Mortality and progression to AIDS after starting highly active antiretroviral therapy
Mortality and progression to AIDS after starting highly active antiretroviral therapy
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DOI：
10.1097/00002030-200310170-00011
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发表时间：
2003-10-17
期刊：
影响因子：
3.8
通讯作者：
de Wolf, F
中科院分区：
文献类型：
--
作者：
van Sighem, AI;van de Wiel, MA;de Wolf, F
目的：研究HIV感染患者开始高效抗逆转录病毒疗法（HAART）后的生存率和进展情况。方法：研究人群包括来自ATHENA观察队列的3724例启动HAART的患者。我们考虑进展为艾滋病定义疾病或死亡，区分艾滋病毒相关和非相关（包括治疗相关）死亡。一个时间依赖的多变量风险模型拟合的患者数据和5年生存概率在各种治疗scenariesestimated.Results：共有459例患者发展为艾滋病和346人死亡，在12 503人年的后续行动。1996年至2000年，艾滋病毒相关死亡率从每100人年3.8例下降到0.7例，而非艾滋病毒相关死亡率没有变化（分别为0.4和0.9，P=0.25）。对于年龄小于50岁、CD 4计数分别高于10 × 10（6）和150 × 10（6）个细胞/l的无症状和有症状的初治患者，连续使用HAART时，预测的5年生存概率高于90%。当在每24周的随访期内使用HAART 20周时，这一限值为450 × 10（6）个细胞/l，当患者在符合治疗条件后延迟开始HAART 1年时，这一限值为110 × 10（6）个细胞/l。因此，最好的治疗策略是在感染的这个阶段开始HAART。然而，考虑到毒性和依从性问题，在CD 4细胞计数高的患者中推迟HAART在临床上可能更合适。非艾滋病毒相关死亡率没有任何变化，表明毒性尚未成为死亡的主要风险因素。(C)2003年利平科特威廉姆斯威尔金斯。
Objectives: To examine survival and progression to AIDS among HIV-infected patients after starting highly active antiretroviral therapy (HAART).Methods: The study population consisted of 3724 patients from the ATHENA observational cohort who initiated HAART. We considered progression to either an AIDS-defining disease or death, distinguishing HIV-related and non-related (including therapy-related) deaths. A time-dependent multivariate hazards model was fitted to the patient data and 5-year survival probabilities under various therapy scenarios estimated.Results: A total of 459 patients developed AIDS and 346 died during 12 503 person-years of follow-up. HIV-related mortality decreased from 3.8 to 0.7 per 100 personyears between 1996 and 2000 whereas non-HIV-related mortality did not change (0.4 and 0.9, respectively, P=0.25). For asymptomatic and symptomatic therapy naive patients younger than 50 years with CD4 counts above 10 X 10(6) and 150 X 10(6) cells/l, respectively, predicted 5-year survival probabilities were above 90% when HAART was used continuously. This limit was 450 X 10(6) cells/l when HAART was used during 20 weeks in each 24 week-period of follow-up, and 110 X 10(6) cells/l when patients delayed initiation of HAART for 1 year after becoming eligible for treatment.Conclusions: Survival probabilities were high among HIV-infected patients initiating HAART at an early stage of infection. The best therapy strategy is therefore to start HAART at this stage of infection. However, deferring HAART in patients with high CD4 cell counts may be clinically more appropriate given toxicity and adherence problems. The lack of any change in non-HIV-related mortality suggests that toxicity has not yet become a major risk factor for death. (C) 2003 Lippincott Williams Wilkins.