Hogg Robert S, Heath Katherine, Bangsberg David, Yip Benita, Press Natasha, O'Shaughnessy Michael V, Montaner Julio S G
Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
AIDS. 2002 May 3;16(7):1051-8. doi: 10.1097/00002030-200205030-00012.
To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival.
DESIGN, SETTING AND PARTICIPANTS: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75% of their medication in the first 12 months.
Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000.
As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9% (+/- 0.5%) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95% confidence interval (CI), 1.16-1.49; P < 0.001] and 2.90 (95% CI, 1.93-4.36; P < 0.001), respectively. In order to control for downward drift, intermittent use of therapy was measured over the first year whereas other factors were measured at the end of year 1. After adjusting for all other factors, those participants who used antiretroviral drugs intermittently were 2.97 times (95% CI, 1.33-6.62; P = 0.008) more likely to die.
Our study demonstrates that even after adjusting for other prognostic factors intermittent use of antiretroviral therapy was associated with increased mortality.
描述间歇性使用三联抗逆转录病毒疗法对生存的影响。
设计、背景和参与者：对1996年8月至1999年12月期间在不列颠哥伦比亚省开始接受三联疗法的1282名18岁及以上未接受过抗逆转录病毒治疗的HIV阳性个体进行基于人群的分析。通过将配发药物的月数除以随访月数来估算治疗使用情况。间歇性治疗定义为参与者在最初12个月内获得的药物少于其应得药物的75%。
从三联抗逆转录病毒疗法开始至2000年9月30日的累积全因死亡率。
截至2000年9月30日，106名受试者死亡。12个月时的累积死亡率为3.9%（±0.5%）。在多变量模型中，在控制了单变量分析中有显著意义的其他变量后，基线CD4细胞计数每减少100个单位以及间歇性使用抗逆转录病毒药物与死亡率增加相关，风险比分别为1.31[95%置信区间（CI），1.16 - 1.49；P < 0.001]和2.90（95%CI，1.93 - 4.36；P < 0.001）。为控制向下漂移，间歇性治疗在第一年进行测量，而其他因素在第1年末进行测量。在对所有其他因素进行调整后，间歇性使用抗逆转录病毒药物的参与者死亡可能性高2.97倍（95%CI，1.33 - 6.62；P = 0.008）。
我们的研究表明，即使在调整了其他预后因素后，间歇性使用抗逆转录病毒疗法仍与死亡率增加相关。
