中国2011―2020年新报告HIV/AIDS短期内死亡特征及风险因素

目的  了解中国新报告HIV/AIDS短期内死亡(诊断后一年内的死亡)的流行病学特征、时间趋势和相关影响因素, 为制定降低HIV/AIDS病死率相关政策提供依据。方法  数据来源于中国疾病预防控制信息系统, 对2011-2020年新报告的15岁及以上的HIV/AIDS短期内死亡情况进行分析, 采用Joinpoint回归模型分析短期内死亡比例随时间变化趋势, 采用多因素logistic回归分析模型和无序多分类logistic回归分析模型探讨HIV/AIDS短期内死亡的影响因素。结果  新报告HIV/AIDS在诊断后一年内死亡的比例为10.68%。2011-2015年新报告HIV/AIDS短期内死亡比例呈快速下降趋势, 年度变化百分比(annual percentage change, APC)(%, 95%CI)为-9.95(-11.29~-8.59)。多元logistic回归分析模型分析结果显示, 男性[OR (95% CI)= 1.60(1.57~1.63)]、年龄≥30岁[30~ < 45岁年龄组: OR (95% CI)=1.89(1.83~1.95);45~ < 60岁年龄组: OR (95% CI)=2.73(2.64~2.81);≥60岁年龄组: OR (95% CI)=4.39(4.25~4.53)]、初中及以下文化程度[OR (95% CI)=1.59(1.55~1.63)]、感染途径为异性性传播[OR (95% CI)=1.81(1.76~1.86)]和注射毒品[OR (95% CI)=1.86(1.77~1.96)]、通过医疗机构[OR (95% CI)=3.33(3.23~3.43)]和自愿咨询检测[OR (95% CI)=2.13(2.06~2.20)]发现、首次CD4⁺T淋巴细胞计数 < 200个/mm³[OR (95% CI)=4.83(4.75~4.92)]和未在30 d内启动抗病毒治疗[OR (95% CI)=2.69(2.64~2.74)]的感染者短期内死亡风险相对较高。无序多分类logistic回归分析模型分析结果提示, 相较于非短期内死亡感染者, 诊断后一年内不同时间段死亡的风险因素基本一致。结论  中国HIV/AIDS诊断后短期内死亡比例较高, 应继续加强扩大检测, 促进早发现、早治疗, 持续巩固HIV防治工作, 降低HIV/AIDS病死率。

Characteristics and risk factors of early death among newly diagnosed HIV/AIDS in China, 2011-2020

Objective To understand epidemiological characteristics, trends and related factors associated with early death (death within one year after diagnosis) among newly diagnosed HIV/AIDS in China, providing evidence for policy making to reduce mortality of HIV/AIDS. Methods Data between 2011 and 2020 on early death among newly diagnosed HIV/AIDS aged ≥15 years old were collected from China Information System for Disease Control and Prevention.Joinpoint regression model was adopted to analyze the trend of early mortality.Multivariate and multinominal logistic regression was performed to explore risk factors of early death among HIV/AIDS. Results Of newly diagnosed HIV/AIDS patients, 10.68% died within one year after diagnosis.The proportion of early death declined quickly between 2011 and 2015[annual percentage change annual percentage change (APC)(%, 95%CI)=-9.95(-11.29--8.59)].Multivariate logistic regression indicated that male[OR (95% CI)=1.60(1.57-1.63)], age ≥ 30 years old[30- < 45 years old: OR (95% CI)=1.89(1.83-1.95);45- < 60 years old: OR (95% CI)=2.73(2.64-2.81);≥60 years old: OR (95% CI)=4.39(4.25-4.53)], having a middle school education or lower[OR (95% CI)=1.59(1.55-1.63)], heterosexual[OR (95% CI)=1.81(1.76-1.86)]and inject drug[OR (95% CI)=1.86(1.77-1.96)]transmission, diagnosed by medical institutions[OR (95% CI)=3.33(3.23-3.43)], voluntary counseling and test[OR (95% CI)=2.13(2.06-2.20)], baseline CD4+T lymphocyte count lower than 200/mm3[OR (95% CI)=4.83(4.75-4.92)], and failure to initiate antiretroviral treatment within 30 days after diagnosis[OR (95% CI)=2.69(2.64-2.74)]increased the risk of early death.Multinominal logistic regression indicated that risk factors of early death remained consistent among HIV/AIDS who died within different time frames. Conclusions There is a high proportion of early death among HIV/AIDS patients in China.Intensified efforts to enhance HIV screening and promote timely initiation of ART are needed.Continued commitment to HIV prevention and treatment is essential to reduce HIV/AIDS mortality.