Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older.
Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older.
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DOI：
10.1097/qai.0000000000001498
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发表时间：
2017-11-01
期刊：
影响因子：
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通讯作者：
Hernán MA
中科院分区：
文献类型：
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作者：
Lodi S;Costagliola D;Sabin C;Del Amo J;Logan R;Abgrall S;Reiss P;van Sighem A;Jose S;Blanco JR;Hernando V;Bucher HC;Kovari H;Segura F;Ambrosioni J;Gogos CA;Pantazis N;Dabis F;Vandenhende MA;Meyer L;Seng R;Gill MJ;Krentz H;Phillips AN;Porter K;Grinsztejn B;Pacheco AG;Muga R;Tate J;Justice A;Hernán MA
临床指南建议对所有 HIV 阳性个体立即开始联合抗逆转录病毒治疗 (ART)。然而，这些指南是基于相对年轻的参与者的试验。我们将 2004 年之后年龄在 50-70 岁、未接受过抗逆转录病毒疗法、未患艾滋病的艾滋病毒阳性个体纳入了艾滋病毒因果合作项目。我们使用参数 g 公式来估计全因死亡率和非艾滋病死亡率的 5 年风险：i) 在基线时立即启动，并在 CD4 计数时启动 ii) <500 个细胞/mm3，以及 iii) <350 个细胞/mm3。分别公布了一般艾滋病毒人群和高死亡率美国退伍军人队列的结果。该研究包括 9596 名个体（28% 美国退伍军人），基线时中位[分位数范围]年龄为 55 [52,60] 岁，CD4 计数为 336 [182,513]。当比较立即开始治疗与 CD4<350 个细胞/mm3 时开始治疗时，一般 HIV 人群的 5 年全因死亡率风险低 0.40% (95% CI 0.10,0.71)，美国退伍军人则低 1.61% (95% CI 0.79,2.67)。当比较立即开始治疗与 CD4<350 个细胞/mm3 时开始治疗时，一般 HIV 人群的 5 年非艾滋病死亡风险低 0.17% (95% CI -0.07,0.43)，美国退伍军人则低 1% (95% CI 0.31,2.00)。立即开始治疗似乎可以降低 50-70 岁患者的全因死亡率和非艾滋病死亡率。
Clinical guidelines recommend immediate initiation of combined antiretroviral therapy (ART) for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants. We included HIV-positive ART-naïve, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under: i) immediate initiation at baseline, and initiation at CD4 count ii) <500 cells/mm3, and iii) <350 cells/mm3. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. The study included 9596 individuals (28% US Veterans) with median [interquantile range] age of 55 [52,60] years and CD4 count 336 [182,513] at baseline. The 5-year risk of all-cause mortality was 0.40% (95% CI 0.10,0.71) lower for the general HIV population and 1.61% (95% CI 0.79,2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4<350 cells/mm3. The 5-year risk of non-AIDS mortality was 0.17% (95% CI -0.07,0.43) lower for the general HIV population and 1% (95% CI 0.31,2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4<350 cells/mm3. Immediate initiation appears to reduce all-cause and non-AIDS mortality in patients aged 50-70 years.