云南省德宏州静脉注射吸毒人群艾滋病毒感染自然史研究

目的 了解静脉注射吸毒人群艾滋病毒(HIV)感染的生存与死亡规律及其影响因素.方法 收集并分析云南省德宏州1989年8-12月发现的196例静脉注射吸毒HIV感染者20年跟踪随访资料.结果 截止观察终点2009年12月31日,196例HIV感染者中177例(90.3%)死亡,10例(5.1%)存活,9例(4.6%)失访.总死亡密度为98.1/1000人年,艾滋病死亡密度为54.9/1000人年.因艾滋病死亡者占所有死亡者的55.9%,其他疾病死亡原因中以疟疾(2.8%)、败血症(2.3%)为主,非病死亡原因中以吸毒过量(13.0%)、意外伤亡(6.8%)为主.以死亡为结局,静脉注射吸毒人群HIV感染者中位生存时间为8.6年(95%CI:7.6～9.7).以艾滋病死亡为结局,则中位生存时间为11.3年(95%CI:10.3～12.8),估计的潜伏期约为10.3年.30岁及以上HIV感染者死亡的危险性是30岁以下者的1.9倍(95%CI:1.2～2.7).吸毒时间越长,生存时间越短(HR=0.7,95%CI:0.6～0.7).结论 静脉注射吸毒人群非艾滋病死亡人数较多.注射吸毒人群中位生存时间和潜伏期低于发达国家同类人群.年龄是影响HIV感染生存时间的重要因素.     

云南省德宏州静脉注射吸毒人群艾滋病毒感染自然史研究

目的 了解静脉注射吸毒人群艾滋病毒(HIV)感染的生存与死亡规律及其影响因素.方法 收集并分析云南省德宏州1989年8-12月发现的196例静脉注射吸毒HIV感染者20年跟踪随访资料.结果 截止观察终点2009年12月31日,196例HIV感染者中177例(90.3%)死亡,10例(5.1%)存活,9例(4.6%)失访.总死亡密度为98.1/1000人年,艾滋病死亡密度为54.9/1000人年.因艾滋病死亡者占所有死亡者的55.9%,其他疾病死亡原因中以疟疾(2.8%)、败血症(2.3%)为主,非病死亡原因中以吸毒过量(13.0%)、意外伤亡(6.8%)为主.以死亡为结局,静脉注射吸毒人群HIV感染者中位生存时间为8.6年(95%CI:7.6～9.7).以艾滋病死亡为结局,则中位生存时间为11.3年(95%CI:10.3～12.8),估计的潜伏期约为10.3年.30岁及以上HIV感染者死亡的危险性是30岁以下者的1.9倍(95%CI:1.2～2.7).吸毒时间越长,生存时间越短(HR=0.7,95%CI:0.6～0.7).结论 静脉注射吸毒人群非艾滋病死亡人数较多.注射吸毒人群中位生存时间和潜伏期低于发达国家同类人群.年龄是影响HIV感染生存时间的重要因素.     

中国中部地区经不安全采供血感染艾滋病毒的自然病程研究

目的 研究中国经不安全采供血感染艾滋病毒(HIV)的发病、死亡自然病程.方法 采用双向性队列研究方法,选择河南省上蔡县既往有偿献血员较为集巾的7个村庄中明确诊断为HIV感染者/艾滋病患者(HIV/AIDS)或疑似AIDS死亡者,收集其发病、死亡及治疗等信息.观察终点为2008年3月31日.用乘积积限法计算艾滋病潜伏期和生存时间,对结局事件的时点进行调整分析.结果 2569例既往有偿献血员HIV感染者,其中疑似AIDS死亡者483例.快速进展者200例(7.8%),长期不进展者337例(13.1%).AIDS潜伏期为8.5～8.9年,发病率为11.7～12.0例/100人年;HIV生存时间8.8～10.7年,死亡率为6.9～8.3例/100人年;AIDS生存时间为1.2～2.0年,死亡率为34.9～51.5例/100人年.结论 通过对结局事件的时点调整,获得相对可靠的既往有偿献血员HIV感染者的AIDS潜伏期、AIDS生存时间和HIV生存时间,分别为8.8年、1.2年和9.8年.     

我国15岁及以上注射吸毒HIV感染者确证后的生存分析

目的了解我国报告注射吸毒HIV感染者的死亡情况及危险因素, 为制定相关防治策略提供依据。方法资料来源于艾滋病综合防治信息系统注射吸毒HIV感染者, 采用回顾性队列研究方法进行分析, 计算死亡密度, 并采用Cox比例风险回归模型分析死亡的风险因素, 采用Excel 2019和SPSS 22.0软件进行数据整理和统计学分析。结果 2001-2020年, 我国累计报告≥15岁注射吸毒HIV感染者119 209例, 其中死亡59 094例, 全死因死亡密度为6.96/100人年, 艾滋病相关死亡密度为1.91/100人年, 总死亡密度呈下降趋势。多因素Cox比例风险回归模型分析结果显示, 注射吸毒HIV感染者全死因死亡风险, 相比于首次CD4+T淋巴细胞(CD4)计数>500个/μl者, 未检测CD4计数、0～、200～和350～个/μl的HR值(95%CI)分别为2.85(2.78～2.93)、2.47(2.40～2.54)、1.58(1.53～1.62)和1.24(1.21～1.28);相比于抗病毒治疗者, 未抗病毒治疗者的HR值(95%CI)为7.13(6.99～7.27);相比于...     

中原地区某村既往有偿献血人群艾滋病发病和死亡规律

目的 研究既往有偿献血人群获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)发病和死亡规律.方法 采用回顾性队列研究方法,对373例既往有偿献血感染人类免疫缺陷病毒(human immunodeficiency virus,HIV)者的发病、死亡规律及其影响因素进行研究.结果 既往有偿献血人群HIV感染率为35.87%(373/1040),AIDS平均潜伏期为8.87年(95%CI:8.76～8.99,Kaplan-Meier法);感染后10年累计发病率为92.23%(344/373),总人时发病率为11.64/100人年;艾滋病患者1年、3年、5年累计生存率分别为94.48%(325/344)、85.76%(295/344)和83.14%(286/344),中位生存时间超过5年;抗病毒治疗天数[(960.29±486.38)d]、感染年龄[(33.39±9.08)岁]和发病年龄[(41.98±8.88)岁]对艾滋病患者生存时间和(或)生存率均有显著性影响(x2=61.355,P=0.000;x2=6.555,P=0.010;x2=3.969,P=0.046).结论 既往有偿献血人群HIV感染者生存时间较长、生存率较高,均显著高于联合国艾滋病规划署(UNAIDS)的研究结果.     

中国中部地区两县既往有偿献血人群艾滋病回顾性队列研究

目的研究既往有偿采供血人群艾滋病感染者的发病死亡规律。方法采用回顾性队列研究的方法，对178例确认的通过献血(浆)感染艾滋病病毒(HIV)的感染者进行回顾性调查，利用Kaplan—Meier乘积极限法计算平均潜伏期和生存时间及其分布。结果HIV感染者的平均潜伏期为8．31年(95％CI：8．04～8．58)(Kaplan—Meier法)。感染后艾滋病总发病率为6．41／100人年。艾滋病发病后平均生存时间为9．90个月(95％CI：8．20～11．60)(Kaplan—Meier法)。结论研究发现既往有偿采供血人群HIV感染者的平均潜伏期短于联合国艾滋病规划署(UNAIDS)研究结果(9．5年)；艾滋病发病率在感染后6年内均显著低于UNAIDS研究结果，第7年后高于UNAIDS结果。感染者发病后平均生存时间短于UNAIDS研究结果。     

两种艾滋病病毒新近感染检测方法在比较不同感染途径患者死亡情况中的应用

目的应用两种艾滋病病毒(HIV)新近感染检测方法区分出HIV新近感染人群,探讨不同感染途径新近感染人群的死亡速度。方法采用ML-PA、BED-CEIA两种HIV-1新近感染检测方法对2006-2011年新报告的HIV/AIDS进行检测,对不同感染途径HIV/AIDS新近感染人群中位生存时间进行分析。结果对2006-2011年2 018例新报告的HIV/AIDS采用ML-PA进行HIV-1新近感染检测,得出新近感染64例(3.17%,95%CI:2.41%～5.58%),其中累计死亡3例(4.69%,95%CI:4.17%～5.29%),性、吸毒感染死亡分别2例、1例;对2009-2011年388例新报告的HIV/AIDS采用BED-CEIA进行HIV-1新近感染检测,得出新近感染35例(9.02%,95%CI:6.17%～15.19%),其中累计死亡2例(5.71%,95%CI:4.94%～6.48%),2例均为异性途径感染死亡。结论两种实验室HIV新近感染检测方法区分出的不同感染途径HIV/AIDS新近感染人群中位生存时间均大于2年。     

我国530例既往不安全有偿供血感染艾滋病病毒者生存分析

目的 探讨既往不安全有偿供血感染艾滋病病毒(HIV)者生存时间及其影响因素.方法 采用回顾性队列研究方法,从山西、山东、湖北、吉林4个省以典型抽样方式选取8个县(区),选择所有2006年1月24日前发现并确认既往不安全有偿采血(浆)者中HIV感染者和艾滋病(AIDS)患者病例,收集其感染、发病、死亡等信息及影响因素.结果 530例病例中,HIV感染者196例(37.0%);AIDS患者334例(63.0%),其中168例(50.3%)抗病毒治疗;152例(29.0%)死亡.在530例患者从感染到观察终点平均观察(10.1±1.8)年中.166例未治疗AIDS患者平均生存时间9.1年(95%CI:9.1～9.4),8年生存率52.0%;而168例已治疗AIDS患者平均生存时间12.1年(95%CI:11.9～12.3),12年生存率80.0%;在抗病毒治疗3年中,治疗者平均生存时间比未治疗者延长而死亡风险降低12.2倍.AIDS患者平均生存时间在性别、年龄、地区、是否高效抗逆转录病毒治疗(HAART)、治疗前基线CD4+ T淋巴细胞水平上存在差异,多因素COX回归分析表明抗病毒治疗是AIDS患者生存首要保护因素(HR=13.3,P=0.00),治疗前基线CD4+T淋巴细胞＜50个/μl的AIDS患者治疗中死亡风险高(HR=10.9,P=0.00).结论 AIDS患者生存时间受到诸多因素影响,但是HAART干预是延长AIDS患者生存时间和降低AIDS患者死亡风险的首要保护措施.     

江门地区吸毒人群与无偿献血人群HIV抗体检测结果分析

目的了解江门地区2000～2003年艾滋病病毒(HIV)通过血液传播感染情况,为艾滋病的预防控制工作提供依据.方法对江门地区吸毒人群和无偿献血人群进行HIV抗体检测和分析.结果吸毒人群检测共1 726例,抗-HIV阳性130例,阳性率7.53%;无偿献血人群检测141 130例,抗-HIV阳性19例,阳性率0.013%.结论吸毒共用针具静脉注射导致血液传播HIV是江门市艾滋病流行的主要途径,无偿献血人群中也有HIV感染者,提示艾滋病已从高危人群向一般人群扩散.吸毒人群是艾滋病防治的重点对象,要采取有效措施加强防治.同时要加强对采供血部门的血液监测,防止HIV经血液传播.     

南昌市1994—2018年HIV/AIDS生存时间及其影响因素分析

目的了解江西省南昌市艾滋病病毒感染者/艾滋病(HIV/AIDS)患者生存时间及其影响因素。方法运用回顾性队列研究方法,以寿命表法计算生存率,采用Kaplan-Meier绘制累积生存率曲线,Cox回归模型分析南昌市1994—2018年5月纳入的2 996例HIV/AIDS患者生存时间的影响因素。结果 2 996例HIV/AIDS患者中,914例因艾滋病及相关疾病死亡,平均死亡率为2.4/100人年;截至观察终点时,中位数生存时间为2.3年,抗病毒治疗组1、2、5、7、10年累积生存率分别为95.0%、92.0%、86.0%、82.0%、74.0%;多因素Cox回归模型分析结果显示,≥60岁年龄组死亡风险是20岁年龄组的1.27倍(95%CI=1.03～1.63),男性患者死亡风险是女性的1.27倍(95%CI=1.03～1.56),基线CD4+T淋巴细胞计数(CD4)缺失组死亡风险是200个/mm3组的1.24倍(95%CI=1.02～1.50),未治疗患者死亡风险是抗病毒治疗患者10.44倍(95%CI=8.71～12.50)。结论确诊时年龄、性别、本地出生、初诊CD4值水平、是否接受抗病毒治疗、可能感染途径等是HIV/AIDS生存时间的主要影响因素,应及早进行艾滋病检测、接受抗病毒治疗,以延长HIV/AIDS生存时间。     

AIDS-free time and survival of an injecting drug users HIV seroconvertors cohort

OBJECTIVE: To analyze AIDS free time, survival and the pre-AIDS survival for a injecting drug users cohort (IDU) of HIV seroconvertors. SUBJECT AND METHODS: Interval for seroconversion was available for 276 IDUs from Centers for AIDS Information and Prevention (CIPS) recruited between 1987 and until June of 1996. AIDS diagnosis and vital status dates were obtained by follow up at hospitals, mortality and AIDS registries, and CIPS visits. The end of follow up was December of 1996. Seroconversion date was estimated as the middle point between last HIV- and first HIV+. Kaplan-Meier extension and Cox regression for truncated data were fitted to estimate AIDS-free and survival times and to observe differences by sex, age consumption time and year of seroconversion. Weibull, and Log-normal parametric models were fitted to estimate median and percentiles of AIDS-free and survival times distribution. RESULTS: 34 cases have been identified as AIDS, 24 as deaths, 9 of them being before AIDS. 63.5% of the individuals were AIDS-free 7 years after seroconversion, and the probability of death was 25.50. Pre-AIDS mortality is around 8.7%. There were not significant differences by sex, age, consumption time and year of seroconversion. Log-normal model fitted better estimating an AIDS-free median time of 10.93 years and 13.67 survival years. CONCLUSION: The incubation period of HIV infection in a cohort of seroconvertors in our environment was around 11 years, not different from that observed out of the Mediterranean area as Holland, Scotland or United States     

Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART

BACKGROUND: We assessed the impact of education on long-term overall and cause-specific mortality among 6575 injecting drug users (IDUs) according to HIV status and introduction of highly active antiretroviral therapy (HAART). METHODS: Community-based cohort study of IDUs recruited in three AIDS prevention centres (1987-1996). Causes of death were ascertained in clinical centres and Mortality Registry and classified as AIDS, drug use related, injuries, or liver diseases. Poisson regression models including education and calendar period interaction and adjusted by sex, age, and HIV were used. RESULTS: In 73 901 person-years of follow-up, there were 1493 deaths (20.2/1000 person-years): 761 related to AIDS, 234 to drug use, 179 to injuries, and 93 to liver diseases. IDUs with university studies had a lower risk of death (RR 0.52; 95% CI 0.36-0.77) than those without studies: this difference was higher after (RR 0.45; 95% CI 0.25-0.80) than before 1997 (RR 0.68; 95% CI 0.41-1.13). Compared to before 1997, while decreases in the risk of AIDS mortality were seen during 1997-2004 for both lower (RR 0.49; 95% CI 0.41-0.58) and higher (RR 0.33; 95% CI 0.23-0.48) educated, only those higher educated experienced a reduction in drug-use mortality (RR 0.54; 95% CI 0.28-1.05) and death from injuries (RR 0.52; 95% CI 0.23-1.21). CONCLUSIONS: Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.     

AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project

This paper presents AIDS incidence and mortality among injecting drug users (IDUs) reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, S?o José do Rio Preto, and Itajaí. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30), homelessness (RR = 6.16), and report of previous sexual relations with same-sex partners (RR = 6.21) were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00), lack of income (RR = 2.65), HIV seropositive status (RR = 4.52), and no history of incarceration (RR = 3.71) were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs.     

A Comparative Study of Mortality Among Puerto Rican Injection Drug Users in East Harlem, New York, and Bayamon, Puerto Rico

Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY—HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR—HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.     

Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.     

云南省德宏州静脉注射毒品者HIV新发感染率及其危险因素研究

目的 了解云南省德宏州静脉注射毒品者(IDU)中HIV新发感染率及其危险因素.方法 2004年10月招募HIV检测阴性的245名IDU进入队列,启动IDU人群艾滋病流行病学队列研究,于2006年底进行第一次随访检测确定HIV发病率.自2007年1月起,不断纳入新发现的HIV阴性的IDU,扩大流行病学研究队列,并每半年进行一次有关毒品使用和性行为等暴露因素的随访调查,同时血清学检测确定HIV新发感染率.结果 截止2008年底,共招募入组760名IDU,至少随访1次者有540人,累积观察1153.6人年,新发现HIV感染者47人,HIV新发感染率为4.07/100人年,其中2004-2006年为4.45/100人年,2007年为4.50/100人年,2008年为2.54/100人年.随访期间,研究对象中IDU比例和HIV新发感染率均有显著下降.Cox比例风险回归模型多因素分析显示,景颇族[风险比(HR)=2.56,95%CI:1.06～6.19]和除傣族以外的其他少数民族(HR=3.26,95%CI:0.89～11.96)的HIV感染风险高于汉族;随访期间注射毒品但未共针者(HR=2.27,95%CI:0.98～5.25)以及有共针注射毒品行为者(HR=5.27,95%CI:2.25～12.34)的HIV感染风险高于随访期间没有注射毒品者.结论 云南省德宏州既往IDU人群中注射吸毒的比例和HIV新发感染率近4年来均呈现下降趋势.共用注射器吸毒仍是IDU人群HIV感染的最重要的危险因素,不同民族IDU的HIV感染风险不同.     

Including pre-AIDS mortality in back-calculation model to estimate HIV prevalence in France, 2000

Since the advent of highly active antiretroviral therapy (HAART) the lengthening of AIDS incubation time has led to a decrease of AIDS incidence and mortality, and to the increase of the proportion of pre-AIDS mortality. The objective was to develop an extension of the back-calculation model by including pre-AIDS mortality and to estimate HIV prevalence in France. Our previous back-calculation model was modified to take into account the probability of survival for HIV-infected individual using the relative risk to die at different period for an HIV-infected person versus the general population (ψ). AIDS cases reported to InVS (Institut de Veille Sanitaire) until March 2003 were back-calculated to estimate HIV incidence until December 2000. AIDS deaths occurring until December 2000 were used to obtain HIV prevalence in 2000. Plausible intervals were calculated taking into account uncertainties on AIDS incubation time. Taking into account pre-AIDS mortality increased the goodness-of-fit of the model to the data. The relative risk, ψ, was estimated as 3 for homo-bisexual men, haemophiliacs and transfused cases, 10 for intravenous drug users, and 4 for heterosexual cases, with no difference over period. HIV prevalence in 2000 was estimated as 88,200 (with a plausible interval of 52,300–168,000), versus 78,200 when mortality was not considered. Pre-AIDS mortality estimates show the amount of this mortality during the era of HAART but also evidenced its existence before HAART. Taking into account pre-AIDS mortality of HIV-infected person in the back-calculation model increased the estimated HIV prevalence.