Changes in the incidence and predictors of human immunodeficiency virus-associated dementia in the era of highly active antiretroviral therapy
Changes in the incidence and predictors of human immunodeficiency virus-associated dementia in the era of highly active antiretroviral therapy
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DOI：
10.1002/ana.21225
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发表时间：
2008-02-01
影响因子：
11.2
通讯作者：
Porter, Kholoud
中科院分区：
文献类型：
--
作者：
Bhaskaran, Krishnan;Mussini, Cristina;Porter, Kholoud
目的：虽然目前已有有效的抗人类免疫缺陷病毒（HIV）治疗方法，但其对脑组织的渗透性各不相同。因此，我们的目的是评估在日历时间的变化，艾滋病毒相关的痴呆症（HIV-D）的风险，与HIV-D risk.Methods的因素：使用协调行动在欧洲（CASCADE）的艾滋病和死亡的血清转化数据，我们分析了与时间相关的因素，从HIV血清转化为HIV-D使用考克斯模型与时间更新的协变量。使用灵活的参数生存models.Results的感染持续时间的影响进行了探讨：222 15,380血清转换发展HIV-D。1997年前（在高效抗逆转录病毒疗法出现之前），每1 000人年的发病率为6.49，到2003年至2006年下降到0.66。与最近的CD 4计数>= 350个细胞/mm（3）相比，HIV-D的95%可信区间为3.47在200至349、100至199和0至99个细胞/mm（3）下分别为1.91-6.28、10.19（5.72-18.15）和39.03（22.96-66.36）。在2003年至2006年期间，血清转换时年龄较大（相对风险=每10年增加3.24 [95%置信区间，2.00-5.24]）和既往获得性免疫缺陷综合征诊断（相对风险= 4.92 [95%置信区间，1.43-16.92]）与HIV-D风险相关，与当前CD 4计数无关。在慢性感染过程中，HIV-D的风险似乎增加了，血清转换后10年时增加了48%，而1.8年时的最低风险则增加了48%。低血糖患者（
Objective: Though effective anti-human immunodeficiency virus (HIV) therapies are now available, they have variable penetration into the brain. We therefore aimed to assess changes over calendar time in the risk for HIV-associated dementia (HIV-D), and factors associated with HIV-D risk.Methods: Using Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) data, we analyzed factors associated with time from HIV seroconversion to HIV-D using Cox models with time-updated covariates. The effect of duration of infection was explored using flexible parametric survival models.Results: 222 of 15,380 seroconverters developed HIV-D. The incidence per 1,000 person-years was 6.49 pre-1997 (before highly active antiretroviral therapy was available), declining to 0.66 by 2003 to 2006. Compared with most recent CD4 count >= 350 cells/mm(3), the adjusted relative risk (95% confidence interval) of HIV-D was 3.47 (1.91-6.28), 10.19 (5.72-18.15), and 39.03 (22.96-66.36) at 200 to 349, 100 to 199, and 0 to 99 cells/mm(3), respectively. In 2003 to 2006, older age at seroconversion (relative risk = 3.24 per 10-year increase [95% confidence interval, 2.00-5.24]) and previous acquired immune deficiency syndrome diagnosis (relative risk = 4.92 [95% confidence interval, 1.43-16.92]) were associated with HIV-D risk, independently of current CD4 count. HIV-D risk appeared to increase during chronic infection, by 48% at 10 years after seroconversion compared with the lowest risk at 1.8 years.Interpretation: HIV-D incidence has reduced markedly since 1997. However, patients with low (