The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals.
The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals.
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DOI：
10.1097/qad.0b013e3283324283
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发表时间：
2010-01-02
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：
HIV-CAUSAL Collaboration;Ray M;Logan R;Sterne JA;Hernández-Díaz S;Robins JM;Sabin C;Bansi L;van Sighem A;de Wolf F;Costagliola D;Lanoy E;Bucher HC;von Wyl V;Esteve A;Casbona J;del Amo J;Moreno S;Justice A;Goulet J;Lodi S;Phillips A;Seng R;Meyer L;Pérez-Hoyos S;García de Olalla P;Hernán MA
评估联合抗逆转录病毒治疗（cART）对HIV感染者死亡率的影响，调整适应症随时间变化的混杂因素后。来自欧洲和美国的12项前瞻性队列研究（HIV-CAUSAL协作），包括62，760名HIV感染者，治疗初治者，平均随访3.3年。边际结构模型的逆概率加权用于调整适应症的测量混杂。2039人在随访期间死亡。开始cART与未开始cART的死亡风险比为0.48（95%置信区间：0.41，0.57）。在按基线时CD 4细胞计数分层的分析中，相应的风险比为0.29（0.22，0.37）<100个细胞/μL，0.33 100-<200个细胞/μL为0.25，0.44，200-<350个细胞/μL为0.38（0.28，0.52），350-<500个细胞/μ L为0.55（0.41，0.74），≥500个细胞/μ L为0.77（0.58，1.01）。估计的风险比随开始cART后的年份而变化，从开始后<1年的0.57（0.49，0.67）到≥ 5年的0.21（0.14，0.31）（趋势p值<0.001）。我们估计cART使HIV感染者的平均死亡率减半。在随访开始时预后较差的患者中，死亡率下降幅度更大。
To estimate the effect of combined antiretroviral therapy (cART) on mortality among HIV-infected individuals after appropriate adjustment for time-varying confounding by indication. A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62,760 HIV-infected, therapy-naïve individuals followed for an average of 3.3 years. Inverse probability weighting of marginal structural models was used to adjust for measured confounding by indication. 2039 individuals died during the follow-up. The mortality hazard ratio was 0.48 (95% confidence interval: 0.41, 0.57) for cART initiation versus no initiation. In analyses stratified by CD4 cell count at baseline, the corresponding hazard ratios were 0.29 (0.22, 0.37) for <100 cells/μL, 0.33 (0.25, 0.44) for 100-<200 cells/μL, 0.38 (0.28, 0.52) for 200-<350 cells/μL, 0.55 (0.41, 0.74) for 350-<500 cells/μL, and 0.77 (0.58, 1.01) for ≥500 cells/μL. The estimated hazard ratio varied with years since initiation of cART from 0.57 (0.49, 0.67) for <1 year since initiation to 0.21 (0.14, 0.31) for ≥ 5 years (p-value for trend<0.001). We estimated that cART halved the average mortality rate in HIV-infected individuals. The mortality reduction was greater in those with worse prognosis at the start of follow-up.