Survival after AIDS diagnosis in adolescents and adults during the treatment era, United States, 1984-1997
Survival after AIDS diagnosis in adolescents and adults during the treatment era, United States, 1984-1997
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DOI：
10.1001/jama.285.10.1308
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发表时间：
2001-03-14
影响因子：
120.7
通讯作者：
Fleming, PL
中科院分区：
文献类型：
--
作者：
Lee, LM;Karon, JM;Fleming, PL
1996年首次观察到获得性免疫机能丧失综合症（艾滋病）死亡人数下降，原因是抗逆转录病毒疗法有所改善，接受治疗的人数比例有所增加。目的了解1984-1997年全国艾滋病患者生存时间变化趋势。设计、环境和研究对象：回顾性队列研究，使用基于人群的美国艾滋病病例和死亡登记数据。主要结果测量1998年12月31日艾滋病诊断后的生存月数，与诊断年份进行比较。结果1984-1997年确诊的394705例艾滋病机会性疾病（OI）患者中位生存时间由1984年的11个月提高到1995年的46个月。在1996年和1997年诊断为成骨不全的患者中，67%在诊断后至少存活36个月，77%在诊断后至少存活24个月。在1993-1997年诊断的296621例艾滋病病例中，65%基于免疫标准，35%基于OI标准；80%为男性；非西班牙裔黑人占42%，非西班牙裔白人占40%，西班牙裔占17%，亚洲人/太平洋岛民占1%，美洲印第安人/阿拉斯加原住民占不到1%。存活至少24个月的概率从1993年免疫诊断的67%增加到1997年的90%，从1993年成骨不全症诊断的49%增加到1997年的80%，从1984年到1997年，黑人、白人和西班牙裔患者的存活时间每年都在增加。1995年和1996年，每名接受艾滋病诊断的儿童的年存活率最高。结论1984 - 1997年艾滋病确诊后的生存时间有所延长，艾滋病发病率在下降的同时，随着慢性人类免疫缺陷病毒病/艾滋病患者数量的增加，生存时间的延长对公共卫生提出了越来越大的挑战。
Context Declines in the number of acquired immunodeficiency syndrome (AIDS) deaths were first observed in 1996, attributed to improvements in antiretroviral therapy and an increase in the proportion of persons receiving therapy.Objective To examine national trends in survival time among persons diagnosed as having AIDS in 1984-1997.Design, Setting, and Subjects Retrospective cohort study using data from a population-based registry of AIDS cases and deaths reported in the United States.Main Outcome Measure Months of survival after AIDS diagnosis through December 31, 1998, compared by year of diagnosis.Results Among 394705 persons with an AIDS-defining opportunistic illness (OI) diagnosed in 1984-1997, median survival time improved from 11 months for 1984 diagnoses to 46 months for 1995 diagnoses. Among persons with an OI diagnosed in 1996 and 1997, 67% were alive at least 36 months after diagnosis and 77% were alive at least 24 months after diagnosis, respectively. Among 296621 AIDS cases diagnosed during 1993-1997, 65% were based on immunologic criteria and 35% on OI criteria; 80% were among men; and 42% were among non-Hispanic blacks, 40% among non-Hispanic whites, 17% among Hispanics, 1% among Asians/Pacific islanders, and less than 1% among American Indians/Alaska natives. The probability of surviving at least 24 months increased from 67% for those with immunologic diagnoses in 1993 to 90% in 1997 and from 49% for those with OI diagnoses in 1993 to 80% in 1997, Survival time increased with each year of diagnosis from 1984 to 1997 for blacks, whites, and Hispanics. The greatest annual survival gains occurred among per sons receiving an AIDS diagnosis in 1995 and 1996.Conclusions Survival time after AIDS diagnosis improved from 1984 to 1997, While AIDS incidence is declining, improved survival times present a growing public health challenge as the number of persons living with chronic human immunodeficiency virus disease/AIDS increases.