Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study.
Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study.
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DOI：
10.1016/s2352-3018(20)30358-1
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发表时间：
2021-05
期刊：
影响因子：
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通讯作者：
Caribbean, Central and South America network for HIV epidemiology (CCASAnet)
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文献类型：
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作者：
Smiley CL;Rebeiro PF;Cesar C;Belaunzaran-Zamudio PF;Crabtree-Ramirez B;Padgett D;Gotuzzo E;Cortes CP;Pape J;Veloso VG;McGowan CC;Castilho JL;Caribbean, Central and South America network for HIV epidemiology (CCASAnet)
在抗逆转录病毒疗法日益普及的低收入和中等收入环境中，关于艾滋病毒感染者预期寿命增长的数据很少。我们计算了在加勒比、中美洲和南美洲艾滋病毒流行病学网络（CCASAnet）内开始抗逆转录病毒治疗的PWH的预期寿命趋势。2003-2017年间，来自阿根廷、巴西、智利、海地、洪都拉斯、墨西哥和秘鲁CCASAnet研究中心的开始ART且≥20岁的PWH贡献了直至死亡、末次联系、数据库关闭或2017年12月的人次。我们使用简化生命表的Chiang方法来估计三个时代（2003-2008年，2009-2012年和2013-2017年）20岁时的预期寿命，并根据ART开始时的人口统计学和临床特征进行估计。我们使用泊松回归模型来衡量死亡率，以解释信息性删失。在30，688名PWH中，17，491名（57%）来自海地，13，197名（43%）来自所有其他地点。在海地的PWH中有1，470人死亡，在其他地点有1，167人死亡。在历年中，所有年龄组的粗死亡率和加权死亡率都有所下降。2003-2008至2013-2017年间，威尔斯亲王医院20岁时的整体预期寿命，（95%置信区间[CI]：12·5-15·2]）至61·2岁（95%CI：59.0 - 63.4），所有其他研究中心为31.0（95%CI：29.3 - 32.8）至69.5岁（95%CI：67.2 - 71.8），接近一般人群的预期寿命（海地为69.9岁，所有其他研究中心为78.0岁）。然而，不同性别/性传播艾滋病毒风险因素、CD 4细胞计数、教育和抗逆转录病毒治疗时或之前的结核病导致的预期寿命差异在各个日历时代都持续存在。在拉丁美洲，接受抗逆转录病毒疗法的艾滋病患者的预期寿命有了显著提高。在开始抗逆转录病毒治疗时，人口统计和临床因素造成的预期寿命持续存在差异，突出表明该区域的弱势群体。美国国立卫生研究院
Sparse data exist on life expectancy gains among persons living with HIV (PWH) in low- and middle-income settings where antiretroviral therapy (ART) is increasingly available. We calculated life expectancy trends among PWH initiating ART within the Caribbean, Central and South America network for HIV epidemiology (CCASAnet). PWH initiating ART and ≥20 years old between 2003–2017 from CCASAnet sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru contributed person-time until the date of death, last contact, database closure, or December 2017. We used the Chiang method of abridged life tables to estimate life expectancy at age 20 for three eras (2003–2008, 2009–2012, and 2013–2017) overall and by demographic and clinical characteristics at ART initiation. We used Poisson regression models to weight mortality rates to account for informative censoring. Among 30,688 PWH, 17,491 (57%) were from Haiti and 13,197 (43%) were from all other sites. There were 1,470 deaths among PWH in Haiti and 1,167 deaths at other sites. Crude and weighted mortality rates decreased among all age groups over calendar eras. From 2003–2008 to 2013–2017, overall life expectancy for PWH at age 20 years increased from 13·9 (95% confidence interval [CI]: 12·5–15·2]) to 61·2 years (95%CI: 59·0–63·4) at Haiti and from 31·0 (95% CI: 29·3–32·8) to 69·5 years (95% CI: 67·2–71·8) at all other sites, approaching life expectancies of the general population (69·9 years in Haiti and 78·0 years at all other sites). However, disparities in life expectancy by sex/sexual HIV transmission risk factor, CD4 cell count, education, and tuberculosis at or prior to ART persisted across calendar eras. Life expectancy among PWH on ART has significantly improved in Latin America. Persistent disparities in life expectancy by demographic and clinical factors at ART initiation highlight vulnerable populations in the region. US National Institutes of Health