2010—2021年我国男男性行为HIV/AIDS患者生存分析

关明玥; 金怡晨; 蔡畅; 陈方方; 秦倩倩; 汤后林

doi:10.16462/j.cnki.zhjbkz.2024.07.014

2010—2021年我国男男性行为HIV/AIDS患者生存分析

doi: 10.16462/j.cnki.zhjbkz.2024.07.014

传染病溯源预警与智能决策全国重点实验室/中国疾病预防控制中心性病艾滋病预防控制中心流行病学室，北京 102206

基金项目:

国家重点研发计划 2022YFC2305201

国家自然科学基金 71874168

详细信息

通讯作者:
汤后林, E-mail: tanghl@chinaaids.cn

秦倩倩, E-mail: qinqq@chinaaids.cn

中图分类号: R183.9
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- 被引次数: 0
出版历程
- 收稿日期: 2023-11-03
- 修回日期: 2024-04-17
- 网络出版日期: 2024-08-19
- 刊出日期: 2024-07-10

Survival analysis of MSM with HIV/AIDS in China from 2010 to 2021

National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases/Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

Funds:

National Key Research and Development Program of China 2022YFC2305201

National Natural Science Foundation of China 71874168

More Information

Corresponding author: QIN Qianqian, E-mail: qinqq@chinaaids.cn; TANG Houlin, E-mail: tanghl@chinaaids.cn

摘要

摘要: 目的了解我国2010—2021年男男性行为(men who have sex with men, MSM)HIV/AIDS患者的生存情况及影响因素，为有效开展MSM人群的AIDS防控工作提供依据。方法资料来源于中国疾病预防控制信息系统，采用回顾性队列研究方法，分析患者的累积生存率，采用Cox比例风险回归模型分析患者死亡的影响因素。结果 2010—2021年我国共报告≥15岁MSM HIV/AIDS患者309 964例，死亡20 371例，全死因死亡密度为1.47/100人年，患者平均生存时间为10.21年(95% CI :10.204~10.225)，第1、5、10年的累积生存率分别为96.56 %、93.06 %、88.73 %。多因素Cox比例风险回归模型分析显示，确证时年龄≥60岁的患者是15~＜30岁患者死亡风险的4.022倍(95% CI :3.792~4.266)；与首次CD4⁺T淋巴细胞计数＞500个/μL的患者相比，未检测CD4⁺T淋巴细胞和首次CD4⁺T淋巴细胞计数＜200个/μL患者的死亡风险分别是7.072倍(95% CI: 6.696~7.470)和3.842倍(95% CI :3.657~4.036)；未接受抗病毒治疗(antiretroviral therapy, ART)患者的死亡风险是接受ART的14.400倍(95% CI: 13.881~14.939)。结论确证时年龄较大、首次CD4⁺T淋巴细胞未检测或首次CD4⁺T淋巴细胞计数＜200个/μL、未接受ART是我国MSM HIV/AIDS患者死亡的主要危险因素，需加强MSM的早发现、早诊断、早治疗，同时需重点关注老年MSM的检测治疗，进一步降低MSM HIV/AIDS患者的死亡风险。
- 艾滋病病毒感染者/艾滋病患者 /
- 男男性行为人群 /
- 生存分析 /
- 影响因素
Abstract: Objective To understand the survival and influencing factors of MSM (men who have sex with men) with HIV/AIDS in China from 2010 to 2021, in order to provide reference for effective AIDS prevention and control in the MSM population. Methods The data were obtained from the China disease control and prevention information system. Retrospective cohort study was used to calculate the mortality density of the patients. Cumulative survival of patients was analyzed, and Cox proportion hazards regression model was performed to assess the risk factors for patient deaths. Results Between 2010 and 2021, 309 964 MSM with HIV/AIDS were reported with 20 371 deaths, and the all-cause mortality density was 1.47 per 100 person-years. The mean survival time of the patients was 10.21 (95% CI: 10.204-10.225) years, and the cumulative survival rates in 1, 5, and 10 years were 96.56 %, 93.06 %, and 88.73 %. The results of multivariate Cox proportional risk regression model showed that patients with confirmed age≥60 years were 4.022 (95% CI: 3.792-4.266) times the risk of death of patients aged 15- < 30 years. Compared with patients with first CD4⁺T-lymphocytes >500 copies/μL, the risk of death for patients with first CD4⁺T-lymphocytes undetected and first CD4⁺T-lymphocytes < 200 copies/μL was 7.072(95% CI: 6.696-7.470) times and 3.842(95% CI: 3.657-4.036) times respectively. Patients who did not receive ART had a 14.400(95% CI: 13.881-14.939) times greater risk of death than those who did receive ART. Conclusions Older age at confirmation, first CD4⁺T-lymphocytes undetected or first CD4⁺T-lymphocytes < 200 copies/μL, and not receiving ART are the main risk factors for death of MSM with HIV/AIDS in China, and early detection, diagnosis, and treatment of MSM need to be strengthened. At the same time, focus needs to be placed on the detection and treatment of elderly MSM, to further reduce the risk of death of MSM with HIV/AIDS.
- HIV/AIDS /
- Men who have sex with men /
- Survival analysis /
- Related factors

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MSM：男男性行为; ART：抗病毒治疗。

Figure 1. Survival curves of HIV/AIDS patients with MSM in China, 2010-2021 according to different age at confirmation (A), first CD4⁺ T-lymphocyte testing status (B) and ART status (C)

MSM: men who have sex with men; ART: antiretroviral therapy.

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表 1 2010—2021年我国MSM HIV/AIDS患者死亡情况及多因素Cox比例风险回归模型分析

Table 1. Deaths and Cox proportional hazard regression model analysis of MSM with HIV/AIDS in China, 2010-2021

特征Characteristics	总人数 ^① Total number of people ^①	死亡人数 ^① Death toll ^①	观察时长/人年 Duration of observation/person-years	死亡密度/100人年^-1 Mortality density/100 person-years^-1	Wald χ²值 value	P值 value	HR值value (95% CI)
确证时年龄/岁Age of confirmation/years
15~＜30	152 316(49.14)	5 418(26.60)	704 308.95	0.77			1.000
30~＜45	103 428(33.37)	6 996(34.34)	476 534.18	1.47	510.900	＜0.001	1.577(1.516~1.641)
45~＜60	44 569(14.38)	5 329(26.16)	173 877.82	3.06	1 270.277	＜0.001	2.442(2.325~2.565)
≥60	9 651(3.11)	2 628(12.90)	32 089.24	8.19	2 150.217	＜0.001	4.022(3.792~4.266)
民族Ethnic group
汉Ethnic Han	291 576(94.07)	19 134(93.93)	1 310 705.29	1.46	28.688	＜0.001	0.854(0.806~0.905)
其他Other	18 388(5.93)	1 237(6.07)	76 104.90	1.63			1.000
婚姻状况Marital status
未婚Not married	201 111(64.88)	9 431(46.30)	913 862.36	1.03			1.000
离异或丧偶Divorced or widowed	44 946(14.50)	4 975(24.42)	206 001.97	2.42	16.385	＜0.001	0.916(0.878~0.956)
已婚Married	63 204(20.39)	5 889(28.91)	263 576.23	2.23	33.650	＜0.001	0.886(0.850~0.923)
不详Unspecified	703(0.23)	76(0.37)	3 369.63	2.26	2.012	0.156	0.849(0.677~1.065)
文化程度Education
初中及以下Junior high school and below	98 382(31.74)	11 106(54.52)	420 310.45	2.64	1 015.967	＜0.001	1.879(1.808~1.953)
高中或中专High school or technical secondary school	81 042(26.15)	5 200(25.53)	379 000.21	1.37	357.763	＜0.001	1.494(1.433~1.557)
大专及以上College or above	130 540(42.11)	4 065(19.95)	587 499.53	0.69			1.000
首次CD4⁺T淋巴细胞计数/(个·μL^-1) First CD4⁺T-lymphocytes count/(copies·μL^-1)
未检测Undetected	8 001(2.58)	4 951(24.30)	6 861.78	72.15	4 920.789	＜0.001	7.072(6.696~7.470)
＜200	71 654(23.12)	7 824(38.41)	290 874.84	2.69	2 861.182	＜0.001	3.842(3.657~4.036)
200~＜350	90 708(29.26)	2 868(14.08)	404 488.43	0.71	47.372	＜0.001	1.219(1.152~1.289)
350~＜500	76 374(24.64)	2 501(12.28)	368 722.79	0.68	12.480	＜0.001	1.109(1.047~1.174)
≥500	63 227(20.40)	2 227(10.93)	315 862.35	0.71			1.000
样本来源Sample sources
检测咨询Testing consulting	135 273(43.64)	5 361(26.32)	613 302.91	0.87			1.000
医疗机构检测Medical institution testing	118 182(38.12)	11 815(58.00)	476 322.08	2.48	985.639	＜0.001	1.705(1.649~1.762)
专题调查Thematic survey	26 209(8.46)	1 292(6.34)	149 842.97	0.86	0.977	0.323	0.970(0.912~1.031)
其他Other	30 300(9.78)	1 903(9.34)	147 342.23	1.29	19.682	＜0.001	1.126(1.069~1.187)
接受抗病毒治疗Received antiviral treatment or not
是Yes	290 775(93.81)	11 239(55.17)	1 339 064.36	0.84			1.000
否No	19 189(6.19)	9 132(44.83)	47 745.83	19.13	20 275.795	＜0.001	14.400(13.881~14.939)
合计Total	309 964(100.00)	20 371(100.00)	1 386 810.19	1.47
注：MSM, 男男性行为。 ①以人数(占比/%)表示。 Note: MSM, men who have sex with men. ① Number of people (proportion/%).

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表 2 2010—2021年我国MSM HIV/AIDS患者生存情况分析

Table 2. Survival analysis of MSM with HIV/AIDS in China, 2010-2021

观察时间/年 Duration of observation/year	期初观察人数 Number of observers at the beginning of the period	期间截尾数 Intercepts during the period	有效观察数 Number of effective observers	死亡人数 Death toll	死亡概率/% probability of death/%	生存概率/% probability of survival/%	累积生存率/% Cumulative survival rate/%	累积生存率标准误 Standard error of cumulative survival
0	309 964	35 891	292 018.5	10 059	3.44	96.56	96.56	0.000
1	264 014	29 702	249 163.0	2 520	1.01	98.99	95.58	0.000
2	231 792	33 361	215 111.5	1 972	0.92	99.08	94.70	0.000
3	196 459	32 297	180 310.5	1 573	0.87	99.13	93.88	0.000
4	162 589	31 650	146 764.0	1 282	0.87	99.13	93.06	0.001
5	129 657	30 992	114 161.0	968	0.85	99.15	92.27	0.001
6	97 697	29 160	83 117.0	773	0.93	99.07	91.41	0.001
7	67 764	23 078	56 225.0	514	0.91	99.09	90.57	0.001
8	44 172	16 591	35 876.5	348	0.97	99.03	89.70	0.000
9	27 233	12 931	20 767.5	224	1.08	98.92	88.73	0.001
10	14 078	8 572	9 792.0	109	1.11	98.89	87.74	0.001
≥11	5 397	5 368	2 713.0	29	1.07	98.93	86.80	0.002
注：MSM, 男男性行为。 Note: MSM, men who have sex with men.

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