The survival benefits of AIDS treatment in the United States
The survival benefits of AIDS treatment in the United States
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DOI：
10.1086/505147
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发表时间：
2006-07-01
影响因子：
6.4
通讯作者：
Freedberg, Kenneth A.
中科院分区：
文献类型：
--
作者：
Walensky, Rochelle P.;Paltiel, A. David;Freedberg, Kenneth A.
背景随着强效联合抗逆转录病毒治疗（ART）的广泛采用，达到了第十个年头，我们的目标是量化美国获得性免疫缺陷综合征（AIDS）护理的累积生存益处。我们定义了与人类免疫缺陷病毒（HIV）疾病护理标准的进步相对应的时代，包括机会性感染预防、ART治疗和预防HIV母婴传播（pMTCT）。使用数学模拟模型确定每个时代的人均生存效益。公布的估计提供了1989年至2003年美国接受治疗的新诊断为艾滋病的成年患者人数。与未经治疗的HIV疾病相关的生存率相比，单独使用肺孢子虫肺炎预防的人均生存率增加了0.26年。与没有治疗相比，除了预防外，四个时代越来越有效的ART导致人均生存期增加7.81，11.05，11.57和13.33年。自1989年以来，美国对艾滋病患者的治疗使其总生存期延长了280万年。pMTCT避免了近2900例婴儿感染，相当于额外增加137，000年的生存获益。在美国，由于对艾滋病患者的护理，至少挽救了300万年的生命，这突出了艾滋病治疗方面取得的重大进展。
Background. As widespread adoption of potent combination antiretroviral therapy ( ART) reaches its tenth year, our objective was to quantify the cumulative survival benefits of acquired immunodeficiency syndrome ( AIDS) care in the United States.Methods. We defined eras corresponding to advances in standards of human immunodeficiency virus ( HIV) disease care, including opportunistic infection prophylaxis, treatment with ART, and the prevention of mother-to-child transmission ( pMTCT) of HIV. Per-person survival benefits for each era were determined using a mathematical simulation model. Published estimates provided the number of adult patients with new diagnoses of AIDS who were receiving care in the United States from 1989 to 2003.Results. Compared with survival associated with untreated HIV disease, per-person survival increased 0.26 years with Pneumocystis jiroveci pneumonia prophylaxis alone. Four eras of increasingly effective ART in addition to prophylaxis resulted in per-person survival increases of 7.81, 11.05, 11.57, and 13.33 years, compared with the absence of treatment. Treatment for patients with AIDS in care in the United States since 1989 yielded a total survival benefit of 2.8 million years. pMTCT averted nearly 2900 infant infections, equivalent to 137,000 additional years of survival benefit.Conclusions. At least 3.0 million years of life have been saved in the United States as a direct result of care of patients with AIDS, highlighting the significant advances made in HIV disease treatment.