Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort.
Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort.
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DOI：
10.1371/journal.pone.0145701
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Barcelona HIV/AIDS working group
中科院分区：
文献类型：
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作者：
Garriga C;García de Olalla P;Miró JM;Ocaña I;Knobel H;Barberá MJ;Humet V;Domingo P;Gatell JM;Ribera E;Gurguí M;Marco A;Caylà JA;Barcelona HIV/AIDS working group
抗逆转录病毒疗法降低了与艾滋病毒有关的死亡率，并使非艾滋病界定的疾病成为相互竞争的死亡原因。这项研究估计了2001年1月至2013年6月一个大城市不同原因的艾滋病毒死亡率及其风险因素。我们随访了3137例新诊断的HIV非AIDS病例。死亡原因分为艾滋病毒相关、非艾滋病毒相关和外部原因。我们使用死亡率、Kaplan-Meier曲线和考克斯模型研究了危险因素对生存率的影响。最后，我们通过精细和灰色模型估计了每个主要死因组的生存率。共发现182例死亡[14.0/1000随访人年（py）; 95%置信区间（CI）：12.0-16.1/1000 py]，其中81.3%的死亡原因已知。HIV相关原因和非HIV相关原因的死亡率相同（4.9/1000 py; CI：3.7-6.1/1000 py），外部原因死亡率较低[1.7/1000 py;（1.0-2.4/1000 py）]。Kaplan-Meier估计显示静脉吸毒者（IDU）和异性恋者的生存率低于男男性行为者（MSM）。与HIV相关死亡原因相关的因素包括：IDU男性（亚危险比（sHR）：3.2; CI：1.5-7.0）和诊断时CD 4 <200（sHR：2.7; CI：1.3-5.7）vs CD 4 ≥500。与非艾滋病毒相关死亡原因相关的因素包括：老龄化（sHR：1.5; CI：1.4-1.7）和异性恋女性（sHR：2.8; CI：1.1-7.3）与MSM。与死亡外部原因相关的因素是男性静脉吸毒者（sHR：28.7; CI：6.7-123.2）和异性恋男性（sHR：11.8; CI：2.5-56.4）与MSM。不同传播群体的存活率存在重大差异。对注射吸毒者和异性恋男性尤其需要改进治疗。
Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013. We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models. 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0–16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7–6.1/1000 py), external was lower [1.7/1000 py; (1.0–2.4/1000 py)]. Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5–7.0) and <200 CD4 at diagnosis (sHR:2.7; CI:1.3–5.7) versus ≥500 CD4. Factors associated with non-HIV-related causes of death include: ageing (sHR:1.5; CI:1.4–1.7) and heterosexual female (sHR:2.8; CI:1.1–7.3) versus MSM. Factors associated with external causes of death were IDU male (sHR:28.7; CI:6.7–123.2) and heterosexual male (sHR:11.8; CI:2.5–56.4) versus MSM. There are important differences in survival among transmission groups. Improved treatment is especially necessary in IDUs and heterosexual males.