Survival rate and the determinants of progression from HIV to AIDS and from AIDS to the death in Iran: 1987 to 2016
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摘要
Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran.Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran.Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death.We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors.Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively.Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm~3, infected with tuberculosis(TB) and not treated by antiretroviral therapy(ART) was 2.17(95% CI: 1.62-2.90), 1.49(95% CI: 1.01-2.20) and 4.88(95% CI: 3.42-6.96) times higher respectively.The risk of progression to AIDS in patients with baseline CD4 less than 200/mm~3 was 2.32(95% CI: 2.14, 2.51) times higher than patients with CD4 > 200/mm~3(P=0.001).On the other hand, tuberculosis increases the risk of death by 49.0%(P=0.04).The hazard ratio of death in patients who did not receive ART was 4.88(95% CI: 3.42, 6.96) times higher than patients who received ART(P<0.001).Conclusion: The early detection of HIV, the screening and treatment of TB and receiving the ART improve the survival of HIV/AIDS patients significantly, and prevent the transmission of HIV to other people.
Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran.Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran.Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death.We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors.Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively.Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm~3, infected with tuberculosis(TB) and not treated by antiretroviral therapy(ART) was 2.17(95% CI: 1.62-2.90), 1.49(95% CI: 1.01-2.20) and 4.88(95% CI: 3.42-6.96) times higher respectively.The risk of progression to AIDS in patients with baseline CD4 less than 200/mm~3 was 2.32(95% CI: 2.14, 2.51) times higher than patients with CD4 > 200/mm~3(P=0.001).On the other hand, tuberculosis increases the risk of death by 49.0%(P=0.04).The hazard ratio of death in patients who did not receive ART was 4.88(95% CI: 3.42, 6.96) times higher than patients who received ART(P<0.001).Conclusion: The early detection of HIV, the screening and treatment of TB and receiving the ART improve the survival of HIV/AIDS patients significantly, and prevent the transmission of HIV to other people.
Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran.Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran.Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death.We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors.Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively.Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm~3, infected with tuberculosis(TB) and not treated by antiretroviral therapy(ART) was 2.17(95% CI: 1.62-2.90), 1.49(95% CI: 1.01-2.20) and 4.88(95% CI: 3.42-6.96) times higher respectively.The risk of progression to AIDS in patients with baseline CD4 less than 200/mm~3 was 2.32(95% CI: 2.14, 2.51) times higher than patients with CD4 > 200/mm~3(P=0.001).On the other hand, tuberculosis increases the risk of death by 49.0%(P=0.04).The hazard ratio of death in patients who did not receive ART was 4.88(95% CI: 3.42, 6.96) times higher than patients who received ART(P<0.001).Conclusion: The early detection of HIV, the screening and treatment of TB and receiving the ART improve the survival of HIV/AIDS patients significantly, and prevent the transmission of HIV to other people.
引文
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[15]Spagnuolo V,Galli L,Salpietro S,Gianotti N,Guffanti M,Cossarini F,et al.Ten year survival among HIV1infected subjects with AIDS or nonAIDS defining malignancies.Int J Cancer 2012;130(12):2990-2996.
[16]Lopez-Gatell H,Cole SR,Margolick JB,Witt MD,Martinson J,Phair JP,et al.Effect of tuberculosis on the survival of HIV-infected men in a country with low TB incidence.AIDS(London,England)2008;22(14):1869.
[17]Reynolds SJ,Makumbi F,Nakigozi G,Kagaayi J,Gray RH,Wawer M,et al.HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy.AIDS(London,England)2011;25(4):473.
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[19]Seyoum D,Degryse JM,Kifle YG,Taye A,Tadesse M,Birlie B,et al.Risk factors for mortality among adult HIV/AIDS patients following antiretroviral therapy in Southwestern Ethiopia:An assessment through survival models.Int J Environ Res Public Health 2017;14(3):2-12.
[20]Djalalinia S,Moghaddam SS,Peykari N,Kasaeian A,Sheidaei A,Mansouri A,et al.Mortality attributable to excess body mass index in Iran:Implementation of the comparative risk assessment methodology.Int J Prev Med 2015;6(1):107.
[2]Centers for Disease Control and Prevention.HIV/AIDS.[Online]Available from:https://www.cdc.gov/hiv/basics/whatishiv.html[Accessed on 4th August 2017].
[3]World Health Organization.HIV/AIDS.[Online]Available from:http://www.who.int/mediacentre/factsheets/fs360/en/[Accessed on 4th Agust2017].
[4]United Nations on AIDS.Latest global and regional statistics on the status of the AIDS epidemic.[Online]Available from:http://www.unaids.org/en/resources/documents/2017/UNAIDS_Fact Sheet[Accessed on 4th Agust 2017].
[5]Centers for Disease Control and Prevention.Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV.1st ed.Washington:CDC;2017.
[6]Nsanzimana S,Remera E,Kanters S,Chan K,Forrest JI,Ford N,et al.Life expectancy among HIV-positive patients in Rwanda:a retrospective observational cohort study.Lancet Global Health 2015;3(3):e169-e77.
[7]World Health Organization.Guidelines for managing advanced HIVdisease and rapid initiation of antiretroviral therapy.1st ed.Geneva:WHO;2017.
[8]Liu ZQ,Zhou N,Bai JY,Guo Y,Yu MH.Analysis of survival and influencing factors of HIV/AIDS patients in Tianjin,2004-2014.Zhonghua Liu Xing Bing Xue Za Zhi 2017;38(3):369-373.
[9]Poorolajal J,Hooshmand E,Mahjub H,Esmailnasab N,Jenabi E.Survival rate of AIDS disease and mortality in HIV-infected patients:Ameta-analysis.Public Health 2016;139(1):3-12.
[10]Poorolajal J,Molaeipoor L,Mohraz M,Mahjub H,Ardekani MT,Mirzapour P,et al.Predictors of progression to AIDS and mortality postHIV infection:A long-term retrospective cohort study.AIDS Care.2015;27(10):1205-1212.
[11]Mirzaei M,Poorolajal J,Khazaei S,Saatchi M.Survival rate of AIDSdisease and mortality in HIV-infected patients in Hamadan,Iran:Aregistry-based retrospective cohort study(1997-2011).Int J STD AIDS2013;24(11):859-866.
[12]World Health Organization.TB and HIV.[Online]Available from:http://www.who.int/tb/areas-of-work/tb-hiv/en/[Accessed on 4th Agust 2017].
[13]Whalen CC,Nsubuga P,Okwera A,Johnson JL,Hom DL,Michael NL,et al.Impact of pulmonary tuberculosis on survival of HIV-infected adults:a prospective epidemiologic study in Uganda.AIDS(London,England)2000;14(9):1219.
[14]Whalen C,Okwera A,Johnson J,Vjecha M,Hom D,Wallis R,et al.Predictors of survival in human immunodeficiency virus-infected patients with pulmonary tuberculosis.The Makerere University-Case Western Reserve University Research Collaboration.Am J Respir Crit Care Med.1996;153(6 Pt 1):1977-1981.
[15]Spagnuolo V,Galli L,Salpietro S,Gianotti N,Guffanti M,Cossarini F,et al.Ten year survival among HIV1infected subjects with AIDS or nonAIDS defining malignancies.Int J Cancer 2012;130(12):2990-2996.
[16]Lopez-Gatell H,Cole SR,Margolick JB,Witt MD,Martinson J,Phair JP,et al.Effect of tuberculosis on the survival of HIV-infected men in a country with low TB incidence.AIDS(London,England)2008;22(14):1869.
[17]Reynolds SJ,Makumbi F,Nakigozi G,Kagaayi J,Gray RH,Wawer M,et al.HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy.AIDS(London,England)2011;25(4):473.
[18]Teeraananchai S,Kerr SJ,Amin J,Ruxrungtham K,Law MG.Life expectancy of HIV-positive people after starting combination antiretroviral therapy:a meta-analysis.HIV Med 2017;18(4):256-266.
[19]Seyoum D,Degryse JM,Kifle YG,Taye A,Tadesse M,Birlie B,et al.Risk factors for mortality among adult HIV/AIDS patients following antiretroviral therapy in Southwestern Ethiopia:An assessment through survival models.Int J Environ Res Public Health 2017;14(3):2-12.
[20]Djalalinia S,Moghaddam SS,Peykari N,Kasaeian A,Sheidaei A,Mansouri A,et al.Mortality attributable to excess body mass index in Iran:Implementation of the comparative risk assessment methodology.Int J Prev Med 2015;6(1):107.