Influence of alternative thresholds for initiating HIV treatment on quality-adjusted life expectancy: A decision model
Influence of alternative thresholds for initiating HIV treatment on quality-adjusted life expectancy: A decision model
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DOI：
10.7326/0003-4819-148-3-200802050-00004
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发表时间：
2008-02-05
影响因子：
39.2
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
--
作者：
Braithwaite, R. Scott;Roberts, Mark S.;Justice, Amy C.
背景资料：启动HIV治疗的最佳阈值尚不清楚。目的：比较启动HIV治疗的不同阈值。设计：使用经过验证的计算机模拟来衡量早期启动抗逆转录病毒治疗的重要危害（毒性、副作用和耐药性积累）对抗重要益处数据来源：退伍军人老龄化队列研究（Veterans Aging Cohort Study）（5742名HIV感染者和11484名匹配的未感染对照）和已发表的报告。新诊断的慢性HIV感染者和不同的病毒载量（10 000、30 000、100 000和300 000拷贝/mL）和年龄（30、40和50年）。时间范围：无限。视角：社会。干预：启动抗逆转录病毒治疗的替代阈值（CD 4计数为200、350和500个细胞/mm（3））。结果测量：生命年和质量调整生命年（QHMS）。基础病例分析结果：尽管该模拟对早期治疗存在偏见，因为它使用了治疗相关毒性的上限假设，但无论病毒载量如何，早期治疗都能增加30岁时的预期寿命和QDs（CD 4起始阈值为500，350和200个细胞/mm（3）的预期寿命分别为18.2年，17.6年和17.2年，病毒载量为10000拷贝/mL和17.3年，15.9年，和14.5年，分别为300000拷贝/毫升的病毒载量），并增加预期寿命在40岁时，如果病毒载量大于30000拷贝/毫升（病毒载量为300000拷贝/mL时的预期寿命分别为12.5年、12.0年和11.4年）。有利于早期治疗的结果通常是稳健的。局限性：有利于后期治疗的结果可能是无效的。研究结果可能是不可推广的women.Conclusion：这种模拟表明，早期启动联合抗逆转录病毒治疗往往是有利的，目前的建议相比。
Background: The optimal threshold for initiating HIV treatment is unclear.Objective: To compare different thresholds for initiating HIV treatment.Design: A validated computer simulation was used to weigh important harms from earlier initiation of antiretroviral therapy (toxicity, side effects, and resistance accumulation) against important benefits (decreased HIV-related mortality).Data Sources: Veterans Aging Cohort Study (5742 HIV-infected patients and 11 484 matched uninfected controls) and published reports.Target Population: Individuals with newly diagnosed chronic HIV infection and varying viral loads (10 000, 30 000, 100 000, and 300 000 copies/mL) and ages (30, 40, and 50 years).Time Horizon: Unlimited.Perspective: Societal.Intervention: Alternative thresholds for initiating antiretroviral therapy (CD4 counts of 200, 350, and 500 cells/mm(3)).Outcome Measures: Life-years and quality-adjusted life-years (QALYs).Results of Base-Case Analysis: Although the simulation was biased against earlier treatment initiation because it used an upper-bound assumption for therapy-related toxicity, earlier treatment increased life expectancy and QALYs at age 30 years regardless of viral load (life expectancies with CD4 initiation thresholds of 500, 350, and 200 cells/mm(3) were 18.2 years, 17.6 years, and 17.2 years, respectively, for a viral load of 10 000 copies/mL and 17.3 years, 15.9 years, and 14.5 years, respectively, for a viral load of 300000 copies/mL), and increased life expectancies at age 40 years if viral loads were greater than 30000 copies/mL (life expectancies were 12.5 years, 12.0 years, and 11.4 years, respectively, for a viral load of 300000 copies/mL).Results of Sensitivity Analysis: Findings favoring early treatment were generally robust.Limitations: Results favoring later treatment may not be valid. The findings may not be generalizable to women.Conclusion: This simulation suggests that earlier initiation of combination antiretroviral therapy is often favored compared with current recommendations.