Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy.
Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy.
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DOI：
10.1097/qad.0000000000000243
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发表时间：
2014-05-15
期刊：
影响因子：
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通讯作者：
UK Collaborative HIV Cohort (UK CHIC) Study
中科院分区：
文献类型：
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作者：
May MT;Gompels M;Delpech V;Porter K;Orkin C;Kegg S;Hay P;Johnson M;Palfreeman A;Gilson R;Chadwick D;Martin F;Hill T;Walsh J;Post F;Fisher M;Ainsworth J;Jose S;Leen C;Nelson M;Anderson J;Sabin C;UK Collaborative HIV Cohort (UK CHIC) Study
这项研究的目的是根据抗逆转录病毒治疗(ART)的反应来估计HIV阳性患者的预期寿命。在2000-2010年间在为英国CHIC研究做出贡献的艾滋病毒诊所开始抗逆转录病毒治疗(不包括静脉注射)的20岁以上的患者被跟踪调查，直到2012年。我们在抗逆转录病毒治疗前和抗逆转录病毒治疗1-5年的每一年中测定了最新的CD4+细胞计数和病毒载量。在每个抗逆转录病毒治疗期间，根据按性别、年龄、最新的CD_4+细胞计数和病毒抑制(艾滋病毒-1RNA和400 拷贝/毫升)估计的死亡率的生命表被用来估计20-85岁的预期死亡年龄。在21例开始抗逆转录病毒治疗的 388例患者中，961例(4.5%)在110 697人年内死亡。在技术开始时，CD4+细胞计数低于200、200-349、至少350个 细胞/μ的35岁男性L的预期死亡年龄分别为71岁(68-73岁)、78岁(74-82岁)和77岁(72-81岁)，而英国一般人口的预期死亡年龄为78岁。35岁的男性在抗逆转录病毒治疗的第一年将他们的CD+细胞计数从不到200个增加到200-349个或至少350个 细胞/μL，并实现了病毒抑制，分别增加了7年和10年。在接受抗逆转录病毒治疗5年后，35岁男性的预期死亡年龄从54岁(48-61岁)(CD_4+细胞计数和200 细胞/μL，未进行病毒抑制)到80岁(76-83岁)(CD_4+细胞计数≥350 细胞/μL和病毒抑制)。治疗成功的艾滋病毒阳性患者的预期寿命是正常的。如果患者有良好的CD4+细胞计数反应和无法检测到的病毒载量，那么从低CD4+细胞计数开始抗逆转录病毒治疗的患者可以显著提高他们的预期寿命。
The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART). Patients aged more than 20 years who started ART during 2000–2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012. We determined the latest CD4+ cell count and viral load before ART and in each of years 1–5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4+ cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20–85 years. Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 person-years. At start of ART, expected age at death [95% confidence interval (CI)] of 35-year-old men with CD4+ cell count less than 200, 200–349, at least 350 cells/μl was 71 (68–73), 78 (74–82) and 77 (72–81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4+ cell count in the first year of ART from less than 200 to 200–349 or at least 350 cells/μl and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48–61) (CD4+ cell count <200 cells/μl and no viral suppression) to 80 (76–83) years (CD4+ cell count ≥350 cells/μl and viral suppression). Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4+ cell count response and undetectable viral load.