Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients.
Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients.
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DOI：
10.1093/cid/ciu261
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发表时间：
2014-07-15
期刊：
影响因子：
--
通讯作者：
Antiretroviral Therapy Cohort Collaboration
中科院分区：
文献类型：
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作者：
Ingle SM;May MT;Gill MJ;Mugavero MJ;Lewden C;Abgrall S;Fätkenheuer G;Reiss P;Saag MS;Manzardo C;Grabar S;Bruyand M;Moore D;Mocroft A;Sterling TR;D'Arminio Monforte A;Hernando V;Teira R;Guest J;Cavassini M;Crane HM;Sterne JA;Antiretroviral Therapy Cohort Collaboration
在开始抗逆转录病毒治疗（ART）的HIV感染患者中，特定原因死亡的模式因ART持续时间而异，并与年龄、性别和传播风险组密切相关。死于非艾滋病恶性肿瘤的人数比死于心血管疾病的人数多得多。背景：在抗逆转录病毒治疗（ART）时代，感染人类免疫缺陷病毒1型（HIV-1）的个体的病因特异性死亡率模式发生了巨大变化。 方法：来自欧洲和北美的16个队列提供了从ART开始随访的成年患者的数据。 估计的风险比（HR）进行了调整的传播风险组，性别，年龄，一年的ART启动，基线CD 4计数，病毒载量，艾滋病状态，之前和之后的第一年的ART.Results.A 65 121（6.5%）患者死亡（中位数，4.5年的后续行动），共4237。 自开始抗逆转录病毒治疗以来，艾滋病死亡率随着时间的推移而大幅下降，但非艾滋病恶性肿瘤的死亡率却在增加（率比，每年1.04; 95%置信区间[CI]，1.0-1.1）。在接受抗逆转录病毒疗法的第一年，男性死亡率高于女性，主要是由于非艾滋病恶性肿瘤和与肝脏有关的死亡。心血管疾病、心脏/血管和恶性肿瘤死亡与年龄的相关性最强。假定通过注射吸毒传播的患者的所有死亡原因的发生率较高，特别是肝脏相关原因（与男男性行为者相比，ART第一年的HR为18.1 [95%CI，6.2-52.7]，此后为9.1 [95%CI，5.8-14.2]）。在基线和12个月时，CD 4计数在预测AIDS、非AIDS感染和非AIDS恶性肿瘤死亡方面具有持续作用。ART缺乏病毒抑制与艾滋病、非艾滋病感染和其他死亡原因有关。结论：更好地了解ART时代的病因特异性死亡率模式和风险因素有助于为HIV感染者制定适当的护理，并为风险因素管理提供指导。
Among HIV-infected patients who initiated antiretroviral therapy (ART), patterns of cause-specific death varied by ART duration and were strongly related to age, sex, and transmission risk group. Deaths from non-AIDS malignancies were much more frequent than those from cardiovascular disease. Background. Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART). Methods. Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART. Results. A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0–1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2–52.7] during the first year of ART and 9.1 [95% CI, 5.8–14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death. Conclusions. Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management.
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作者：
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通讯作者：
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