Cornelisse P G, Montessori V, Yip B, Craib K J, O'Shaughnessy M V, Montaner J S, Hogg R S
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.
Int J STD AIDS. 2000 Jan;11(1):52-6. doi: 10.1258/0956462001914788.
Our objective was to characterize the effect of zidovudine therapy on AIDS dementia complex (dementia) free survival among HIV-infected men and women in a population-based cohort with free access to antiretroviral therapy in the province of British Columbia. Time to diagnosis of dementia among individuals was examined on the basis of zidovudine duration, CD4+ cell count at first treatment, gender, and transmission group [men having sex with men (MSM), intravenous drug users (IDU), heterosexuals]. We restricted the analysis to subjects with CD4+ cells counts within 12 months prior to treatment start date. Among 641 participants eligible for analysis, median duration of follow-up was 3.6 years, under which 86 (9.3%) events of dementia occurred. Participants were less likely to develop dementia with: increased zidovudine exposure (OR=0.26, 95% CI: 0.14-0.49), at least 260 CD4+ cells/mm3 (median) (OR=0.52, 95% CI: 0.34-0.78), and MSM risk group (OR=0.57, 95% CI: 0.35-0.94). Those infected through heterosexual contact had an increased risk (RR=2.04, 95% CI: 1.02-4.07). Using Cox's proportional hazards model, controlling for CD4+ cell count at treatment start date, independent predictors of dementia-free survival were: duration of zidovudine (OR=0.28, 95% CI: 0.15-0.52) and MSM transmission group (OR=0.61, 95% CI: 0.37-1.00). In this observational treatment cohort, factors associated with dementia-free survival include duration of zidovudine (AZT) therapy and MSM transmission group. It is not clear from these data whether the AZT protective effect is exclusive to this agent or whether other therapies might offer a similar protective effect.
我们的目标是，在不列颠哥伦比亚省一个可免费获得抗逆转录病毒治疗的基于人群的队列中，描述齐多夫定治疗对感染HIV的男性和女性艾滋病痴呆综合征（痴呆症）无进展生存期的影响。根据齐多夫定使用时长、首次治疗时的CD4+细胞计数、性别和传播途径（男男性行为者[MSM]、静脉吸毒者[IDU]、异性恋者），对个体的痴呆症诊断时间进行了研究。我们将分析限制在治疗开始日期前12个月内CD4+细胞计数的受试者。在641名符合分析条件的参与者中，中位随访时间为3.6年，在此期间发生了86例（9.3%）痴呆症事件。随着以下因素的出现，参与者患痴呆症的可能性降低：齐多夫定暴露增加（OR=0.26，95%CI：0.14-0.49）、至少260个CD4+细胞/mm3（中位数）（OR=0.52，95%CI：0.34-0.78）以及MSM风险组（OR=0.57，95%CI：0.35-0.94）。通过异性接触感染的人风险增加（RR=2.04，95%CI：1.02-4.07）。使用Cox比例风险模型，在控制治疗开始日期时的CD4+细胞计数后，无痴呆症生存期的独立预测因素为：齐多夫定使用时长（OR=0.28，95%CI：0.15-0.52）和MSM传播途径（OR=0.61，95%CI：0.37-1.00）。在这个观察性治疗队列中，与无痴呆症生存期相关的因素包括齐多夫定（AZT）治疗时长和MSM传播途径。从这些数据中尚不清楚AZT的保护作用是否仅针对该药物，或者其他疗法是否可能提供类似的保护作用。
