Natural history of HIV infection in the era of combination antiretroviral therapy
Natural history of HIV infection in the era of combination antiretroviral therapy
复制标题
DOI：
10.1097/00002030-199910010-00017
复制
发表时间：
1999-10-01
期刊：
影响因子：
3.8
通讯作者：
Chaisson, RE
中科院分区：
文献类型：
--
作者：
Moore, RD;Chaisson, RE
背景资料：使用含蛋白酶底物（PI）的联合抗逆转录病毒疗法已导致HIV感染中机会性疾病和死亡率（事件）的发生率降低。我们希望在我们的临床实践中量化这些事件发生率的变化，并描述CD 4、HIV-1 RNA和接受PI联合治疗的患者事件发生之间的关系。方法：我们评估了CD 4计数小于或等于500个细胞x10（6）/l的HIV感染患者。我们计算了1994年至1998年的事件发生率，并分析了事件发生率的时间变化与抗逆转录病毒治疗的使用之间的关系。在PI联合治疗的患者中，我们确定了实现和维持不可检测的HIV-1 RNA应答的概率，并确定了CD 4、HIV-1 RNA和发生事件的相关性。结果：机会性疾病的发病率从1994年的23.7起事件/100人年下降到1998年的14.0起事件/100人年（P < 0.001）。死亡率从1994年的20.2例死亡/100人年下降到1998年的8.4例死亡/100人年（P < 0.001）。使用PI联合治疗与机会性疾病或死亡的相对发生率为0.66 [95%可信区间（CI），0.51-0.85; P < 0.001]。1998年16种机会性疾病中每一种的相对发病率与1994年大致相同，但淋巴瘤、宫颈癌和消耗综合征除外，这些疾病的发病率似乎没有下降。大约60%接受PI治疗的患者实现了检测不到的HIV-1 RNA，其中65%的患者保持了HIV-1 RNA的持久抑制。实现检测不到HIV-1 RNA与事件风险降低相关，并且是与CD 4水平升高最密切相关的变量。通过多变量分析，并发的CD 4水平是最强相关的发展events.Conclusions：我们观察到一个显着下降的机会性疾病和死亡的发病率从1994年到1998年与联合抗逆转录病毒治疗。在接受PI联合治疗期间发生事件的患者不太可能达到不可检测的HIV-1 RNA，并且可能具有较低的并发CD 4水平。(C)1999年利平科特威廉姆斯&威尔金斯。
Background: The use of protease inhibitor-containing (PI) combination antiretroviral therapy has led to a reduction in the incidence of opportunistic illness and mortality (events) in HIV infection. We wished to quantify the changing incidence of these events in our clinical practice and delineate the relationship between CD4, HIV-1 RNA, and development of events in patients receiving PI combination therapy.Methods: We assessed HIV-infected patients with CD4 counts less than or equal to 500 cells x 10(6)/l. We calculated the incidence of events from 1994 through 1998 and analyzed the association of temporal changes in event incidence and use of antiretroviral therapy. In patients on PI combination therapy, we determined the probability of achieving and maintaining an undetectable HIV-1 RNA response and determined the association of CD4, HIV-1 RNA, and developing an event.Results: The incidence of opportunistic illness declined from 23.7 events/100 person-years in 1994 to 14.0 events/100 person-years in 1998 (P < 0.001). Mortality declined from 20.2 deaths/100 person-years in 1994 to 8.4 deaths/100 person-years in 1998 (P < 0.001). Use of PI combination therapy was associated with a relative rate of opportunistic illness or death of 0.66 [95% confidence interval (CI), 0.51-0.85; P < 0.001]. The relative incidence of each of 16 opportunistic illnesses was approximately the same in 1998 as in 1994 except for lymphoma, cervical cancer and wasting syndrome which do not appeared to have declined in incidence. Approximately 60% of patients who received PI therapy achieved an undetectable HIV-1 RNA, and 65% of these patients maintained durable suppression of HIV-1 RNA. Achieving an undetectable HIV-1 RNA was associated with a decreased risk of an event, and was the variable most strongly associated with an increase in CD4 level. By multivariate analysis, the concurrent CD4 level was most strongly associated with developing an event.Conclusions: We observed a significant decline in the incidence of opportunistic illness and death from 1994 through 1998 associated with combination antiretroviral therapy. Patients who develop events while being treated with PI combination therapy were not likely to have achieved an undetectable HIV-1 RNA and are likely to have a low concurrent CD4 level. (C) 1999 Lippincott Williams & Wilkins.