Early diagnosis and treatment of HIV infection: magnitude of benefit on short-term mortality is greatest in older adults
Early diagnosis and treatment of HIV infection: magnitude of benefit on short-term mortality is greatest in older adults
复制标题
DOI：
10.1093/ageing/aft052
复制
发表时间：
2013-07-01
期刊：
影响因子：
6.7
通讯作者：
Delpech, Valerie
中科院分区：
文献类型：
--
作者：
Davis, Daniel H. J.;Smith, Ruth;Delpech, Valerie
背景：50岁及以上被诊断为艾滋病毒感染的成年人的数量和比例有所上升。本研究比较了CD 4细胞计数和抗逆转录病毒治疗（ART）对成人死亡率的影响诊断年龄>= 50与那些诊断在一个年轻的age.Methods：回顾性队列分析国家监测报告的艾滋病毒诊断的成年人（15岁及以上）在英格兰，威尔士和北方爱尔兰。在考克斯比例风险模型中确定了年龄、诊断时的CD 4计数和ART对死亡率的相对影响。结果：在2000年至2009年期间确诊为HIV感染的63，805名成年人中，9%（5，683人）的年龄≥ 50岁;老年人更可能是白色、异性恋和CD 4计数< 200个细胞/mm（3）艾滋病（AIDS）诊断时分别为19%和9%（P < 0.01）。老年人的一年死亡率较高（10比3%，P < 0.01），尤其是那些诊断为CD 4 < 200 cells/mm（3）而未接受治疗的患者（46比15%，P < 0.01）。虽然CD < 200 cells/mm 3时开始ART的相对死亡风险降低在两个年龄组中相似，但老年人的绝对风险差异更大（死亡人数减少40人，而死亡人数减少12%），因此治疗老年人以防止一例死亡所需的人数为2人，而年轻人则需要8人。结论：老年人从抗逆转录病毒疗法中获益的幅度大于年轻人。老年人应被视为艾滋病毒检测的对象。加上及时治疗，早期诊断可能会大大减少这一群体的死亡。
Background: the number and proportion of adults diagnosed with HIV infection aged 50 years and older has risen. This study compares the effect of CD4 counts and anti-retroviral therapy (ART) on mortality rates among adults diagnosed aged >= 50 with those diagnosed at a younger age.Methods: retrospective cohort analysis of national surveillance reports of HIV-diagnosed adults (15 years and older) in England, Wales and Northern Ireland. The relative impacts of age, CD4 count at diagnosis and ART on mortality were determined in Cox proportional hazards models.Results: among 63,805 adults diagnosed with HIV between 2000 and 2009, 9% (5,683) were aged >= 50 years; older persons were more likely to be white, heterosexual and present with a CD4 count < 200 cells/mm(3) (48 versus 32% P < 0.01) and AIDS at diagnosis (19 versus 9%, P < 0.01). One-year mortality was higher in older adults (10 versus 3%, P < 0.01) and especially in those diagnosed with a CD4 < 200 cells/mm(3) left untreated (46 versus 15%, P < 0.01). While the relative mortality risk reduction from ART initiation at CD < 200 cells/mm(3) was similar in both age groups, the absolute risk difference was higher among older adults (40 versus 12% fewer deaths) such that the number needed to treat older adults to prevent one death was two compared with eight among younger adults.Conclusions: the magnitude of benefit from ART is greater in older adults than younger adults. Older persons should be considered as a target for HIV testing. Coupled with prompt treatment, earlier diagnosis is likely to reduce substantially deaths in this group.