安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素

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。

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

  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.