Risk of non-AIDS-related mortality may exceed risk of AIDS-related mortality among individuals enrolling into care with CD4+ counts greater than 200 cells/mm3
Risk of non-AIDS-related mortality may exceed risk of AIDS-related mortality among individuals enrolling into care with CD4+ counts greater than 200 cells/mm3
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DOI：
10.1097/01.qai.0000247229.68246.c5
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发表时间：
2007-02-01
影响因子：
3.6
通讯作者：
Moore, Richard D.
中科院分区：
文献类型：
--
作者：
Lau, Bryan;Gange, Stephen J.;Moore, Richard D.
目的：为了量化原因特异性死亡风险归因于非艾滋病相关和艾滋病相关的原因之前和之后出现的高效抗逆转录病毒疗法（HAART）。方法：竞争风险的方法被用来确定累积的艾滋病相关和非艾滋病相关的死亡风险之间的1990年和2003年底在约翰霍普金斯艾滋病毒临床队列，前瞻性队列研究。结果：从1997年开始采用高效抗逆转录病毒疗法，全因死亡率下降，并一直稳定在每1000人年约39例死亡。在此期间，与艾滋病有关的死亡率继续下降（P = 0.008），而与非艾滋病有关的死亡率上升（P < 0.001）。使用竞争风险方法，在HAART时代，对于CD 4（+）计数：200个细胞/mm（3）的患者，可归因于艾滋病相关原因的死亡风险仍然显著高于可归因于非艾滋病相关原因的死亡风险。然而，对于那些CD 4（+）计数> 200个细胞/mm 3的人，非艾滋病相关的死亡率高于艾滋病相关的死亡率，特别是在注射毒品使用者中。其他传播类别有类似的艾滋病相关和非艾滋病相关的累积mortalitys.Conclusions：HAART降低了HIV感染者的死亡率。但是，要进一步努力降低这一人群的死亡率，就需要更多地关注传统上不被认为与艾滋病毒有关的疾病。
Objective: To quantify cause-specific mortality risk attributable to non-AIDS-related and AIDS-related causes before and after the advent of highly active antiretroviral therapy (HAART).Methods: Competing-risk methods were used to determine the cumulative AIDS-related and non-AID S-related risk of mortality between 1990 and the end of 2003 in the Johns Hopkins HIV Clinical Cohort, a prospective cohort study.Results: Beginning in 1997 with the introduction of HAART, all-cause mortality declined and has remained stable at approximately 39 deaths per 1000 person-years. AIDS-related mortality continued to decline in this period (P = 0.008), whereas non-AIDS-related mortality increased (P < 0.001). Using competing-risk methods, the risk of dying attributable to AIDS-related causes remains significantly higher than the risk of dying attributable to non-AIDS-related causes for patients with a CD4(+) count : 200 cells/mm(3) in the HAART era. For those with a CD4(+) count > 200 cells/mm(3), however, non-AIDS-related mortality was greater than AIDS-related mortality, particularly among injection drug users. Other transmission categories had similar AIDS-related and non-AIDS-related cumulative mortalities.Conclusions: HAART has reduced mortality rates among HIV-infected individuals. but further efforts to reduce mortality in this population require increased attention to conditions that have not traditionally been considered to be HIV related.