Effect of exposure to atmospheric PM2.5 and its components on disease progression in men living with HIV
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摘要:
目的 探讨大气细颗粒物(fine particulate matter, PM2.5)及其组分暴露对男性人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者疾病进展的影响情况，并识别脆弱人群。 方法 选取2000―2021年在武汉市艾滋病(acquired immunodeficiency syndrome, AIDS)综合响应信息管理系统中新报告的男性HIV感染者作为研究对象。运用Fine-Gray竞争风险生存分析、分位数g计算模型以及交互效应模型评估大气PM2.5及其组分暴露对男性HIV感染者疾病进展的影响，识别PM2.5中的关键毒性组分、探寻脆弱人群。 结果 共纳入5 571名新报告的男性HIV感染者，随访期间1 151名研究对象进展为AIDS，发生率为69.10/1 000人年。Fine-Gray竞争风险生存分析结果显示，大气PM2.5的累积平均暴露浓度每增加10 μg/m3，AIDS的发生风险增加28.8%(95% CI: 25.5%~32.2%); PM2.5组分中有机物、黑碳、铵盐、硝酸盐、硫酸盐的累积平均暴露浓度每增加1 μg/m3，AIDS的发生风险分别增加8.6%、49.0%、20.4%、11.2%、14.5%。≥60岁，BMI≥24 kg/m2，教育程度为高中、大学及以上，曾经吸烟的感染者更容易受到大气PM2.5及其组分暴露的影响。 结论 大气PM2.5暴露增加男性HIV感染者进展为AIDS的风险，硫酸盐和黑碳是PM2.5发挥毒性作用的关键组分。相关部门应高度关注高危人群，帮助改善并维持其免疫功能处于最佳水平，以期减缓HIV感染者的疾病进展。 Abstract:Objective To investigate the impact of atmospheric fine particulate matter (PM2.5) and its components on the progression of disease progression in human immunodeficiency virus (HIV)-infected males. Methods The study employed Fine-Gray competing risk survival analysis to assess the impact of PM2.5 and its components on the progression of acquired immunodeficiency syndrome (AIDS) in newly diagnosed HIV-infected males in Wuhan from 2000 to 2021. The quantile G-computation models and interaction models were used to identify key toxic components of PM2.5 and vulnerable individuals. Results A total of 5 571 newly diagnosed HIV-infected males were included in the study, with 1 151 progressing to AIDS during the follow-up period, corresponding to an incidence rate of 69.10/1 000 person-years. The fine-Gray competing risk survival analysis revealed that each 10 μg/m3 increase in cumulative average PM2.5, the risk of progressing to AIDS increased by 28.8% (95% CI: 25.5%-32.2%). Among the PM2.5 components, each 1 μg/m3 increase in cumulative average exposure to organic matter, black carbon, ammonium, nitrate, and sulfate was associated with increased risk of progressing to AIDS of 8.6%, 49.0%, 20.4%, 11.2%, and 14.5%, respectively. Individuals aged 60 and above, with a BMI ≥ 24 kg/m2, higher education levels, or a history of smoking are more vulnerable to the effects of atmospheric PM2.5 and its components. Conclusions Exposure to atmospheric PM2.5 can increase the risk of AIDS progression in HIV-infected males. SO42- and BC are key components of PM2.5 that exerts the toxic effects. It is important for AIDS prevention and control departments to prioritize the high-risk individuals, and focus on improving and maintaining their immune function at optimal level in order to decelerate the disease progression of AIDS. -
图 1 大气PM2.5及其组分暴露与HIV感染者AIDS发病的竞争风险
A~F：依次表示PM2.5、有机物、黑碳、铵盐、硝酸盐和硫酸盐不同暴露与艾滋病发病的竞争风险结果; HR：风险比；PM2.5，细颗粒物; HIV，人类免疫缺陷病毒；AIDS，艾滋病。
Figure 1. Exposure to atmospheric PM2.5 and its components and the risk of AIDS onset in HIV-infected individuals
A-F: Competing risk of different exposures to PM2.5, organic matter, black carbon, ammonium, nitrate and sulfate were expressed in turn; HR: hazard ratio; PM2.5: fine particulate matter; HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
图 2 大气PM2.5对HIV感染者AIDS发病或死亡的影响
模型对年龄、体重指数、婚姻状况、教育程度、吸烟状况、饮酒情况、高血压、糖尿病、冠心病、气温及相对湿度等因素进行了全面调整。生存曲线横轴为随访天数(d)，纵轴为生存概率; PM2.5: 细颗粒物；HIV: 人类免疫缺陷病毒；AIDS: 艾滋病。
Figure 2. Effect of atmospheric PM2.5 on AIDS or mortality in HIV-infected patients
The model was fully adjusted for age, body mass index, marital status, education level, smoking status, alcohol consumption, hypertension, diabetes, coronary heart disease, temperature and relative humidity. The horizontal axis of the survival curve is the number of days of follow-up (d), and the vertical axis is the survival probability; PM2.5: fine particulate matter; HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
图 3 大气PM2.5及其组分暴露对AIDS发病影响的亚组分析
A~F：依次表示PM2.5、有机物、黑碳、铵盐、硝酸盐和硫酸盐暴露与AIDS病程影响的亚组分析; 横轴为效应大小，纵轴为亚组变量; HR: 风险比；PM2.5: 细颗粒物；AIDS: 艾滋病; a表示P＜0.05。
Figure 3. Subgroup analysis of the effects of exposure to atmospheric PM2.5 and its components on the incidence of AIDS
A-F: Subgroup analysis indicating the impact of exposure to PM2.5, organic matter, black carbon, ammonium salts, nitrates, and sulfates on the progression of AIDS; HR: hazard ratio; PM2.5: fine particulate matter; AIDS: acquired immunodeficiency syndrome; a: P < 0.05.
表 1 5 571名研究对象基线时一般人口学特征
Table 1. General demographic characteristics of the 5 571 study subjects at baseline
基本特征
Basic characteristics总人数
Total number of people① (n=5 571)艾滋病发病
Onset of acquired immunodeficiency syndrome①(n=1 151)艾滋病相关死亡
Acquired immunodeficiency syndrome-related deaths①(n=313)年龄/岁Age/years 36.62±15.31 40.84±15.65 57.76±15.34 BMI/(kg·m-2) 21.78±2.91 21.22±2.68 21.61±1.45 吸烟状况Smoking status 不吸烟Non-smoker 4 017(72.11) 744(64.64) 198(63.26) 曾经吸烟Former smoker 501(8.99) 150(13.03) 64(20.45) 吸烟Current smoker 1 053(18.90) 257(22.33) 51(16.29) 饮酒情况Drinking situation 不饮酒Non-drinker 4 030(72.34) 776(67.42) 152(48.56) 曾经饮酒Former drinker 413(7.41) 111(9.64) 76(24.28) 饮酒Current drinker 1 128(20.25) 264(22.94) 85(27.16) 糖尿病Diabetes 否No 5 236(93.99) 1 053(91.49) 248(79.23) 是Yes 335(6.01) 98(8.51) 65(20.77) 高血压Hypertension 否No 5 044(90.54) 1 010(87.75) 215(68.69) 是Yes 527(9.46) 141(12.25) 98(31.31) 冠心病Coronary heart disease 否No 5 434(97.54) 1 105(96.00) 277(88.50) 是Yes 137(2.46) 46(4.00) 36(11.50) 教育程度Educational level 初中及以下Middle school and below 1 334(23.94) 414(35.97) 189(60.38) 高中High school 1 435(25.76) 322(27.98) 85(27.16) 大学及以上University and above 2 802(50.30) 415(36.05) 39(12.46) 工作类型Types of work 室外工作者Outdoor workers 2 152(38.63) 513(44.57) 148(47.28) 室内工作者Indoor workers 3 002(53.89) 494(42.92) 137(43.77) 不确定Uncertain 417(7.48) 144(12.51) 28(8.95) 婚姻状况Marital status 未婚Not married 3 427(61.51) 573(49.78) 59(18.85) 已婚Married 912(16.37) 221(19.20) 110(35.14) 离异/丧偶Divorced/widowed 1 232(22.12) 357(31.02) 144(46.01) 民族Ethnic group 汉族Han Chinese 5 493(98.60) 1 143(99.30) 312(99.68) 其他Other 78(1.40) 8(0.70) 1(0.32) 性病史History of sexually transmitted diseases 有Yes 4 111(73.79) 872(75.76) 241(77.00) 无No 544(9.77) 104(9.04) 15(4.79) 不确定Uncertain 916(16.44) 175(15.20) 57(18.21) 首次CD4+T淋巴细胞计数/(个·μL-1) First CD4+ T lymphocytes/(cells·μL-1) 0~＜200 603(11.40) 146(13.32) 37(12.21) 200~＜500 3 419(64.64) 690(62.96) 195(64.36) ≥500 1 267(23.96) 260(23.72) 71(23.43) 注：①以人数(占比/%)或x±s表示。
Note: ① Number of people (proportion/%) or x±s.
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