Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection.
Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection.
复制标题
DOI：
10.1097/qad.0000000000001417
复制
发表时间：
2017-04-24
期刊：
影响因子：
--
通讯作者：
INSIGHT START Study Group
中科院分区：
文献类型：
--
作者：
Lifson AR;Grund B;Gardner EM;Kaplan R;Denning E;Engen N;Carey CL;Chen F;Dao S;Florence E;Sanz J;Emery S;INSIGHT START Study Group
确定与延迟开始抗逆转录病毒治疗（ART）相比，健康艾滋病毒感染者（PLWH）立即开始抗逆转录病毒治疗（ART）是否对健康相关生活质量（QOL）或自我评估的身体、精神和整体健康状况有更有利的影响。生活质量在START（抗逆转录病毒治疗的战略时机）中进行测量，该研究将来自35个国家的健康的CD4+细胞/μl≤500的未接受抗逆转录病毒治疗的PLWH随机分配到立即接受抗逆转录病毒治疗和延迟接受抗逆转录病毒治疗。在基线，第4个月和第12个月，然后每年，参与者完成“感知当前健康”的视觉模拟量表（VAS）和简短的12项健康调查版本2，从中计算：(1)一般健康（GH）感知；(2)物理成分摘要（PCS）和(3)精神成分摘要（MCS）；VAS和GH评分从0=最低到100=最高。研究开始时的生活质量高（平均评分：VAS=80.9， GH=72.5， PCS=53.7， MCS=48.2）。在平均3年的随访中，所有生活质量指标的变化都有利于即时组（p<0.001）；估计差异为：VAS=1.9， GH=3.6， PCS=0.8， MCS=0.9。当评估不同人口统计学和临床亚组的生活质量变化时，治疗差异继续有利于直接组。有主要结局的患者生活质量较差；然而，当排除那些有原发性事件的患者时，结果仍然有利于立即接受ART治疗的患者。在一项国际随机试验中，在CD4+细胞/μl为100 500的首次接受抗逆转录病毒治疗的参与者中，与推迟治疗相比，立即开始抗逆转录病毒治疗的自我评估生活质量有适度但显著的改善，这支持了患者在HIV诊断后尽快开始抗逆转录病毒治疗的健康益处。
To determine if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV (PLWH) had a more favorable impact on health-related quality of life (QOL), or self-assessed physical, mental and overall health status. QOL was measured in START (Strategic Timing of Antiretroviral Therapy), which randomized healthy ART naive PLWH with >500 CD4+ cells/μl from 35 countries to immediate versus deferred ART. At baseline, months 4 and 12, then annually, participants completed a visual analogue scale (VAS) for “perceived current health” and the Short-Form 12-Item Health Survey version 2 from which were computed: (1) General health (GH) perception; (2) Physical Component Summary (PCS), and (3) Mental Component Summary (MCS); the VAS and GH were rated from 0=lowest to 100=highest. QOL at study entry was high (mean scores: VAS=80.9, GH=72.5, PCS=53.7, MCS=48.2). Over a mean follow-up of 3 years, changes in all QOL measures favored the immediate group (p<0.001); estimated differences were: VAS=1.9, GH=3.6, PCS=0.8, MCS=0.9. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group. QOL was poorer in those experiencing primary outcomes; however, when excluding those with primary events, results remained favorable for immediate ART recipients. In an international randomized trial in ART-naive participants with >500 CD4+ cells/μl, there were modest but significant improvements in self-assessed QOL among those initiating ART immediately compared to deferring treatment, supporting patient-perceived health benefits of initiating ART as soon as possible after an HIV diagnosis.