Incomplete viral suppression and mortality in HIV patients after antiretroviral therapy initiation
Incomplete viral suppression and mortality in HIV patients after antiretroviral therapy initiation
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DOI：
10.1097/qad.0000000000001573
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发表时间：
2017-09-10
期刊：
影响因子：
3.8
通讯作者：
Eron, Joseph J., Jr.
中科院分区：
文献类型：
--
作者：
Lee, Jennifer S.;Cole, Stephen R.;Eron, Joseph J., Jr.
目的：为了确定是否有一个阈值下1000拷贝/毫升的抗逆转录病毒治疗开始后，与10年的全因mortality.Design相关的可检测的HIV RNA：本研究包括近8000例来自美国的多中心临床队列谁开始抗逆转录病毒治疗之间的1998年1月1日和2013年12月31日。在开始治疗后6个月评估病毒载量。从治疗开始后6个月开始随访患者（1998年7月1日至2014年6月30日）直至死亡，10年后或2014年12月31日对数据进行行政删失。我们使用非参数多重插补来解释左删失的病毒载量测量值，使用考克斯比例风险模型来估计全因死亡风险比，Nelson-Aalen累积风险估计用于构建风险曲线，暴露权重的逆概率用于标准化总研究人群的估计风险比和风险曲线。标准化风险比估计值和95%置信区间图表明，在30至500拷贝之间没有可证实的病毒载量阈值。ml与10年死亡率显著增加相关。在开始治疗后6个月，病毒载量在400和999拷贝/ml之间的患者的标准化10年死亡风险与病毒载量在1000和400万拷贝/ml之间的患者的死亡风险相当（20 vs. 23%）。开始治疗后6个月血浆HIV RNA的不完全抑制与10年全因死亡风险显著相关，强调了治疗开始后快速抑制病毒载量的重要性。版权所有（C）2017威科医疗集团All rights reserved.
Objective: To determine whether there is a threshold of detectable HIV RNA under 1000 copies/ml after antiretroviral therapy initiation associated with 10-year all-cause mortality.Design: This study included nearly 8000 patients from a US-based multicenter clinical cohort who started antiretroviral therapy between 1 January 1998 and 31 December 2013. Viral load was assessed 6 months after initiation of therapy. Patients were followed from 6 months after therapy initiation (between 1 July 1998 and 30 June 2014) until death, and data were administratively censored after 10 years or on 31 December 2014.Methods: We used nonparametric multiple imputation to account for left-censored viral load measurements, Cox proportional hazards models to estimate all-cause mortality hazard ratios, Nelson-Aalen cumulative hazard estimates to construct risk curves, and inverse probability of exposure weights to standardize estimated hazard ratios and risk curves to the total study population.Results: Plots of standardized hazard ratio estimates and 95% confidence intervals indicated there was no demonstrable viral load threshold between 30 and 500 copies/ml associated with a marked increase in 10-year mortality. The standardized 10-year risk of mortality among patients with viral loads between 400 and 999 copies/ml 6 months after starting treatment was comparable with the risk of mortality among patients with viral loads between 1000 and 4 million copies/ml (20 vs. 23%).Conclusion: Incomplete suppression of plasma HIV RNA 6 months after starting therapy is associated with substantial 10-year all-cause mortality risk, highlighting the importance of rapid viral load suppression after therapy initiation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.