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抗逆转录病毒疗法和机会性感染一级化学预防对艾滋病诊断后生存的影响。成人/青少年疾病谱研究组。

Effects of antiretroviral therapy and opportunistic illness primary chemoprophylaxis on survival after AIDS diagnosis. Adult/Adolescent Spectrum of Disease Group.

作者信息

McNaghten A D, Hanson D L, Jones J L, Dworkin M S, Ward J W

机构信息

Council of State and Territorial Epidemiologists, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

出版信息

AIDS. 1999 Sep 10;13(13):1687-95. doi: 10.1097/00002030-199909100-00012.

Abstract

OBJECTIVE

To examine the effects of antiretroviral therapy (ART) and opportunistic illness chemoprophylaxis on the survival of persons with AIDS and survival time based on year of AIDS diagnosis.

DESIGN

Longitudinal medical record review.

SETTING

Ninety-three hospitals and clinics in nine cities in the USA.

PATIENTS

We observed 19,565 persons with AIDS from 1990 through January 1998.

INTERVENTIONS

Prescribed use of antiretroviral monotherapy, dual- and triple-combination therapies, primary prophylaxis against Pneumocystis carinii pneumonia and Mycobacterium avium complex, and pneumococcal vaccine.

MAIN OUTCOME MEASURES

Time from AIDS diagnosis to death in the presence and absence of ART. Survival curves were compared of AIDS cases diagnosed during 1990-1992 and 1993-1995.

RESULTS

Triple ART had the greatest effect on the risk of death [relative risk (RR), 0.15; 95% confidence limit (CL), 0.12, 0.17], followed by dual ART (RR, 0.24; 95% CL, 0.22, 0.26), and monotherapy (RR, 0.38; 95% CL, 0.36, 0.40). Risk of death was decreased among persons receiving Pneumocystis carinii pneumonia prophylaxis (RR, 0.79; 95% CL, 0.70, 0.89) and Mycobacterium avium complex prophylaxis (RR, 0.76; 95% CL, 0.68, 0.86). Median survival increased from 31 months [95% confidence interval (CI), 30-32 months] for AIDS cases diagnosed during 1990-1992 to 35 months (95% CI, 35-38 months) for cases diagnosed during 1993-1995.

CONCLUSIONS

The risk of death was decreased for persons receiving triple ART compared with persons receiving dual therapy and persons receiving monotherapy. Increased use of ART and improved ART regimens probably contributed to prolonged survival of persons whose diagnosis was made during 1993-1995 compared with persons whose diagnosis was made during 1990-1992.

摘要

目的

基于艾滋病诊断年份,研究抗逆转录病毒疗法(ART)和机会性感染化学预防对艾滋病患者生存及生存时间的影响。

设计

纵向病历回顾。

地点

美国九个城市的93家医院和诊所。

患者

我们观察了1990年至1998年1月期间的19565例艾滋病患者。

干预措施

规定使用抗逆转录病毒单药治疗、双药和三药联合治疗、针对卡氏肺孢子虫肺炎和鸟分枝杆菌复合群的一级预防以及肺炎球菌疫苗。

主要观察指标

在接受和未接受ART的情况下,从艾滋病诊断到死亡的时间。比较了1990 - 1992年和1993 - 1995年诊断的艾滋病病例的生存曲线。

结果

三联ART对死亡风险的影响最大[相对风险(RR),0.15;95%置信区间(CL),0.12,0.17],其次是双药ART(RR,0.24;95% CL,0.22,0.26)和单药治疗(RR,0.38;95% CL,0.36,0.40)。接受卡氏肺孢子虫肺炎预防的患者死亡风险降低(RR,0.79;95% CL,0.70,0.89),接受鸟分枝杆菌复合群预防的患者死亡风险降低(RR,0.76;95% CL,0.68,0.86)。1990 - 1992年诊断的艾滋病病例的中位生存期从31个月[95%置信区间(CI),30 - 32个月]增加到1993 - 1995年诊断的病例的35个月(95% CI,35 - 38个月)。

结论

与接受双药治疗和单药治疗的患者相比,接受三联ART的患者死亡风险降低。与1990 - 1992年诊断的患者相比,1993 - 1995年诊断的患者中ART使用增加及ART方案改善可能有助于延长生存期。

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