Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis
Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis
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DOI：
10.1016/s0140-6736(00)02061-4
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发表时间：
2000-04-01
期刊：
影响因子：
168.9
通讯作者：
Schechter, M
中科院分区：
文献类型：
--
作者：
Babiker, A;Darby, S;Schechter, M
背景我们使用来自欧洲，北美和澳大利亚的数据，以评估艾滋病潜伏期和HIV-1生存的影响，以及是否在血清转换的年龄的影响与暴露类别和时间不同，因为seroconversion.Methods 38研究HIV-1感染者的血清转换的日期可以可靠地估计包括在分析中。对来自15个国家的13030名HIV-1感染者的个人数据进行了集中整理、检查和分析。我们计算了死亡率和艾滋病发病率的估计值，并根据观察到的死亡或艾滋病病例数和相应的危险人年数，估计了血清转换后每年存活和发展艾滋病的个体比例。分析进行了调整后的血清转换，时间，血清转换，和其他因素assumption.Findings死亡率和艾滋病的发病率随着时间的推移，因为血清转换和年龄在血清转换。中位生存期从15-24岁血清转换时的12.5年（95%CI 12.1-12.9）到45-54岁血清转换时的7.9年（7.4-8.5）不等，而发展为AIDS的相应值分别为11.0年（10.7-11.7）和7.7年（7.1-8.6）。暴露类别对生存率无明显影响。对于艾滋病发病率，我们注意到的暴露类别效应是由男性之间性行为感染的卡波西肉瘤的高发病率解释的。我们估计，在血清转换时年龄在25-29岁之间的人中，90%（89-91）和60%（57-62）分别存活到血清转换后的5年和10年，而13%（12-15）和46%（44-49），发展成艾滋病（不包括卡波西肉瘤）。解释在广泛使用高效抗逆转录病毒疗法之前（1996年以前），在欧洲、北美和澳大利亚，自血清转换以来的时间和血清转换时的年龄是艾滋病生存和发展的主要决定因素。
Background We used data from Europe, North America, and Australia to assess the effect of exposure category on the AIDS incubation period and HIV-1 survival and whether the effect of age at seroconversion varies with exposure category and with time since seroconversion.Methods 38 studies of HIV-1-infected individuals whose dates of seroconversion could be reliably estimated were included in the analysis. Individual data on 13 030 HIV-1-infected individuals from 15 countries were collated, checked, and analysed centrally. We calculated estimates of mortality and AIDS incidence rates and estimated the proportions of individuals surviving and developing AIDS at each year after seroconversion from the numbers of observed deaths or cases of AIDS and the corresponding person-years at risk. Analyses were adjusted for age at seroconversion, time since seroconversion, and other factors as appropriate.Findings Mortality and AIDS incidence increased strongly with time since seroconversion and age at seroconversion. Median survival varied from 12.5 years (95% CI 12.1-12.9) for those aged 15-24 years at seroconversion to 7.9 years (7.4-8.5) for those aged 45-54 years at seroconversion, whereas for development of AIDS the corresponding values were 11.0 years (10.7-11.7) and 7.7 years (7.1-8.6). There was no appreciable effect of exposure category on survival. For AIDS incidence, the exposure category effect that we noted was explained by the high incidence of Kaposi's sarcoma in those infected through sex between men. We estimated that among people aged 25-29 years at seroconversion 90% (89-91) and 60% (57-62) survived to 5 years and 10 years, respectively, after seroconversion, whereas 13% (12-15) and 46% (44-49), respectively, developed AIDS (excluding Kaposi's sarcoma).Interpretation Before widespread use of highly-active antiretroviral therapy (before 1996), time since seroconversion and age at seroconversion were the major determinants of survival and development of AIDS in Europe, North America, and Australia.