Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons-San Francisco, 1981-2012
Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons-San Francisco, 1981-2012
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DOI：
10.1093/infdis/jiv235
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发表时间：
2015-11-01
影响因子：
6.4
通讯作者：
Schwarcz, Sandra
中科院分区：
文献类型：
--
作者：
Djawe, Kpandja;Buchacz, Kate;Schwarcz, Sandra
目标。研究改进的人类免疫缺陷病毒（HIV）治疗是否与艾滋病定义性机会性疾病（AIDS-OIs）诊断后更好的生存率相关，以及艾滋病- ois设计的生存率如何不同。我们使用HIV监测数据进行生存分析。我们估计了三藩市成年艾滋病患者首次诊断为AIDS- oi后的生存率，这三个治疗时期是：1981-1986；1987 - 1996;和1997 - 2012。我们使用Cox比例风险模型来确定1997-2012年间AIDS-OI的调整死亡率风险。在20858例艾滋病患者中，最常见的诊断为肺囊虫性肺炎（39.1%）和卡波西肉瘤（20.1%）。总体5年生存率从1981-1986年的7%上升到1997-2012年的65%。1997-2012年，在调整已知混杂因素并以肺囊虫肺炎为参考类别后，首次艾滋病- oi后的死亡率最高的是脑淋巴瘤（风险比[HR]， 5.14； 95%可信区间[CI]， 2.98-8.87）和进行性多灶性脑白质病（HR, 4.22; 95% CI, 2.49-7.17）。自1981年以来，首次诊断为艾滋病成骨不全后的生存率显著提高。即使在对已知混杂因素进行调整后，一些艾滋病- oi的死亡风险仍然比其他疾病高得多。在当前的艾滋病毒治疗时代，仍然需要更好的预防和治疗策略来预防艾滋病- oi的发生。
Objective. To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI.Design. We used HIV surveillance data to conduct a survival analysis.Methods. We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012.Results. Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17).Conclusions. Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era.