Determinants of survival following HIV-1 seroconversion after the introduction of HAART
Determinants of survival following HIV-1 seroconversion after the introduction of HAART
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DOI：
10.1016/s0140-6736(03)14570-9
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发表时间：
2003-10-18
期刊：
影响因子：
168.9
通讯作者：
Walker, AS
中科院分区：
文献类型：
--
作者：
Porter, K;Babiker, AG;Walker, AS
研究背景高效抗逆转录病毒治疗（HAART）于1997年引入。我们的目的是评估这种治疗对艾滋病后的生存和进展的持续影响HIV-1 seroconfermentation.Methods我们使用考克斯模型来估计日历年对艾滋病和死亡的时间在22个队列的人从欧洲，澳大利亚和加拿大谁有血清转化。使用回顾性和前瞻性数据。我们比较了1997年前（HAART前）、1997-98年（HAART的有限使用）和1999-2001年（HAART的广泛使用）急性HIV-1感染期间血清转换年龄、暴露类别、性别和表现的影响。与1997年前的数据相比，1997年死亡的风险比（HR）急剧下降至0.47 [95% CI 0.39-0-56]，2001年进一步下降至0.16 [0.12-0.22]。相应地，接受高效抗逆转录病毒疗法的人次比例从1997年的22%增加到2001年的57%。与高效抗逆转录病毒疗法之前的时代相比，1999-2001年注射毒品使用者的死亡率明显高于通过男男性行为感染的男性（风险比4.28 [2.86-6.41]）。然而，尽管1997年之前，血清转换时45岁或以上人群患艾滋病的风险高于16-24岁人群（2.03 [1.67-2.47]），但在1999-2001年，几乎没有证据表明不同年龄的风险存在差异（HR=1.17 [0.60-2.30];相互作用p=0.06）。没有观察到年龄对存活率的影响的这种衰减（p=0.63）。然而，自从引入HAART以来，HIV-1感染者的预测存活率持续增加。年龄和暴露类别作为进展决定因素的重要性似乎已经改变。
Background Highly active antiretroviral therapy (HAART) was introduced in 1997. We aimed to assess the continuing effect of this treatment on survival and progression to AIDS after HIV-1 seroconversion.Methods We used Cox models to estimate the effect of calendar year on time to AIDS and death in 22 cohorts of people from Europe, Australia, and Canada who had seroconverted. Retrospective and prospective data were used. We compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART).Findings Of 7740 seroconverters, 2000 (26%) had died. Compared with pre-1997 data, the hazard ratio (HR) for death fell sharply to 0.47 [95% Cl 0.39-0-56] in 1997, dropping further to 0.16 [0.12-0.22] in 2001. Correspondingly, the proportion of person-time on HAART increased from 22% in 1997 to 57% in 2001. By contrast with the pre-HAART era, injecting drug users had significantly higher mortality in 1999-2001 than did men infected through sex with men (HR 4.28 [2.86-6.41]). However, whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years (2.03 [1.67-2.47]), in 1999-2001 there was little evidence of a difference in risk by age (HR=1.17 [0.60-2.30]; interaction p=0.06). No such attenuation in the effect of age on survival was observed (p=0.63).Interpretation Predicted survival for people with HIV-1 has continued to increase, since the introduction of HAART; however. the importance of age and exposure category as determinants of progression seems to have changed.