Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy A Multinational Prospective Cohort Study
Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy A Multinational Prospective Cohort Study
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DOI：
10.7326/m20-5226
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发表时间：
2021-06-01
影响因子：
39.2
通讯作者：
Bucher, Heiner C.
中科院分区：
文献类型：
--
作者：
Chammartin, Frederique;Lodi, Sara;Bucher, Heiner C.
背景资料：立即开始抗逆转录病毒治疗（ART），无论CD 4细胞计数如何，都可以降低无症状艾滋病毒阳性者发生艾滋病和非艾滋病相关事件的风险，这是护理的标准。然而，大多数艾滋病毒阳性者在其CD 4计数降至500 × 10（9）个细胞/L以下时开始抗逆转录病毒治疗。延迟ART对非AIDS定义和AIDS定义癌症风险的后果尚不清楚，这是HIV死亡的最常见原因之一。目的：评估立即ART策略对癌症的长期风险差异。设计：多国前瞻性队列研究。设置：D：A：D（抗HIV药物不良事件数据收集）研究，该研究包括来自欧洲、澳大利亚和美国的HIV阳性者。参与者：8318例HIV阳性者，在ART初治期间，CD 4细胞计数和病毒载量各至少测量1次（研究期间，2006年至2016年）。使用参数g公式，调整基线和时间依赖性混杂因素（CD 4细胞计数和病毒载量），以评估10年内发生非AIDS定义和AIDS定义癌症的即时与延迟风险（CD 4计数
Background: Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 x 10(9) cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear.Objective: To estimate the long-term risk difference for cancer with the immediate ART strategy.Design: Multinational prospective cohort study.Setting: The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States.Participants: 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016).Measurements: The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts