Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care.
Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care.
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DOI：
10.1097/qai.0000000000001014
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发表时间：
2016-09-01
期刊：
影响因子：
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通讯作者：
Silverberg MJ
中科院分区：
文献类型：
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作者：
Marcus JL;Chao CR;Leyden WA;Xu L;Quesenberry CP Jr;Klein DB;Towner WJ;Horberg MA;Silverberg MJ
目前尚不清楚艾滋病毒感染者和未感染艾滋病毒者之间是否存在生存差距。我们在1996-2011年期间在Kaiser Permanente加州进行了一项队列研究，使用简化的寿命表来估计20岁时的预期剩余寿命（“预期寿命”）。在24 768名艾滋病毒感染者和257 600名未感染艾滋病毒者中，分别有2 229人和4 970人死亡，死亡率分别为每10万人年1827人和326人。1996-1997年，艾滋病毒感染者和未感染者20岁时的预期寿命分别为19.1岁和63.4岁，相应的差距为44.3岁（95%置信区间：38.4至50.2岁）。2008年，艾滋病毒感染者20岁时的预期寿命增至47.1岁，2011年增至53.1岁，2011年的差距缩小至11.8岁（8.9-14.8岁）。2008-2011年，艾滋病毒感染者20岁时的预期寿命从黑人的45.8岁和有注射吸毒史的46.0岁到西班牙裔的52.2岁不等。在2008-2011年，开始抗逆转录病毒治疗（CD 4 ≥500个细胞/微升）的艾滋病毒感染者在20岁时的预期寿命为54.5岁，与未感染艾滋病毒者的差距缩小至7.9岁（5.1-10.6岁）。对于这些HIV感染者，在没有B或C型肝炎感染史、吸烟、药物/酒精滥用或任何这些危险因素的亚组中，差距进一步缩小。即使在早期治疗和获得护理的情况下，艾滋病毒感染者与未感染艾滋病毒者相比，预期寿命仍有8年的差距。
It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care. We conducted a cohort study within Kaiser Permanente California during 1996–2011, using abridged life tables to estimate the expected years of life remaining (“life expectancy”) at age 20. Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996–1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9–14.8 years) in 2011. In 2008–2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008–2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1–10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors. Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.