Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies.
Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies.
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DOI：
10.1371/journal.pmed.1001418
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发表时间：
2013
期刊：
影响因子：
15.8
通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa Collaboration
中科院分区：
文献类型：
--
作者：
Johnson LF;Mossong J;Dorrington RE;Schomaker M;Hoffmann CJ;Keiser O;Fox MP;Wood R;Prozesky H;Giddy J;Garone DB;Cornell M;Egger M;Boulle A;International Epidemiologic Databases to Evaluate AIDS Southern Africa Collaboration
Leigh Johnson及其同事利用2001年至2010年间6个项目的信息，估计了正在接受抗逆转录病毒治疗的艾滋病毒阳性南非成年人的预期寿命。对于低收入和中等收入国家中接受抗逆转录病毒治疗的艾滋病毒阳性成人的预期寿命，几乎没有估计数字。我们的目的是估计南非开始抗逆转录病毒治疗的患者的预期寿命，并将其与艾滋病毒阴性的成年人进行比较。数据收集自六个南非抗逆转录病毒治疗队列。分析仅限于37740名首次开始抗逆转录病毒治疗的艾滋病毒阳性成人。通过将患者记录与国家人口登记册联系起来，获得了死亡率估计数。使用相对生存模型，对不同基线CD4类型和不同持续时间按年龄估计可归因于艾滋病毒的超额死亡率。使用南非人口模型估计非艾滋病毒死亡率。男性开始抗逆转录病毒治疗的平均预期寿命在20岁时的27.6岁（95% CI: 25.2-30.2）和60岁时的10.1岁（95% CI: 9.3-10.8）之间变化，而同一年龄的女性的估计寿命要高得多，分别为36.8岁（95% CI: 34.0-39.7）和14.4岁（95% CI: 13.3-15.3）。如果基线CD4计数≥200个细胞/µl， 20岁女性的预期寿命为43.1年（95% CI: 40.1-46.0），如果基线CD4计数<50个细胞/µl，预期寿命为29.5年（95% CI: 26.2-33.0）。基线CD4计数≥200个细胞/µl的患者的预期寿命在相同年龄和性别的hiv阴性成人的70% - 86%之间，并且在开始ART后存活2年的患者的预期寿命增加了15%-20%。然而，由于缺乏较长时间的死亡率数据，该分析受到限制。南非艾滋病毒阳性的成年人可以有接近正常的预期寿命，只要他们在CD4细胞计数降至200细胞/微升以下之前开始抗逆转录病毒治疗。这些发现表明，高收入国家接受抗逆转录病毒治疗的艾滋病毒阳性个体接近正常的预期寿命也适用于低收入和中等收入国家。根据最新数据，目前全球有3400多万人感染艾滋病毒/艾滋病。2011年，估计有250万人新感染艾滋病毒，同年有170万人死于艾滋病。自1980年代这一流行病开始以来，6 000多万人感染了艾滋病毒，近3 000万人死于与艾滋病毒有关的原因。尽管统计数字令人震惊，但自从采用抗逆转录病毒药物的有效组合以来，艾滋病病毒感染者的预期寿命在过去十年中有了显著改善。在高收入国家，艾滋病毒阳性患者如果终生服用这些药物（作为抗逆转录病毒治疗），预期寿命可接近正常水平。最近调查艾滋病毒感染者预期寿命的研究主要集中在高收入环境中的情况。低收入和中等收入国家的情况大不相同。被诊断患有艾滋病毒的人往往开始治疗较晚，治疗方案有时被中断，很大一部分患者失去了随访。重要的是要对低收入和中等收入国家的预期寿命进行现实的估计，以便向患者提供最佳信息。因此，在这项研究中，研究人员使用了一个模型来估计南非开始抗逆转录病毒治疗的患者的预期寿命，使用的数据来自几个抗逆转录病毒治疗项目。研究人员使用了2001年至2010年间在南非西开普省、豪登省和夸祖鲁-纳塔尔省的六个项目中收集的数据。研究人员计算了从ART开始到死亡日期或研究结束的观察时间。然后，研究人员使用了一种相对生存方法，对南非从开始抗逆转录病毒治疗开始的不同时期内，相对于非艾滋病毒死亡率，归因于艾滋病毒的超额死亡率进行了建模。使用这些方法，研究人员发现，在这段时间内，37740名成年人开始接受抗逆转录病毒治疗，患者记录系统中记录了2066例死亡。在16250名失去随访的患者中，研究人员在人口登记册中确定了2947例死亡。当他们将这些数字输入到他们的模型中时，研究人员估计死亡率为每1000人年观察（PYO） 83.2人，男性（每1000人年观察99.8人）高于女性（每1000人年观察72.6人）。研究人员还发现，决定接受治疗的患者预期寿命的最重要因素是他们开始抗逆转录病毒治疗的年龄：男性开始抗逆转录病毒治疗的平均预期寿命在20岁时的27.6岁到60岁时的10.1岁之间，而女性的相应估计分别为36.8岁和14.4岁。预期寿命也受到基线CD4计数的显著影响；基线CD4计数≥200个细胞/µl的患者的预期寿命为同年龄和性别的hiv阴性成人的70% - 86%，而CD4计数<50个细胞/µl开始抗逆转录病毒治疗的患者的预期寿命为hiv阴性成人的48% - 61%。重要的是，研究人员发现，在开始抗逆转录病毒治疗后的前24个月存活下来的患者的预期寿命也比刚刚开始治疗的同龄患者高出15%-20%。这些发现表明，在南非，开始抗逆转录病毒治疗的患者的预期寿命约为正常预期寿命的80%，前提是他们在CD4细胞计数降至200细胞/微升以下之前开始治疗。虽然这些结果令人鼓舞，但这项研究强调，如果要使大多数艾滋病毒阳性的南非人达到接近正常的预期寿命，卫生服务必须克服重大挑战，例如处理较晚诊断、CD4检测使用率低、失去抗逆转录病毒治疗前的护理和延迟抗逆转录病毒治疗的开始。随着CD4细胞计数较高的患者在未来开始抗逆转录病毒治疗的比例预计会增加，长期生存率有望进一步提高。因此，至关重要的是，要建立适当的筹资制度和降低成本的创新方法，以确保在低收入和中等收入国家提供抗逆转录病毒药物的长期可持续性。请通过本摘要的在线版本（http://dx.doi.org/10.1371/journal.pmed.1001418）访问这些网站。评价艾滋病国际流行病学数据库有来自世界各区域的更多统计信息。艾滋病研究基金会（amfAR）与发展中国家的保健工作者和艾滋病组织合作，制定和实施有效的艾滋病毒研究、治疗、预防和教育战略
Leigh Johnson and colleagues estimate the life expectancies of HIV positive South African adults who are taking antiretroviral therapy by using information from 6 programmes between 2001 and 2010. Few estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults. Data were collected from six South African ART cohorts. Analysis was restricted to 37,740 HIV-positive adults starting ART for the first time. Estimates of mortality were obtained by linking patient records to the national population register. Relative survival models were used to estimate the excess mortality attributable to HIV by age, for different baseline CD4 categories and different durations. Non-HIV mortality was estimated using a South African demographic model. The average life expectancy of men starting ART varied between 27.6 y (95% CI: 25.2–30.2) at age 20 y and 10.1 y (95% CI: 9.3–10.8) at age 60 y, while estimates for women at the same ages were substantially higher, at 36.8 y (95% CI: 34.0–39.7) and 14.4 y (95% CI: 13.3–15.3), respectively. The life expectancy of a 20-y-old woman was 43.1 y (95% CI: 40.1–46.0) if her baseline CD4 count was ≥200 cells/µl, compared to 29.5 y (95% CI: 26.2–33.0) if her baseline CD4 count was <50 cells/µl. Life expectancies of patients with baseline CD4 counts ≥200 cells/µl were between 70% and 86% of those in HIV-negative adults of the same age and sex, and life expectancies were increased by 15%–20% in patients who had survived 2 y after starting ART. However, the analysis was limited by a lack of mortality data at longer durations. South African HIV-positive adults can have a near-normal life expectancy, provided that they start ART before their CD4 count drops below 200 cells/µl. These findings demonstrate that the near-normal life expectancies of HIV-positive individuals receiving ART in high-income countries can apply to low- and middle-income countries as well. Please see later in the article for the Editors' Summary According to the latest figures, more than 34 million people worldwide currently live with HIV/AIDS. In 2011, an estimated 2.5 million people were newly infected with HIV, and in the same year 1.7 million people died from AIDS. Since the beginning of the epidemic in the 1980s, more than 60 million people have contracted HIV and nearly 30 million have died of HIV-related causes. Despite the stark statistics, the life expectancy for people infected with the AIDS virus has dramatically improved over the past decade since the introduction of an effective combination of antiretroviral drugs. In high-income countries, people who are HIV-positive can expect a near-normal life expectancy if they take these drugs (as antiretroviral treatment—ART) throughout their life. Recent studies investigating the life expectancy of people living with HIV have mostly focused on the situation in high-income settings. The situation in low- and middle-income countries is vastly different. People who are diagnosed with HIV are often late in starting treatment, treatments regimes are sometimes interrupted, and a large proportion of patients are lost to follow-up. It is important to gain a realistic estimate of life expectancy in low- and middle-income countries so patients can be given the best information. So in this study the researchers used a model to estimate the life expectancy of patients starting ART in South Africa, using data from several ART programs. The researchers used data collected from six programs in South Africa based in Western Cape, Gauteng, and KwaZulu-Natal between 2001 and 2010. The researchers calculated the observation time from the time of ART initiation to the date of death or to the end of the study. Then the researchers used a relative survival approach to model the excess mortality attributable to HIV, relative to non-HIV mortality rates in South Africa, over different periods from ART initiation. Using these methods, the researchers found that over the time period, 37,740 adults started ART and 2,066 deaths were recorded in patient record systems. Of the 16,250 patients who were lost to follow-up, the researchers identified 2,947 further deaths in the population register. When they inputted these figures into their model, the researchers estimated that the mortality rate was 83.2 per 1,000 person-years of observation (PYO), and was higher in males (99.8 per 1,000 PYO) than in females (72.6 per 1,000 PYO). The researchers also found that the most significant factor determining the life expectancy of treated patients was their age at ART initiation: the average life expectancy of men starting ART varied between 27.6 years at age 20 and 10.1 years at age 60, while corresponding estimates in women were 36.8 and 14.4, respectively. Life expectancies were also significantly influenced by baseline CD4 counts; life expectancies in patients with baseline CD4 counts ≥200 cells/µl were between 70% and 86% of those of HIV-negative adults of the same age and sex, while patients starting ART with CD4 counts of <50 cells/µl had life expectancies that were between 48% and 61% of those of HIV-negative adults. Importantly, the researchers found that life expectancies were also 15%–20% higher in patients who survived their first 24 months after starting ART than in patients of the same age who had just started therapy. These findings suggest that in South Africa, patients starting ART have life expectancies around 80% of normal life expectancy, provided that they start treatment before their CD4 count drops below 200 cells/µl. Although these results are encouraging, this study highlights that health services must overcome major challenges, such as dealing with late diagnosis, low uptake of CD4 testing, loss from pre-ART care, and delayed ART initiation, if near-normal life expectancies are to be achieved for the majority of HIV-positive South Africans. With the anticipated increase in the fraction of patients starting ART at higher CD4 counts in the future, long-term survival can be expected to increase even further. It is therefore critical that appropriate funding systems and innovative ways to reduce costs are put in place, to ensure the long-term sustainability of ART delivery in low- and middle-income countries. Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001418. The International Epidemiologic Databases to Evaluate AIDS has more statistical information from world regions amfAR, the Foundation for AIDS Research, works with health care workers and AIDS organizations in developing countries to create and implement effective HIV research, treatment, prevention, and education strategies
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影响因子：
56.3
作者：
Baernighausen, Till;Chaiyachati, Krisda;Chimbindi, Natsayi;Peoples, Ashleigh;Haberer, Jessica;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise
DOI：
10.1097/qad.0b013e32833d45c5
发表时间：
2010-09-10
期刊：
AIDS (London, England)
影响因子：
--
作者：
Cornell M;Grimsrud A;Fairall L;Fox MP;van Cutsem G;Giddy J;Wood R;Prozesky H;Mohapi L;Graber C;Egger M;Boulle A;Myer L;International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
DOI：
10.1097/qai.0b013e3181b563e7
发表时间：
2010-01-01
影响因子：
3.6
作者：
Harrison, Kathleen McDavid;Song, Ruiguang;Zhang, Xinjian
通讯作者：
Zhang, Xinjian
影响因子：
3.7
作者：
DEAN, C;LAWLESS, JF
通讯作者：
LAWLESS, JF
影响因子：
168.9
作者：
Braitstein, P;Brinkhof, MWG;Egger, M
通讯作者：
Egger, M