The impact of zidovudine on dementia-free survival in a population of HIV-positive men and women on antiretroviral therapy
The impact of zidovudine on dementia-free survival in a population of HIV-positive men and women on antiretroviral therapy
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DOI：
10.1258/0956462001914788
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发表时间：
2000-01-01
影响因子：
1.4
通讯作者：
Hogg, RS
中科院分区：
文献类型：
--
作者：
Cornelisse, PGA;Montessori, V;Hogg, RS
我们的目的是描述齐多夫定治疗对不列颠哥伦比亚省一个免费获得抗逆转录病毒治疗的人群中艾滋病痴呆综合征（痴呆）无存活率的影响。根据齐多夫定持续时间、首次治疗时的CD 4+细胞计数、性别和传播组[男男性行为者（MSM）、静脉注射吸毒者（IDU）、异性恋者]，对个体中诊断为痴呆的时间进行了检查。我们将分析限制在治疗开始日期前12个月内具有CD 4+细胞计数的受试者。在符合分析条件的641名参与者中，中位随访时间为3.6年，其中发生了86起（9.3%）痴呆事件。参与者不太可能发展为痴呆症：增加齐多夫定暴露（OR=0.26，95% CI：0.14-0.49），至少260 CD 4+细胞/mm（3）（中位数）（OR=0.52，95% CI：0.34-0.78）和MSM风险组（OR=0.57，95% CI：0.35-0.94）。经异性性接触感染者的危险性增加（RR=2.04，95%CI：1.02-4.07）。使用考克斯比例风险模型，控制治疗开始日期的CD 4+细胞计数，无痴呆生存期的独立预测因素为：齐多夫定的持续时间（OR=0.28，95%CI：0.15-0.52）和MSM传播组（OR=0.61，95% CI：0.37-1.00）。在该观察性治疗队列中，与无痴呆存活相关的因素包括齐多夫定（AZT）治疗的持续时间和MSM传播群体。从这些数据来看，尚不清楚AZT的保护作用是否仅限于这种药物，或者其他疗法是否可能提供类似的保护作用。
Our objective was to characterize the effect of zidovudine therapy on AIDS dementia complex (dementia) free survival among HIV-infected men and women in a population-based cohort with free access to antiretroviral therapy in the province of British Columbia. Time to diagnosis of dementia among individuals was examined on the basis of zidovudine duration, CD4+ cell count at first treatment, gender, and transmission group [men having sex with men (MSM), intravenous drug users (IDU), heterosexuals]. We restricted the analysis to subjects with CD4+ cells counts within 12 months prior to treatment start date. Among 641 participants eligible for analysis, median duration of follow-up was 3.6 years, under which 86 (9.3%) events of dementia occurred. Participants were less likely to develop dementia with: increased zidovudine exposure (OR=0.26, 95% CI: 0.14-0.49), at least 260 CD4+ cells/mm(3) (median) (OR=0.52, 95% CI: 0.34-0.78), and MSM risk group (OR=0.57, 95% CI: 0.35-0.94). Those infected through heterosexual contact had an increased risk (RR=2.04, 95% CI: 1.02-4.07). Using Cox's proportional hazards model, controlling for CD4+ cell count at treatment start date, independent predictors of dementia-free survival were: duration of zidovudine (OR=0.28, 95% CI: 0.15-0.52) and MSM transmission group (OR=0.61, 95% CI: 0.37-1.00).In this observational treatment cohort, factors associated with dementia-free survival include duration of zidovudine (AZT) therapy and MSM transmission group. It is not clear from these data whether the AZT protective effect is exclusive to this agent or whether other therapies might offer a similar protective effect.