Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies.
Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies.
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DOI：
10.1016/s2352-3018(17)30066-8
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发表时间：
2017-08
期刊：
影响因子：
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通讯作者：
Antiretroviral Therapy Cohort Collaboration
中科院分区：
文献类型：
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作者：
Antiretroviral Therapy Cohort Collaboration
在过去二十年中，艾滋病毒感染者的保健得到了极大改善。对这些改善如何影响预后和预期寿命的可靠估计对患者，临床医生和卫生保健规划者至关重要。我们研究了1996年至2013年开始联合抗逆转录病毒治疗（ART）的患者的3年生存率和预期寿命的变化。我们分析了来自18个欧洲和北美HIV-1队列的数据。如果患者（年龄≥16岁）在1996年至2010年期间开始接受三种或三种以上药物的ART治疗，并且有至少3年的潜在随访，则有资格参加本分析。我们估计了四个日历期（1996-99，2000-03 [对照]，2004-07，2008-10）ART开始后第一年和ART开始后第二年和第三年的校正（年龄，性别，AIDS，风险组，CD 4细胞计数和ART开始时的HIV-1 RNA）全因和病因特异性死亡风险比（HR）。我们根据开始ART治疗的日历期估计了预期寿命。我们的分析包括88504例患者，其中2106例在ART治疗的第一年死亡，2302例在ART治疗的第二年或第三年死亡。2008-10年开始ART治疗的患者在ART治疗后第一年的全因死亡率低于2000-03年开始ART治疗的患者（校正HR 0.71，95%CI 0.61 - 0.83）。 2008-10年开始抗逆转录病毒治疗的患者在开始抗逆转录病毒治疗后第二年和第三年的全因死亡率也低于2000-03年开始的患者（0.57，0.49 - 0.67）;这种下降不能完全用1年时的病毒载量和CD 4细胞计数来解释。在2008-10年开始抗逆转录病毒治疗的患者中，非艾滋病死亡率较低（与2000-03年相比）（0·48，0·34-0·67）和第二年和第三年（0·29，0·21-0·40）。1996年至2010年期间，开始抗逆转录病毒治疗的20岁患者的预期寿命在女性中增加了约9年，在男性中增加了10年。即使在ART晚期，ART前3年的生存率也在继续提高，这可能反映了向毒性较小的抗逆转录病毒药物的过渡、依从性的提高、预防措施和合并症的管理。应更新预测模型和预期寿命估计数，以反映这些改善。英国医学研究理事会、英国国际发展部、欧盟EDCTP 2项目。
Health care for people living with HIV has improved substantially in the past two decades. Robust estimates of how these improvements have affected prognosis and life expectancy are of utmost importance to patients, clinicians, and health-care planners. We examined changes in 3 year survival and life expectancy of patients starting combination antiretroviral therapy (ART) between 1996 and 2013. We analysed data from 18 European and North American HIV-1 cohorts. Patients (aged ≥16 years) were eligible for this analysis if they had started ART with three or more drugs between 1996 and 2010 and had at least 3 years of potential follow-up. We estimated adjusted (for age, sex, AIDS, risk group, CD4 cell count, and HIV-1 RNA at start of ART) all-cause and cause-specific mortality hazard ratios (HRs) for the first year after ART initiation and the second and third years after ART initiation in four calendar periods (1996–99, 2000–03 [comparator], 2004–07, 2008–10). We estimated life expectancy by calendar period of initiation of ART. 88 504 patients were included in our analyses, of whom 2106 died during the first year of ART and 2302 died during the second or third year of ART. Patients starting ART in 2008–10 had lower all-cause mortality in the first year after ART initiation than did patients starting ART in 2000–03 (adjusted HR 0·71, 95% CI 0·61–0·83). All-cause mortality in the second and third years after initiation of ART was also lower in patients who started ART in 2008–10 than in those who started in 2000–03 (0·57, 0·49–0·67); this decrease was not fully explained by viral load and CD4 cell count at 1 year. Rates of non-AIDS deaths were lower in patients who started ART in 2008–10 (vs 2000–03) in the first year (0·48, 0·34–0·67) and second and third years (0·29, 0·21–0·40) after initiation of ART. Between 1996 and 2010, life expectancy in 20-year-old patients starting ART increased by about 9 years in women and 10 years in men. Even in the late ART era, survival during the first 3 years of ART continues to improve, which probably reflects transition to less toxic antiretroviral drugs, improved adherence, prophylactic measures, and management of comorbidity. Prognostic models and life expectancy estimates should be updated to account for these improvements. UK Medical Research Council, UK Department for International Development, EU EDCTP2 programme.