Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies.
Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies.
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DOI：
10.1016/s0140-6736(08)61113-7
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发表时间：
2008-07-26
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影响因子：
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通讯作者：
Antiretroviral Therapy Cohort Collaboration
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作者：
Antiretroviral Therapy Cohort Collaboration
联合抗逆转录病毒疗法显著提高了存活率和生活质量，但在人口一级对预期寿命的影响尚不清楚。我们的目的是比较联合抗逆转录病毒治疗的HIV阳性个体的死亡率和预期寿命的变化。抗逆转录病毒治疗队列合作是欧洲和北美艾滋病毒队列研究的多国合作。如果患者年龄在16岁或以上，并且在开始联合治疗时未接受过抗逆转录病毒治疗，则将其纳入本分析。我们构建了简化的生命表，以估计1996-99年、2000-02年和2003-05年接受联合抗逆转录病毒治疗的个体的预期寿命，并按性别、基线CD 4细胞计数和注射吸毒史分层。对20岁和35岁接受抗逆转录病毒综合疗法治疗者的平均剩余寿命进行了估计。还计算了20至64岁的潜在寿命损失年数和粗死亡率。1996- 1999年、2000- 2002年和2003- 2005年，分别有18 587、13 914和10 854名合格患者开始联合抗逆转录病毒治疗。在研究期间观察到2056例（4.7%）死亡，粗死亡率从1996-99年的每1000人年16.3例死亡下降到2003-05年的每1000人年10.0例死亡。同时，每1000人年的潜在寿命损失年数也从366年下降到189年。20岁时的预期寿命从36.1（SE 0.6）岁增加到49.4（SE 0.5）岁。妇女的预期寿命高于男子。假定通过注射吸毒传播的患者的预期寿命低于其他传播组的患者（2003-05年为32.6 [1.1]年对44.7 [0.3]年）。基线CD 4计数较低的患者的预期寿命低于基线计数较高的患者（CD 4细胞计数低于100个细胞/μL的患者为32·4 [1·1]年，而计数≥ 200个细胞/μL的患者为50·4 [0·4]年）。1996年至2005年期间，接受抗逆转录病毒综合疗法治疗的艾滋病毒感染者的预期寿命有所增加，尽管患者分组之间存在相当大的差异。然而，在这些国家，20岁时的平均剩余寿命约为一般人口的三分之二。
Combination antiretroviral therapy has led to significant increases in survival and quality of life, but at a population-level the effect on life expectancy is not well understood. Our objective was to compare changes in mortality and life expectancy among HIV-positive individuals on combination antiretroviral therapy. The Antiretroviral Therapy Cohort Collaboration is a multinational collaboration of HIV cohort studies in Europe and North America. Patients were included in this analysis if they were aged 16 years or over and antiretroviral-naive when initiating combination therapy. We constructed abridged life tables to estimate life expectancies for individuals on combination antiretroviral therapy in 1996–99, 2000–02, and 2003–05, stratified by sex, baseline CD4 cell count, and history of injecting drug use. The average number of years remaining to be lived by those treated with combination antiretroviral therapy at 20 and 35 years of age was estimated. Potential years of life lost from 20 to 64 years of age and crude death rates were also calculated. 18 587, 13 914, and 10 854 eligible patients initiated combination antiretroviral therapy in 1996–99, 2000–02, and 2003–05, respectively. 2056 (4·7%) deaths were observed during the study period, with crude death rates decreasing from 16·3 deaths per 1000 person-years in 1996–99 to 10·0 deaths per 1000 person-years in 2003–05. Potential years of life lost per 1000 person-years also decreased over the same time, from 366 to 189 years. Life expectancy at age 20 years increased from 36·1 (SE 0·6) years to 49·4 (0·5) years. Women had higher life expectancies than men. Patients with presumed transmission via injecting drug use had lower life expectancies than those from other transmission groups (32·6 [1·1] years vs 44·7 [0·3] years in 2003–05). Life expectancy was lower in patients with lower baseline CD4 counts than in those with higher baseline counts (32·4 [1·1] years for CD4 cell counts below 100 cells per μL vs 50·4 [0·4] years for counts of 200 cells per μL or more). Life expectancy in HIV-infected patients treated with combination antiretroviral therapy increased between 1996 and 2005, although there is considerable variability in subgroups of patients. However, the average number of years remaining to be lived at age 20 years was about two-thirds of that in the general population in these countries.