Mortality in HIV-hepatitis C co-infected patients in Canada compared to the general Canadian population (2003-2013)
Mortality in HIV-hepatitis C co-infected patients in Canada compared to the general Canadian population (2003-2013)
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DOI：
10.1097/qad.0000000000000377
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发表时间：
2014-08-24
期刊：
影响因子：
3.8
通讯作者：
Cooper, Curtis
中科院分区：
文献类型：
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作者：
Klein, Marina B.;Rollet-Kurhajec, Kathleen C.;Cooper, Curtis
目的：最近的研究表明，HIV单一感染者的全因死亡率接近一般人群。我们的目的是比较参与者在加拿大合并感染队列的一般人群，以确定是否合并感染的患者有类似的改善mortality. Design：前瞻性多中心队列study.Methods：在2003年和2013年之间，死亡被捕获使用特定的病例报告，并通过链接到省级人口动态统计的参与者失去了后续行动。使用2009年加拿大人类死亡率数据库中的年龄、性别和省份特异性死亡率计算标准化死亡率（SMR），并在最近一次访视时对参与者的行为和临床特征进行比较。在1150例患者中，我们观察到133例死亡超过3351人年（4.0/100人年，95%置信区间3.3，4.6）。SMR（95%置信区间）为：总体12.1（10.1，14.2）;男性9.3（7.5，11.1），女性19.4（12.7，26.2）。CD4_细胞计数低于200个细胞/μ l [25.5（17.7，33.3）]、主动注射吸毒[19.9（13.9，25.9）]和吸烟[14.9（12.1，17.7）]与死亡率过高密切相关。自发清除[4.5（-0.6，9.5）]或治疗诱导清除丙型肝炎病毒（HCV）感染[5.1（1.3，8.8）]的患者SMR最低。相反，晚期肝病患者的SMR较高[17.0（11.7，22.3）]。在任何类别中没有SMRs的方法死亡率在一般Canadian population.Conclusions：HIV-HCV合并感染者的死亡风险仍然显着增加，尽管抗逆转录病毒治疗。针对可改变的风险因素，如物质使用，吸烟，坚持抗逆转录病毒治疗和及时提供HCV治疗的干预措施可以大大降低死亡率。(C)2014威科健康垂直酒吧Lippincott威廉姆斯& Wilkins
Objective: Recent studies suggest all-cause mortality in HIV mono-infected patients approaches that of the general population. We aimed to compare participants in the Canadian Co-infection Cohort to the general population to determine if co-infected patients have had similar improvements in mortality.Design: Prospective multicentre cohort study.Methods: Between 2003 and 2013, deaths were captured using specific case reports and through linkage to provincial vital statistics for participants lost to follow-up. Standardized mortality ratios (SMRs) were calculated using age, sex and province-specific mortality rates from the Canadian Human Mortality Database, 2009, and compared across behavioural and clinical characteristics of participants at their most recent visit.Results: Among the 1150 patients, we observed 133 deaths over 3351 person-years (4.0 per 100 person-years, 95% confidence interval 3.3, 4.6). SMRs (95% confidence interval) were: 12.1(10.1, 14.2) overall; 9.3 (7.5, 11.1) for men and 19.4 (12.7, 26.2) for women. CD4_ cell counts below 200 cells/mu l [25.5 (17.7, 33.3)], active injection drug use [19.9 (13.9, 25.9)] and smoking [14.9 (12.1, 17.7)] were strongly associated with excess mortality. Lowest SMRs were seen for those who had spontaneous [4.5 (-0.6, 9.5)] or treatment-induced clearance of hepatitis C virus (HCV) infection [5.1 (1.3, 8.8)]. Conversely, high SMRs were seen with advanced liver disease [17.0 (11.7, 22.3)]. In no category did SMRs approach mortality seen in the general Canadian population.Conclusions: HIV-HCV co-infected persons remain at markedly increased risk for death despite antiretroviral therapy. Interventions targeting modifiable risk factors such as substance use, smoking, adherence to antiretrovirals and timely provision of HCV therapy could substantially reduce death rates. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins