基于全球视角的中国HIV/AIDS合并耐药结核疾病负担及趋势分析

陈晨; 付晗; 刘宇龙; 陈诗奇; 王飞; 刘如如; 张祎玮; 王欣

doi:10.16462/j.cnki.zhjbkz.2025.08.013

基于全球视角的中国HIV/AIDS合并耐药结核疾病负担及趋势分析

doi: 10.16462/j.cnki.zhjbkz.2025.08.013

陈晨¹,
付晗¹,
刘宇龙¹,
陈诗奇¹,
王飞¹,
刘如如¹,
张祎玮²,
王欣^1, ,

1.
西安市疾病预防控制中心消毒科，西安 710054
2.
西安市疾病预防控制中心理化科，西安 710054

详细信息

通讯作者:
王欣，E-mail: wangxin12675@163.com

中图分类号: R181;R512.91;R52
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出版历程
- 收稿日期: 2025-04-23
- 修回日期: 2025-06-12
- 刊出日期: 2025-08-10

Analysis on disease burden and epidemiological trends of HIV/AIDS co-infection with drug-resistant tuberculosis in China on the global perspective

1.
Department of Disinfection and Infection Control, Xi'an Center for Disease Control and Prevention, Xi'an 710054, China
2.
Laboratory of Physical and Chemical Testing, Xi'an Center for Disease Control and Prevention, Xi'an 710054, China

More Information

Corresponding author: WANG Xin, E-mail: wangxin12675@163.com

摘要

摘要: 目的分析1995―2021年中国人类免疫缺陷病毒(human immunodeficiency virus, HIV)导致的艾滋病(acquired immune deficiency syndrome, AIDS)(简称HIV/AIDS)合并耐药结核[包括耐多药结核(multidrug-resistant tuberculosis, MDR-TB)和广泛耐药结核(extensively drug-resistant tuberculosis, XDR-TB)]的疾病负担及趋势变化，为优化防控策略提供科学依据。方法从2021年全球疾病负担(Global Burden of Disease, GBD)数据库提取年龄标化发病率(age-standardized incidence rate, ASIR)及年龄标化死亡率(age-standardized mortality rate, ASMR)指标，运用Joinpoint回归模型计算发病率、死亡率的年度变化百分比(annual percentage change, APC)和平均年度变化百分比(average annual percent change, AAPC)，分析转折点。结果 1995―2021年，中国HIV/AIDS MDR-TB的ASIR和ASMR分别从1.40/万和0.33/万降至0.61/万和0.16/万，总体负担下降，但2015年后回升。HIV/AIDS XDR-TB的ASIR和ASMR虽低但呈增长趋势[AAPC分别为5.83%(t=15.12，P < 0.05)、6.38%(t=9.96，P < 0.05)]。女性HIV/AIDS MDR-TB和XDR-TB的ASIR、ASMR降幅高于男性；HIV/AIDS MDR-TB中5~＜15岁年龄组发病率和死亡率均上升，HIV/AIDS XDR-TB各年龄组均上升。结论中国需构建HIV/AIDS耐药结核病的精准防控体系，重点加强对男性和青少年的筛查，普及快速诊断技术并规范用药管理。
- 人类免疫缺陷病毒/艾滋病 /
- 耐药结核 /
- 疾病负担
Abstract: Objective To analyze the disease burden and trends of human immunodeficiency virus (HIV)-induced acquired immune deficiency syndrome (AIDS) co-infection with drug-resistant tuberculosis-including multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB)-in China from 1995 to 2021, and to provide scientific evidence for optimizing prevention and control strategies. Methods Data on age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were extracted from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression models were used to calculate annual percentage change (APC) and average annual percent change (AAPC) for both incidence and mortality rates and to identify turning points. Results From 1995 to 2021, the age-standardized incidence rate (ASIR) and mortality rate (ASMR) of HIV/AIDS-associated multidrug-resistant tuberculosis (MDR-TB) in China decreased from 1.40 per 10 000 and 0.33 per 10 000 to 0.61 per 10 000 and 0.16 per 10 000, respectively, but increased again after 2015. Although baseline values were low, both ASIR and ASMR of HIV/AIDS-associated extensively drug-resistant tuberculosis (XDR-TB) exhibited statistically significant upward trends [AAPC: 5.83% (t=15.12, P < 0.05) and 6.38% (t=9.96, P < 0.05), respectively]. Sex analysis revealed that female demonstrated greater declines in ASIR and ASMR for both HIV/AIDS-MDR-TB and HIV/AIDS-XDR-TB than male. Significant increases in incidence and mortality of HIV/AIDS-MDR-TB were observed in the 5- < 15 year group. All age groups showed increasing incidence and mortality of HIV/AIDS-XDR-TB during the study period. Conclusions China needs to establish a precise prevention and control system for HIV/AIDS drug-resistant tuberculosis, with a focus on enhancing screening among male and adolescent populations, promoting rapid diagnostic techniques, and standardizing the management of anti-tuberculosis drugs.
- Human immunodeficiency virus/acquired immune deficiency syndrome /
- Drug-resist tuberculosis /
- Disease burden

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图 1 1995―2021年中国与全球HIV/AIDS合并耐药结核年龄标化发病率及标化死亡率趋势分析

A: 中国与全球标化发病率趋势; B: 中国与全球标化死亡率趋势; HIV：人类免疫缺陷病毒; AIDS：艾滋病; MDR-TB：耐多药结核; XDR-TB：广泛耐药结核。

Figure 1. Trends in age-standardized incidence and mortality rates of HIV/AIDS co-infection with drug-resistant tuberculosis in China and globally, 1995-2021

A: trends in age-standardized incidence rates in China and globally; B: trends in age-standardized mortality rates in China and globally; HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; MDR-TB: multidrug-resistant tuberculosis; XDR-TB: extensively drug-resistant tuberculosis.

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图 2 1995-2021年中国不同性别人群HIV/AIDS合并耐药结核年龄标化发病率及标化死亡率年度变化分析

A：HIV/AIDS合并耐多药结核标化发病率年度变化；B：HIV/AIDS合并耐多药结核标化死亡率年度变化；C：HIV/AIDS合并广泛耐药结核标化发病率年度变化；D：HIV/AIDS合并广泛耐药结核标化死亡率年度变化；HIV：人类免疫缺陷病毒；AIDS：艾濨病；MDR-TB：耐多药结核；XDR-TB：广泛耐药结核；a：P＜0.05。

Figure 2. Annual percent changes in age-standardized incidence rate and age-standardized mortality rate of HIV/AIDS coinfection with drug-resistant tuberculosis among different gender populations in China, 1995-2021

A: annual ctunge in ASIR cf HIV/AIDS MDR-TB; B: annual change in ASMR of HIV/AIDS MDR-TB; C: annual change in ASIR of HIV/AIDS XDR-TB; D: annual change in ASMR of HIV/AIDS XDR-TB; HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; MDR-TB: multidrug-resistant tuberculosis; XDR-TB: extensively drug-resistant tuberculosis; a: P<0.05.

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表 1 1995―2021年中国与全球HIV/AIDS合并耐药结核的疾病负担

Table 1. Trends in the disease burden of HIV/AIDS co-infection with drug-resistant tuberculosis in China and globally, 1995-2021

疾病种类 Disease	指标 Index	中国 China			全球 Global
疾病种类 Disease	指标 Index	1995年 year	2021年 year	增长率 Increase rate/%	1995年 year	2021年 year	增长率 Increase rate/%
HIV/AIDS MDR-TB	发病数/例 Incidence case/case	1 819	1 053	-42.10	19 650	45 589	132.01
	死亡数/例 Mortality case/case	390	292	-25.14	9 180	17 458	90.18
	年龄标化发病率/万 Age-standardized incidence rate/per 10 000	1.40	0.61	-56.43	3.43	5.55	61.81
	年龄标化死亡率/万 Age-standardized mortality rate/per 10 000	0.33	0.16	-51.52	1.64	2.13	29.88
HIV/AIDS XDR-TB	发病数/例 Incidence case/case	16	96	487.21	94	1 606	1 606.46
	死亡数/例 Mortality case/case	8	57	623.41	60	840	1 292.46
	年龄标化发病率/万 Age-standardized incidence rate/per 10 000	0.01	0.06	500.00	0.02	0.19	850.00
	年龄标化死亡率/万 Age-standardized mortality rate/per 10 000	0.01	0.03	200.00	0.01	0.10	900.00
注：HIV，人类免疫缺陷病毒；AIDS，艾滋病；MDR-TB，耐多药结核；XDR-TB，广泛耐药结核。 Note: HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; MDR-TB, multidrug-resistant tuberculosis; XDR-TB, extensively drug-resistant tuberculosis.

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表 2 1995―2021年中国与全球HIV/AIDS合并耐药结核感染的疾病负担年度平均变化

Table 2. Average annual percent change in the disease burden of HIV/AIDS co-infection with drug-resistant tuberculosis in China and globally, 1995-2021

疾病种类 Diseases	地区 Region	年龄标化发病率 Age-standardized incidence rate		年龄标化死亡率 Age-standardized mortality rate
疾病种类 Diseases	地区 Region	AAPC/%	95% CI	AAPC/%	95% CI
HIV/AIDS MDR-TB	中国 China	-3.12^①	-3.48~-2.88	-2.69^①	-3.08~-2.40
	全球 Global	1.82^①	1.62~2.02	0.78^①	0.55~1.03
HIV/AIDS XDR-TB	中国 China	5.83^①	5.21~6.29	6.38^①	5.57~7.06
	全球 Global	9.82^①	9.59~10.07	8.72^①	8.40~9.06
注：HIV，人类免疫缺陷病毒；AIDS，艾滋病；MDR-TB，耐多药结核；XDR-TB，广泛耐药结核；AAPC，平均年度变化百分比。 ① P < 0.05。 Note: HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; MDR-TB, multidrug-resistant tuberculosis; XDR-TB, extensively drug-resistant tuberculosis; AAPC, average annual percent change. ① P < 0.05.

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表 3 1995―2021中国不同性别人群HIV/AIDS合并耐药结核感染的疾病负担年度变化情况

Table 3. Average annual percent change of the disease burden of HIV/AIDS coinfection with drug-resistant tuberculosis co-infection among different gender in China, 1995-2021

疾病种类 Diseases	性别 Gender	年龄标化发病率 Age-standardized incidence rate		年龄标化死亡率 Age-standardized mortality rate
疾病种类 Diseases	性别 Gender	AAPC/%	95% CI	AAPC/%	95% CI
HIV/AIDS MDR-TB	男 Male	-2.90^①	-3.21~-2.67	-2.47^①	-2.83~-2.20
	女 Female	-3.77^①	-4.10~-3.54	-3.35^①	-3.74~-3.06
HIV/AIDS XDR-TB	男 Male	6.08^①	5.49~6.54	6.61^①	5.88~7.24
	女 Female	4.91^①	4.33~5.36	5.66^①	4.81~6.36
注：HIV，人类免疫缺陷病毒；AIDS，艾滋病；MDR-TB，耐多药结核；XDR-TB，广泛耐药结核；AAPC，平均年度变化百分比。 ① P < 0.05。 Note: HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; MDR-TB, multidrug-resistant tuberculosis; XDR-TB, extensively drug-resistant tuberculosis; AAPC, average annual percent change. ① P < 0.05.

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表 4 1995―2021中国不同年龄组HIV/AIDS合并耐药结核感染的疾病负担年度变化情况

Table 4. Average annual percent change of the disease burden of HIV/AIDS and drug-resistant tuberculosis co-infection among different age in China, 1995-2021

疾病种类 Diseases	年龄组/岁 Age group/years	发病率 Incidence rate		死亡率 Mortality rate
疾病种类 Diseases	年龄组/岁 Age group/years	AAPC/%	95% CI	AAPC/%	95% CI
HIV/AIDS MDR-TB	< 5	-3.48^①	-3.78~-3.25	-3.78^①	-4.26~-3.45
	5~＜15	1.01^①	0.83~1.16	0.90^①	0.50~1.19
	15~＜50	-2.90^①	-3.28~-2.62	-1.32^①	-1.67~-1.04
	50~＜70	-2.84^①	-3.22~-2.58	-3.13^①	-3.77~-2.67
	≥70	-3.63^①	-4.06~-3.34	-3.78^①	-4.37~-3.27
HIV/AIDS XDR-TB	< 5	5.52^①	4.97~5.94	5.52^①	5.03~5.96
	5~＜15	9.88^①	9.26~10.32	10.09^①	9.52~10.68
	15~＜50	6.31^①	5.58~6.80	7.72^①	7.01~8.32
	50~＜70	5.21^①	4.54~5.73	5.53^①	4.74~6.17
	≥70	4.97^①	4.18~5.56	5.18^①	4.20~6.09
注：HIV，人类免疫缺陷病毒；AIDS，艾滋病；MDR-TB，耐多药结核；XDR-TB，广泛耐药结核；AAPC，平均年度变化百分比。 ① P < 0.05。 Note: HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; MDR-TB, multidrug-resistant tuberculosis; XDR-TB, extensively drug-resistant tuberculosis; AAPC, average annual percent change. ① P < 0.05.

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