Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study
Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study
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DOI：
10.1186/s12879-019-4676-x
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发表时间：
2019-12-30
影响因子：
3.7
通讯作者：
Shokoohi, Mostafa
中科院分区：
文献类型：
--
作者：
Gheibi, Zahra;Shayan, Zahra;Shokoohi, Mostafa
背景：人类免疫缺陷病毒（HIV）感染已成为全球关注的问题。确定导致艾滋病毒患者死亡的因素有助于控制获得性免疫缺陷综合症（艾滋病）的流行。到目前为止，对包括伊朗在内的中东和北非地区艾滋病毒感染者的死亡率及其决定因素知之甚少。本研究的目的是评估艾滋病相关死亡率（ARM）和非艾滋病相关死亡率（NARM）的危险因素与艾滋病毒感染者在Iransh.Methods：这项20年的回顾性研究进行了1160人与艾滋病毒的数据收集自1997年至2017年。研究结果（ARM和NARM）与各种研究变量的相关性，包括诊断时的人口统计学状态和随访期间的临床指标，以确定患者死亡率的预测因素。采用考克斯比例风险模型和竞争风险模型进行拟合，计算校正风险比（AHR）、亚分布风险比（SHR）和95%可信区间（CI）。在总死亡人数中，ARM和NARM分别为251例（64.2%）和140例（35.8%）。艾滋病和非艾滋病造成的死亡率分别为3.2/1000人月和4.5/1000人月。在开始治疗后6个月接受联合抗逆转录病毒治疗（cART），接受肺孢子虫肺炎（PCP）预防，以及诊断时较高的CD 4计数，降低了ARM和NARM的风险。然而，年龄较大、艾滋病毒诊断较晚和艾滋病毒临床晚期增加了艾滋病相关死亡的危险。此外，男性性别，年龄较大，监禁的历史，和最后的艾滋病毒临床阶段增加了非艾滋病mortality.Conclusions：艾滋病和非艾滋病引起的死亡率仍然很高，在伊朗的艾滋病毒感染者，特别是男性和那些晚期诊断。在感染的早期阶段采取有效的策略识别感染者，并针对死亡风险较高的个体，似乎可以降低艾滋病毒感染者的死亡率。
Background: Human Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran.Methods: This 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported.Results: during the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality.Conclusions: Mortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people.