Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy
Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy
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DOI：
10.1097/qad.0b013e32802ef30c
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发表时间：
2007-03-30
期刊：
影响因子：
3.8
通讯作者：
Montaner, Julio S. G.
中科院分区：
文献类型：
--
作者：
Lima, Viviane D.;Hogg, Robert S.;Montaner, Julio S. G.
目的：分析加拿大不列颠哥伦比亚省1993年至2004年间开始抗逆转录病毒治疗的HIV阳性患者死亡率和预期寿命的时间变化。方法：对1993年1月至2004年9月期间开始抗逆转录病毒治疗的2238名HIV阳性患者进行分析。主要分析终点是按四个时间段分层的全因死亡率：1993-1995年、1996-1998年、1999-2001年和2002-2004年。使用COX比例风险模型及其相关的951%可信区间(0)估计死亡风险。结果：对治疗后12个月累积死亡率的产品极限估计值从1993-1995年的15.8%(+1.6%)下降到2002-2004年的6.11%(1.1%)。20岁的预期寿命从1993-1995年的9.1岁(2.3岁)增加到2002-2004年的23.6岁(4.4岁)。1993-1995年的受试者比2002-2004年开始接受治疗的受试者更有可能死亡(危险比2.78；95%可信区间1.92-3.85)。接受双重治疗或含有3种或3种以上抗逆转录病毒药物的患者死亡的可能性分别比开始接受单一治疗的患者低1.49倍(95%可信区间1.23~1.82)和2.56倍(95%可信区间2.13~3.13)。结论：在12年的研究期间，死亡率显著下降，预期寿命增加。预期寿命的延长和死亡率的降低与现代形式的高龄抗逆转录病毒疗法的使用直接相关。(C)2007年，Lippincott Williams&Wilkins。
Objective: To characterize the temporal changes in mortality and life expectancy among HIV-positive individuals initiating antiretroviral therapy in British Columbia, Canada, from 1993 to 2004.Methods: This analysis was restricted to 2238 anti retroviral-naive HIV-positive individuals who started antiretroviral therapy between January 1993 and September 2004. The primary analysis endpoint was all-cause mortality stratified by four time periods: 1993-1995, 1996-1998, 1999-2001, and 2002-2004. Cox proportional hazard models, with associated 951% confidence intervals (0), were used to estimate the hazard of death. Abridged life tables were constructed to compare life expectancies at the age of 20 years.Results: Product limit estimates of the cumulative mortality rate at 12 months after therapy initiation decreased from 15.8%, (+1.6%) in 1993-1995 to 6.11% ( 1.1%) in 2002-2004. Life expectancy at the age of 20 years has increased from 9.1 years ( 2.3 years) in 1993-1995 to 23.6 years ( 4.4 years) in 2002-2004. Subjects in 1993-1995 were more likely to die than those who started therapy in 2002-2004 (hazard ratio 2.78; 95% CI 1.92-3.85). Patients who initiated dual therapy or therapies containing three or more antiretroviral drugs were, respectively, 1.49 (95% CI 1.23-1.82) and 2.56 (95% CI 2.13-3.13) times less likely to die than those who started on monotherapy.Conclusion: A significant and progressive decrease in mortality and increase in life expectancy were observed over the 12-year study period. The increase in life expectancy and decrease in mortality were directly associated with the use of modern forms of HAART. (c) 2007 Lippincott Williams & Wilkins.