 0.001 2.71(2.51~2.93) < 0.001
      350~ < 500 1.88(1.73~2.04) < 0.001 1.83(1.69~1.99) < 0.001
    下载: 导出CSV
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  • 收稿日期:  2021-10-11
  • 修回日期:  2022-01-18
  • 网络出版日期:  2022-04-14
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