Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis.
Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis.
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DOI：
10.1097/qad.0000000000000941
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发表时间：
2016-01-28
期刊：
影响因子：
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通讯作者：
Collaboration of Observational HIV Epidemiological Research in Europe (COHERE)
中科院分区：
文献类型：
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作者：
Antiretroviral Therapy Cohort Collaboration (ART-CC);Canadian Observational Cohort Collaboration (CANOC);UK Collaborative HIV Cohort Study (UK CHIC);Collaboration of Observational HIV Epidemiological Research in Europe (COHERE)
评估HIV-1感染者从抗逆转录病毒治疗（ART）开始和病毒治疗失败后的病毒亚型预后。来自8个欧洲和3个加拿大队列的数据的协作分析。对1996年至2012年间开始三重ART并拥有病毒亚型数据的成年人（N>20 000）进行了死亡率随访。我们估计了各亚型的粗死亡率风险比（MHR）和调整后的死亡率风险比（MHR）（根据基线时的年龄、性别、治疗方案、CD 4+细胞计数和艾滋病、开始抗逆转录病毒治疗期间、按队列、来源地区和风险组分层）。我们估计了病毒失败后的MHR，病毒失败定义为实现病毒抑制后两次HIV-RNA测量值大于500拷贝/ml。最常见的亚型为B（15 419; 74%）、C（2091; 10%）、CRF 02 AG（1057; 5%）、A（873; 4%）、CRF 01 AE（506; 2.4%）、G（359; 1.7%）和D（232; 1.1%）。 亚型强烈模式的原产地和风险组。在104649人-年的观察期间，1172/20784例患者死亡。 与B亚型相比，A亚型的死亡率较高，但与所有其他亚型相似。当按队列分层时，A与B的MHR为1.13（95%置信区间0.85，1.50），按地区和风险分层时增加至1.78（1.27，2.51），调整协变量后减弱至1.59（1.14，2.23）。对于开始ART时CD 4+细胞计数低于或高于100个细胞/μl的患者，A组与B组的MHR分别为2.65（1.64，4.28）和0.95（0.57，1.57）。A、B、C亚型病毒感染失败后的死亡率无差异。A亚型患者的预后较差，这一观察结果可能受到社会人口统计学因素的混淆。
To estimate prognosis by viral subtype in HIV-1-infected individuals from start of antiretroviral therapy (ART) and after viral failure. Collaborative analysis of data from eight European and three Canadian cohorts. Adults (N>20 000) who started triple ART between 1996 and 2012 and had data on viral subtype were followed for mortality. We estimated crude and adjusted (for age, sex, regimen, CD4+ cell count, and AIDS at baseline, period of starting ART, stratified by cohort, region of origin and risk group) mortality hazard ratios (MHR) by subtype. We estimated MHR subsequent to viral failure defined as two HIV-RNA measurements greater than 500 copies/ml after achieving viral suppression. The most prevalent subtypes were B (15 419; 74%), C (2091; 10%), CRF02AG (1057; 5%), A (873; 4%), CRF01AE (506; 2.4%), G (359; 1.7%), and D (232; 1.1%). Subtypes were strongly patterned by region of origin and risk group. During 104 649 person-years of observation, 1172/20 784 patients died. Compared with subtype B, mortality was higher for subtype A, but similar for all other subtypes. MHR for A versus B were 1.13 (95% confidence interval 0.85,1.50) when stratified by cohort, increased to 1.78 (1.27,2.51) on stratification by region and risk, and attenuated to 1.59 (1.14,2.23) on adjustment for covariates. MHR for A versus B was 2.65 (1.64,4.28) and 0.95 (0.57,1.57) for patients who started ART with CD4+ cell count below, or more than, 100 cells/μl, respectively. There was no difference in mortality between subtypes A, B and C after viral failure. Patients with subtype A had worse prognosis, an observation which may be confounded by socio-demographic factors.