Effectiveness of highly active antiretroviral therapy in Spanish cohorts of HIV seroconverters:: differences by transmission category
Effectiveness of highly active antiretroviral therapy in Spanish cohorts of HIV seroconverters:: differences by transmission category
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DOI：
10.1097/00002030-200302140-00009
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发表时间：
2003-02-14
期刊：
影响因子：
3.8
通讯作者：
Hernàndez-Aguado, I
中科院分区：
文献类型：
--
作者：
Pérez-Hoyos, S;del Amo, J;Hernàndez-Aguado, I
目的：评价高效抗逆转录病毒疗法(HAART)在人类免疫缺陷病毒(HIV)进展中的人群有效性，并确定HAART治疗效果在GEMES(西班牙多中心血清转换者研究)中的异质性。设计：多中心队列研究。方法：对20世纪80年代至2000年1月1091例有良好记录的HIV血清转换患者的资料进行分析。采用Kaplan-Meier方法和Cox比例风险模型，比较不同历期HIV感染者在1992、1992-1995(参考)、1996-1997、1998和1999年前的艾滋病风险和死亡风险，允许较晚进入，拟合历期作为时间依赖协变量，并调整传播类别、年龄和性别。结果：艾滋病风险的显著降低始于1998年[危险比(HR)，0.59；95%可信区间(CI)，0.35-1.01]，在1999年(HR，0.45；95%氯，0.24-0.84)。死亡风险在1997年出现下降，但直到1999年才达到边缘显著水平(HR，0.53；95%CI，0.26-1.07)。女性进展为艾滋病和死亡的速度较慢(HR分别为0.68和0.53；95%CI分别为0.46~0.99和0.33~0.87)。与男男性行为者(MSM)相比，静脉注射吸毒者(IDU)感染艾滋病和死亡的风险降低较低。结论：与1992-1995年相比，1998年和1999年后Geme的艾滋病发病率和死亡率分别下降，其中MSM比IDU更明显，IDU是西班牙最常见的类别。(C)2003年，里平科特·威廉姆斯·威尔金斯。
Objective: To evaluate the population effectiveness of highly active antiretroviral therapy (HAART) in HIV progression and determine the heterogeneity of the effect of HAART in GEMES (Spanish multicenter study of seroconverters).Design: Multicenter cohort study.Methods: Data from 1091 persons with well-documented HIV seroconversion dates from 1980s to January 2000 were analysed. Risk of AIDS and death in subjects with same duration of HIV infection were compared in different calendar periods; before 1992, 1992-1995 (reference), 1996-1997, 1998 and 1999 with Kaplan-Meier methods and Cox proportional hazards models, allowing for late entry, fitting calendar period as time-dependent covariate and adjusting for transmission category, age and gender.Results: Statistically significant reductions in the risk of AIDS were first observed in 1998 [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.35-1.01] becoming more pronounced in 1999 (HR, 0.45; 95% Cl, 0.24-0.84). Reduction in the risk of death was seen in 1997, though only reached borderline significance in 1999 (HR, 0.53; 95% Cl, 0.26-1.07). Progression to AIDS and death was slower in women (HR, 0.68; 95% Cl, 0.46-0.99 and HR, 0.53; 95% Cl, 0.33-0.87, respectively). Compared with men who have sex with men (MSM), intravenous drug users (IDU) had lower reductions in the risk of AIDS and death.Conclusions: Reductions in incidence of AIDS and death in GEMES are seen after 1998 and 1999, respectively, compared with 1992-1995, being more pronounced in MSM compared with IDU, the commonest category in Spain. (C) 2003 Lippincott Williams Wilkins.