新疆阿克苏地区艾滋病病毒感染者/患者死亡信息报告情况和死因分析

目的分析新疆阿克苏地区艾滋病病毒感染者/患者的死亡原因和病死率,采取有针对性的防治措施,降低艾滋病病死率,减少其他原因造成的死亡。方法依据全国艾滋病综合防治数据信息系统提供的2013年报告艾滋病病毒感染者/患者死亡病例数据信息,分析死亡原因。结果 2013年报告艾滋病病毒感染者/患者死亡病例224例,其中艾滋病相关死亡48例,艾滋病无关死亡167例,无法判定8例,死亡报告不规范1例;死亡时病程阶段为艾滋病病毒感染151例,艾滋病患者73例;艾滋病相关死亡,HIV感染确认（替代策略）检测阳性与死亡间隔时间中位数为3年3个月,间隔时间小于1年占35.42%;艾滋病无关死亡间隔时间中位数2年4个月,间隔时间小于1年占25.75%;男女性别（χ2=0.26）、异性性传播与注射吸毒（χ2=0.19）、HIV感染确认（替代策略）检测阳性与死亡各间隔时间艾滋病相关或无关死亡构成比（χ2=3.85）差异无统计学意义（P〉0.05）;艾滋病相关死亡直接原因中结核分枝杆菌感染（肺内）构成比最高占43.75%,其次是肺外结核病14例占29.17%;艾滋病无关死亡直接原因中其他非疾病外因死亡（损伤等）构成比最高,占20.36%,其次为呼吸系统疾病占19.16%,心脑血管疾病居第三位,占16.17%,注射毒品者吸毒过量较为常见;死亡病例中死于家中占70.30%,死亡信息收集大部分来源于患者家属或朋友占64.57%。结论各级医疗机构应当高度关注艾滋病引发死亡的原因,加强对自愿咨询检测和伴侣检测的宣传和倡导,提高检测的针对性和检测效率,加强艾滋病/结核病双重感染的防控工作,抗病毒治疗机构要注重对心脑血管疾病的医疗救助;努力完善＂零歧视＂的支持性社会环境。     

1997-2011年昆明市HIV感染者和AIDS病人死亡情况分析

目的分析昆明市艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)死亡情况。方法从"国家艾滋病综合防治数据信息系统"中下载历史卡片,按录入日期选择2011年12月31日前现住址为昆明市的死亡病例进行分析。结果至2011年底,累计报告现住址为昆明市的HIV/AIDS死亡病例851例,其中男性占78.5%,汉族占91.1%,已婚有配偶的占42.5%,初中文化程度占43.1%,农民和家政/家务和待业的分别占37.0%和34.7%。平均死亡年龄(40.2±12.2)岁,71.0%的死亡年龄在25～44岁间。因AIDS、非AIDS其他疾病、吸毒过量、其他原因而死亡的分别占47.7%、23.1%、9.2%、6.2%,还有13.7%的死亡原因不详。HIV确认阳性后存活时间的中位数只有1.1年,确认阳性后1年内死亡的比例达47.9%。结论近几年昆明市HIV/AIDS死亡病例数逐年增加,AIDS已经成为主要的死亡原因;死亡原因的报告质量急需提高;病例发现晚,急需扩大HIV检测覆盖面。     

河南省部分艾滋病高流行村庄居民死亡状况调查

目的了解艾滋病(AIDS)相关死亡的变化趋势,以及艾滋病相关死亡对当地死亡状况造成的影响。方法采用回顾性调查的方法,对河南省驻马店市上蔡县7个行政村,1995年1月1日-2007年10月31日,所有死亡者进行名单摸底、入户调查和死因推断,分析死亡构成及变化。结果共计死亡2546人,其中艾滋病病毒感染者(HIV)/AIDS死亡521例(20.5%),疑似AIDS死亡525例(20.6%),非AIDS死亡1500例(58.9%)。30～49岁青壮年死亡人数的比例,从1995-1997年的15%上升到1998年的21.5%,在2002年达到42.3%,之后逐年下降,到2007年为25.5%。30～49岁年龄组HIV/AIDS死亡者和疑似AIDS死亡者,分别占该组死亡人数的59.7%和59.8%。全人群死亡率在1995-1999年为7‰左右,在2002年出现高峰,为14.9‰。结论艾滋病和疑似艾滋病的死亡,成为当地死亡的主要原因,尤其是青壮年的死亡。     

2001-2013年菏泽市HIV/AIDS病人死亡情况分析

目的分析菏泽市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的死亡情况。方法从"国家艾滋病综合防治信息系统"中,下载2001年1月1日至2013年12月31日现住址为菏泽市的死亡HIV/AIDS病例,回顾性分析这些病例的死亡情况。结果至2013年底,累计报告现住址为菏泽市的HIV/AIDS病人死亡病例171例,其中男性占63.74%,已婚占69.59%,血液传播占53.22%。平均死亡年龄(40.5±13.41)岁,年龄最小3岁,最大78岁。因AIDS、非AIDS其他疾病、其他原因、吸毒过量而死亡的分别占67.84%、17.54%、8.19%、0.58%;5.85%的死亡原因不详。死亡病例抗病毒治疗的比例为18.13%。2009年之前的死亡病例以血液传播为主,占74.19%;近5年(2009-2013年)的死亡病例以异性性传播为主,占48.71%。确认阳性后1年内死亡的比例为76.02%。结论艾滋病为菏泽市HIV/AIDS病人死亡的主要原因;死亡病例传播途径由血液传播为主转向性传播为主;病例发现晚,应扩大HIV检测范围。     

成都市新都区431例≥50岁HIV/AIDS病人生存时间及其影响因素分析

目的了解成都市新都区≥50岁艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的生存时间,并探讨相关影响因素。方法通过中国艾滋病综合防治信息系统下载2008-2017年报告现住址为新都区且年龄≥50岁的HIV/AIDS病例资料,计算病死率和累计生存概率,采用COX比例风险回归模型分析死亡的相关影响因素。结果新都区2008-2017年累计报告HIV/AIDS病人431例,死亡115例,占26.68%。病死率从2008年0升至2011年57.14%,后降至2017年14.75%。死亡者均为汉族,以60～69岁为主,占38.26%,男性占83.48%,未婚/离异/丧偶者占63.48%,61.74%为农民/工人,小学及以下占65.22%,94.78%为异性性传播,8.70%有性病史。≥50岁HIV阳性人群的平均生存时间为5.08年[95%可信区间(CI):4.55～5.61年],1、3、5年累计生存概率分别为78.18%、66.00%、53.09%。COX回归分析显示,年龄和首次CD4+T淋巴细胞计数是≥50岁HIV/AIDS病人死亡的影响因素。结论成都市新都区≥50岁HIV/AIDS死亡病例以男性为主,未婚/离异/丧偶比例高且文化程度偏低,≥50岁HIV/AIDS病例死亡风险高,与其年龄和首次CD4+T淋巴细胞计数有关。     

驻马店市1995-2010年HIV/AIDS流行病学分析

目的分析驻马店市艾滋病病毒(HIV)感染者/艾滋病病人(AIDS)的流行特征和变化趋势。方法对该市1995-2010年上报的HIV/AIDS的流行病学调查资料进行分析。结果该市累计报告HIV/AIDS 14 717例,其中AIDS病人9 779例,死亡3 809例。报告病例以人群集中筛查发现为主。感染途径以有偿供血为主,占68.7%,其中既往有偿供血人员比较集中的3个县HIV阳性人数占总数的72.1%;既往输血感染占14.9%;性接触感染占10.2%(主要是配偶间)。2005年死亡人数最高,达648例,近几年病死率有下降趋势。结论该市因既往不规范采供血造成HIV感染,目前已进入死亡高峰期,近年经性传播比例逐年上升,存在HIV向一般人群蔓延的危险。     

1997--2011年昆明市HIV感染者和AIDS病人死亡情况分析

目的分析昆明市艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（简称HIV/AIDS病人）死亡情况。方法从＂国家艾滋病综合防治数据信息系统＂中下载历史卡片,按录入日期选择2011年12月31日前现住址为昆明市的死亡病例进行分析。结果至2011年底,累计报告现住址为昆明市的HIV/AIDS死亡病例851例,其中男性占78.5%,汉族占91.1%,已婚有配偶的占42.5%,初中文化程度占43.1%,农民和家政/家务和待业的分别占37.0%和34.7%。平均死亡年龄（40.2±12.2）岁,71.0%的死亡年龄在25～44岁间。因AIDS、非AIDS其他疾病、吸毒过量、其他原因而死亡的分别占47.7%、23.1%、9.2%、6.2%,还有13.7%的死亡原因不详。HIV确认阳性后存活时间的中位数只有1.1年,确认阳性后1年内死亡的比例达47.9%。结论近几年昆明市HIV/AIDS死亡病例数逐年增加,AIDS已经成为主要的死亡原因;死亡原因的报告质量急需提高;病例发现晚,急需扩大HIV检测覆盖面。     

2013年北京市新报告HIV/AIDS病人中晚发现病例的特征

目的了解北京市2013年新报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)中,晚发现病例的比例及相关影响因素。方法利用艾滋病综合防治信息系统数据,对北京市2013年1月1日至2013年12月31日期间新报告的病例进行分析。结果 2013年北京市共新报告HIV/AIDS病人2770例。根据中国疾病预防控制中心2014年提出的定义,其中晚发现病例的比例为22.38%。不同特征的病例晚发现比例不同:女性、已婚有配偶、异性性传播感染和样本来自医院的病例晚发现比例较高,分别为33.33%、36.78%、33.24%和34.46%。另外,随着年龄的增加和文化程度的降低晚发现比例有所上升。结论性别、婚姻状况、传播途径、样本来源、年龄和文化程度等,是影响北京市2013年新报告的HIV/AIDS病人晚发现比例的重要因素。     

2010-2020年云南省德宏州红河州玉溪市艾滋病疾病负担分析北大核心CSCD

目的 以2010-2020年云南省艾滋病相对严重地区（德宏州和红河州）和一般地区（玉溪市）为例，探索建立艾滋病疾病负担分析方法并应用于艾滋病疫情评估中。方法 采用三个州市2010-2020年艾滋病病例报告数据和死亡数据资料分析疾病负担变化趋势，根据WHO设计的Excel计算模块测算伤残调整寿命年（DALY）、伤残损失健康寿命年（YLD）和过早死亡损失寿命年（YLL），分析艾滋病疾病负担趋势、年龄趋势和疾病负担构成。结果2010-2020年德宏州、红河州、玉溪市的DALY分别为22 912.80、74 555.07、5 306.40人年；三个州市艾滋病疾病负担均主要集中在青壮年，德宏州、红河州30～39年龄段人群疾病负担最高，玉溪市40～49年龄段人群疾病负担最高；2010-2020年三州市艾滋病疾病负担构成均以YLL为主，德宏州YLL占93.43%，红河州YLL占92.70%，玉溪市YLL占91.61%。结论 三州市艾滋病疾病负担总体呈先上升后下降的趋势，德宏州、红河州的疾病负担仍处于较高水平，三州市的YLL均占疾病负担的绝大部分，青壮年和老年人的疾病负担较为严重。     

天津市2008-2011年MSM人群HIV流行趋势分析

目的了解天津市2008-2011年男男性行为人群(MSM)艾滋病病毒(HIV)的流行趋势,为在该人群中开展相关控制措施提供依据。方法分析2008-2011年天津市监测中新发现的MSM中的HIV/艾滋病(AIDS)病例情况、MSM人群血清学监测的数据以及横断面调查数据。结果新发现HIV/AIDS病例中,MSM病例所占比例最高,2008-2011年病例报告显示的构成比及报告数量增长最快的传播途径是男男性传播。MSM病例中流动人口占53.3%,未婚占61.0%,高中及以上文化程度占69.6%,15～29岁占47.2%。无偿献血及自愿咨询和检测发现的阳性病例中,MSM所占的比例最高。血清学监测结果显示,天津市MSM人群HIV感染率维持在稳定水平。横断面调查结果显示,MSM近6个月发生同性性行为时每次都使用安全套构成的中位数为35.85%,近6个月中最近1次发生同性性行为时安全套使用率中位数为59.55%,近6个月与异性发生性行为比例的中位数为18.05%,梅毒检出的中位数为18.25%,HIV检出的中位数为6.25%。结论 MSM人群为天津市HIV/AIDS感染的主要人群,艾滋病流行趋势严重,危险行为普遍存在,急需采取有效措施控制HIV通过其传播及扩散。     

HIV感染者/AIDS病人死亡原因的研究进展

近年来,随着越来越多的艾滋病病毒（HIV）感染者进入艾滋病（AIDS）发病期,越来越多的感染者死于AIDS相关疾病。另外,随着抗病毒治疗的覆盖率不断扩大,HIV感染者/AIDS病人死于AIDS相关疾病的比例不断降低,而死于其他非AIDS相关疾病的比例却不断升高。文章就当前国内外对HIV感染者/AIDS病人死亡原因的有关研究进展进行综述,为医疗机构加强和提高对重点疾病的诊疗技术水平提供理论支持,也为中国AIDS死因监测的建立提供理论依据。     

云南省德宏州外籍暗娼艾滋病感染及其影响因素

目的了解云南省德宏州外籍暗娼艾滋病病毒（HIV）感染及相关因素状况。方法运用普查方法,对德宏州3个边境县（市）全部暗娼活动场所的外籍暗娼进行调查。匿名问卷调查收集社会人口学、艾滋病防治服务及高危行为等信息,并抽取5毫升静脉血进行HIV抗体血清学检测。结果共有238名外籍暗娼接受调查,HIV感染率为4.2％。34.5％最近1个月与客人发生性行为时未坚持使用安全套。多因素非条件Logistic回归分析结果显示,23～26岁感染HIV风险是≤22岁的10.8倍,最近1次与客人发生性行为时未使用安全套者感染HIV风险是使用者的7.8倍;未使用安全套的危险因素有艾滋病知识不知晓[比值比（OR）=4.4,95％可信区间（CD：1.9～10.2],年龄〉26岁（OR=2.4,95％CI：1.0～5.7）,以及在当地工作≥6个月（OR=2.8,95％CI：l.6～5.1）。结论德宏州外籍暗娼HIV感染率高,安全套坚持使用率不高,迫切需要加大艾滋病预防干预覆盖面及干预力度。     

Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003

OBJECTIVES: To examine changes over a 2-year period in both the mortality rate and the causes of death in a geographically defined HIV-infected population. METHODS: A database search of primary care information for the dates and causes of death for all patients documented with HIV infection and living in Southern Alberta between 1984 and 2003 was undertaken. Sociodemographic and clinical characteristics were obtained. Causes of death were then individually confirmed by reviewing the patients' hospital charts, autopsy reports, or death certificates and coded using the International Classification of Diseases, 9th Revisions. AIDS deaths were reconciled with Public Health Reports. The time span was divided into pre-highly active antiretroviral therapy (HAART) (1984-1996) and current HAART (1997-2003) periods. RESULTS: Between 1984 and 2003, there were 560 deaths in the 1987 individuals living with HIV infection in Southern Alberta. Of these, 436 deaths (78%) occurred pre-HAART and 124 (22%) in the current HAART period. The crude mortality rate declined from 117 deaths per 1000 patient-years pre-HAART to 24 in the current HAART period. In the pre-HAART era, 90% of all deaths were AIDS related whereas only 67% were AIDS related in the current HAART era. The leading causes of AIDS deaths were AIDS multiple causes (31%), Mycobacterium avium complex (18%), Pneumocystis pneumonia (10%) and non-Hodgkin's lymphoma (7%). The proportion of non-AIDS related deaths increased from 7% pre-HAART to 32% in the current HAART era. Accidental deaths, including drug overdose (29%), suicide (7%) and violence (3%), hepatic disease (19%), non-AIDS related malignancies (19%), and cardiovascular disease (16%) accounted for the majority of non-AIDS related deaths. No deaths directly caused by drug toxicity were found. Overall, 21% of patients who died were antiretroviral (ARV)-naive. A total of 14% of patients dying from AIDS were ARV-naive in contrast to 35% dying from non-HIV related conditions. Of all those dying from AIDS, 23% died<3 months after their initial diagnosis, reflecting late presentation. In the current HAART era, 87% of patients who died from AIDS were extensively treated, reflecting HAART treatment failures due mostly to multiclass drug resistance (42%), inexorable disease progression despite ARV (32%), lack of ability or interest to be maintained on a lifelong HAART programme (21%) and, rarely, drug intolerance (<1%). CONCLUSIONS: Deaths from AIDS-related causes have decreased significantly, but deaths from non-AIDS related conditions have increased, both as an absolute number of deaths and as a proportion of all deaths in HIV-infected patients. The increasing age of the HIV population, and the increased mean CD4 count, increased proportion of intravenous drug users, increased hepatitis B virus and hepatitis C virus coinfection rate, and increased history of smoking seen in our population also influenced the mortality rate and causes of death. These factors must also be considered in projecting future trends in mortality of an HIV-infected population.     

Causes of death among HIV-infected patients in the era of highly active antiretroviral therapy,Bordeaux, France, 1998-1999

Objectives

To describe the causes of death in HIV‐infected patients in the era of highly active antiretroviral therapy (HAART).

Method

A retrospective survey conducted in Bordeaux, France. Medical records of all deaths that had occurred in 1998 and 1999 amongst patients followed within the Aquitaine cohort were reviewed by the same physician. Immediate and underlying causes of death were described, taking into account the morbidity at the time of death.

Results

Sixty‐six deaths occurred in 1998, and 41 in 1999. Sixty‐seven per cent of deceased patients were male. Median age at time of death was 43 years (range 25–71), median CD4 was 162 cells/µL (0–957); 28% of patients had a CD4 count > 200 cells/µL and 7% plasma viral load < 500 HIV‐RNA copies/mL. Amongst morbidity present at the time of death, there were 23 bacterial infections, 16 non‐Hodgkin's lymphomas, 16 cirrhoses, 15 non HIV‐related malignancies, 13 central nervous system diseases and 10 myocardiopathies. The main immediate causes of death were: multiple organ failure (21%), coma (18%), septic shock (15%) and acute respiratory failure (14%). Underlying causes of death were AIDS‐defining events (48%), non AIDS HIV‐related infection (3%), hepatitis B‐ or C‐associated cirrhosis (14%), non HIV‐related malignancies (11%), cardiovascular events (10%), suicide and overdose (6%), treatment‐related fatalities (4%), injury (2%) and unknown (2%). Patients dying from AIDS‐related events were more often female, had a lower CD4 count, a higher level of HIV‐RNA, a shorter history of HIV infection and were less often coinfected with hepatitis B and C viruses than those dying from other underlying causes.

Conclusions

AIDS‐related events are no longer the major causes of death of HIV‐infected patients in the era of HAART. This evolving mortality pattern justifies an adaptation of both the epidemiological surveillance and the clinical monitoring of HIV‐infected patients.

     

Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984-2005

Background

The aim of this study was to analyse the trends of mortality and causes of death among HIV‐infected patients in Taiwan from 1984 to 2005.

Methods

Registered data and death certificates for HIV‐infected patients from Taiwan Centers for Disease Control were reviewed. Mortality rate and causes of deaths were compared among patients whose HIV diagnosis was made in three different study periods: before the introduction of highly active antiretroviral therapy (HAART) (pre‐HAART: from 1 January 1984 to 31 March 1997), in the early HAART period (from 1 April 1997 to 31 December 2001), and in the late HAART period (from 1 January 2002 to 31 December 2005). A subgroup of 1161 HIV‐infected patients (11.4%) followed at a university hospital were analysed to investigate the trends of and risk factors for mortality.

Results

For 10 162 HIV‐infected patients with a mean follow‐up of 1.97 years, the mortality rate of HIV‐infected patients declined from 10.2 deaths per 100 person‐years (PY) in the pre‐HAART period to 6.5 deaths and 3.7 deaths per 100 PY in the early and late HAART periods, respectively (P<0.0001). For the 1161 patients followed at a university hospital (66.8% with CD4 count <200 cells/μL), HAART reduced mortality by 89% in multivariate analysis, and the adjusted hazard ratio for death was 0.28 (95% confidence interval 0.24, 0.33) in patients enrolled in the late HAART period compared with those in the pre‐HAART period. Seventy‐six per cent of the deaths in the pre‐HAART period were attributable to AIDS‐defining conditions, compared with 36% in the late HAART period (P<0.0001). The leading causes of non‐AIDS‐related deaths were sepsis (14.7%) and accidental death (8.3%), both of which increased significantly throughout the three study periods. Compared with patients acquiring HIV infection through sexual contact, injecting drug users were more likely to die from non‐AIDS‐related causes.

Conclusions

The mortality of HIV‐infected patients declined significantly after the introduction of HAART in Taiwan. In the HAART era, AIDS‐related deaths decreased significantly while deaths from non‐AIDS‐related conditions increased.     

Causes of the first AIDS-defining illness and subsequent survival before and after the advent of combined antiretroviral therapy

OBJECTIVES: To analyse the impact of combined antiretroviral treatment (cART) on survival with AIDS, according to the nature of the first AIDS-defining clinical illness (ADI); to examine trends in AIDS-defining causes (ADC) and non-AIDS-defining causes (non-ADC) of death. METHODS: From the French Hospital Database on HIV, we studied trends in the nature of the first ADI and subsequent survival in France during three calendar periods: the pre-cART period (1993-1995; 8027 patients), the early cART period (1998-2000; 3504 patients) and the late cART period (2001-2003; 2936 patients). RESULTS: The three most frequent initial ADIs were Pneumocystis carinii (jirovecii) pneumonia (PCP) (15.6%), oesophageal candidiasis (14.3%) and Kaposi's sarcoma (13.9%) in the pre-cART period. In the late cART period, the most frequent ADIs were tuberculosis (22.7%), PCP (19.1%) and oesophageal candidiasis (16.2%). The risk of death after a first ADI fell significantly after the arrival of cART. Lower declines were observed for progressive multifocal leukoencephalopathy, lymphoma and Mycobacterium avium complex infection. After an ADI, the 3-year risk of death from an ADC fell fivefold between the pre-cART and late cART periods (39%vs. 8%), and fell twofold for non-ADCs (17%vs. 9%). CONCLUSIONS: The relative frequencies of initial ADI have changed since the advent of cART. Tuberculosis is now the most frequent initial ADI in France; this is probably the result of the increasing proportion of migrants from sub-Saharan Africa. After a first ADI, cART has a major impact on ADCs and a smaller impact on deaths from other causes. The risk of death from AIDS and from other causes is now similar.     

Adult mortality and probable cause of death in rural northern Malawi in the era of HIV treatment

Objectives Developing countries are undergoing demographic transition with a shift from high mortality caused by communicable diseases (CD) to lower mortality rates caused by non‐communicable diseases (NCD). HIV/AIDS has disrupted this trend in sub‐Saharan Africa. However, in recent years, HIV‐associated mortality has been reduced with the introduction of widely available antiretroviral therapy (ART). Side effects of ART may lead to increased risk of cardiovascular diseases, raising the prospects of an accelerated transition towards NCD as the primary cause of death. We report population‐based data to investigate changes in cause of death owing to NCD during the first 4 years after introduction of HIV treatment. Methods We analysed data from a demographic surveillance system in Karonga district, Malawi, from September 2004 to August 2009. ART was introduced in mid‐2005. Clinician review of verbal autopsies conducted 2–6 weeks after a death was used to establish a single principal cause of death. Results Over the entire period, there were 905 deaths, AIDS death rate fell from 505 to 160/100 000 person‐years, and there was no evidence of an increase in NCD rates. The proportion of total deaths attributable to AIDS fell from 42% to 17% and from NCD increased from 37% to 49%. Discussion Our findings show that 4 years after the introduction of ART into HIV care in Karonga district, all‐cause mortality has fallen dramatically, with no evidence of an increase in deaths owing to NCD.