Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 X 109 cells/L
Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 X 109 cells/L
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DOI：
10.7326/0003-4819-139-10-200311180-00008
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发表时间：
2003-11-18
影响因子：
39.2
通讯作者：
Montaner, JSG
中科院分区：
文献类型：
--
作者：
Wood, E;Hogg, RS;Montaner, JSG
背景资料：当CD 4（+）细胞计数降至0.350 × 10（9）细胞/L以下时，延迟高效抗逆转录病毒治疗（HAART）在HIV感染患者中的安全性尚不确定。目的：评估基线CD 4（+）细胞计数和坚持HAART对生存率的影响。设计：前瞻性观察研究。背景：加拿大全省范围的HIV/AIDS治疗项目。患者：1996年8月1日至2000年7月31日期间开始HAART并随访至2002年3月31日的1422名HIV感染者。测量：患者按基线CD 4+细胞计数和粘附水平分层。使用Kaplan-Meier方法和考克斯回归估计的校正相对风险评价累积死亡率。结果如下：Kaplan-Meier分析显示，在粘附患者中，CD 4（+）计数为0.200 x 10（9）个细胞/L或更高时开始HAART没有生存益处。校正分析显示，与CD 4+细胞计数为0.350 × 109个细胞/L或更高时开始HAART的粘附患者相比，CD 4+细胞计数为0.200至0.349 × 109个细胞/L时开始HAART的非粘附患者的死亡率在统计学上升高（校正的相对危险度，2.56 [95% CI，1.36 - 4.84]; P = 0.004）。然而，与CD 4（+）细胞计数为0.350 × 109细胞/L或更高时开始HAART的粘附患者相比，CD 4（+）细胞计数为0.200至0.349 × 109细胞/L时开始HAART的粘附患者的死亡率在统计学上相似（校正后的相对危险度为0.82 [CI为0.45 ~ 1.49]; P > 0.2）。结论：延迟HAART直至CD 4+细胞计数降至福尔斯0.200 × 10（9）个细胞/L不会增加药物依从性良好的HIV感染患者的死亡率。如果HAART开始低于0.200 x 10（9）个细胞/L，则死亡率增加。此外，非粘附患者的死亡率高于具有相似CD 4（+）细胞计数的粘附患者。当CD 4+细胞计数高于0.200 × 10（9）个细胞/L时，药物依从性是生存的关键决定因素，而不是开始HAART时的CD 4+细胞计数。
Background: The safety of delaying highly active antiretroviral therapy (HAART) in HIV-infected patients is uncertain when the CD4(+) cell count declines below 0.350 x 10(9) cells/L. Objective: To evaluate the effect of baseline CD4(+) cell count and adherence to HAART on survival rates. Design: Prospective observational study. Setting: Province-wide Canadian HlV/AIDS treatment program. Patients: 1422 HIV-infected persons initiating HAART between 1 August 1996 and 31 July 2000 and followed through 31 March 2002. Measurements: Patients were stratified by baseline CD4+ cell count and adherence level. Cumulative mortality rates were evaluated by using Kaplan-Meier methods and Cox regression-estimated adjusted relative hazards. Results: Kaplan-Meier analyses showed no survival benefit of starting HAART at a CD4(+) count of 0.200 x 10(9) cells/L or greater among adherent patients. Adjusted analysis showed that compared with adherent patients who initiated HAART at a CD4+ cell count of 0.350 x 10(9) cells/L or greater, nonadherent patients who initiated HAART when the CD4+ cell count was 0.200 to 0.349 x 109 cells/L had statistically elevated mortality rates (adjusted relative hazard, 2.56 [95% Cl, 1.36 to 4.84]; P = 0.004). However, compared with adherent patients who initiated HAART at a CD4(+) cell count of 0.350 x 109 cells/L or greater, adherent patients who initiated HAART when the CD4(+) cell count was 0.200 to 0.349 x 10(9) cells/L had statistically similar mortality rates (adjusted relative hazard, 0.82 [Cl, 0.45 to 1.49]; P > 0.2). Conclusions: Delaying HAART until the CD4(+) cell count falls to 0.200 x 10(9) cells/L does not increase the mortality rate in HIV-infected patients with good medication adherence. Mortality rates increase if HAART is initiated below 0.200 x 10(9) cells/L. Also, nonadherent patients have higher mortality rates than adherent patients with similar CD4(+) cell counts. Above a CD4(+) cell count of 0.200 x 10(9) cells/L, medication adherence is the critical determinant of survival, not the CD4(+) cell count at which HAART is begun.