Bogaards Johannes A, Weverling Gerrit Jan, Geskus Ronald B, Miedema Frank, Lange Joep M A, Bossuyt Patrick M M, Goudsmit Jaap
Department of Human Retrovirology, Academic Medical Center, University of Amsterdam, The Netherlands.
Antivir Ther. 2003 Feb;8(1):43-50.
To evaluate CD4 cell count-driven strategies for the initiation of highly active antiretroviral therapy (HAART) in terms of the reduction of the incidence of AIDS-defining events in resource-poor settings.
Data from the Amsterdam Cohort Study on HIV infection and AIDS were used to estimate the hazard of AIDS in untreated HIV-1 infection and after initiation of HAART, respectively, conditional on CD4 cell count. Different strategies for initiating therapy were compared by calculating the expected HAART administration rate and 1-year cumulative AIDS incidence in three different population settings, varying in the stage of HIV-1 infection at the time of presentation.
Among 695 HIV-1-infected cohort participants, the 1-year AIDS incidence density (ID) ranged from 3.2 per 100 person-years for CD4 cell counts 600-700 cells/mm3, to 31.9 per 100 person-years for CD4 cell counts 100-200 cells/mm3 and 77.9 per 100 person-years for CD4 cell counts below 100 cells/mm3. Upon initiation of HAART, the ID in the lowest CD4 strata declined to 13.3 and 16.3 per 100 person-years, respectively. Extrapolated to developing countries, supply of HAART to patients presenting with HIV-1 infection below 200 CD4 cells/mm3 is expected to give an administration rate of 67%, while the AIDS incidence will drop from over 30% to almost 10%.
Introduction of HAART in populations with advanced HIV-1 infection can accomplish a threefold reduction of the AIDS incidence when HAART is administered to patients with CD4 cell counts below 200 cells/mm3. In a hospital-based setting in resource-poor environments this ensures an efficient treatment allocation.
在资源匮乏地区，根据艾滋病定义事件发生率的降低情况，评估以CD4细胞计数为导向启动高效抗逆转录病毒治疗（HAART）的策略。
来自阿姆斯特丹HIV感染与艾滋病队列研究的数据分别用于估计未经治疗的HIV-1感染及启动HAART后发生艾滋病的风险，以CD4细胞计数为条件。通过计算三种不同人群环境中的预期HAART给药率和1年累积艾滋病发病率，比较不同的治疗启动策略，这三种人群环境在就诊时HIV-1感染阶段有所不同。
在695名HIV-1感染队列参与者中，1年艾滋病发病密度（ID）范围为：CD4细胞计数600 - 700个/立方毫米时为每100人年3.2例，CD4细胞计数100 - 200个/立方毫米时为每100人年31.9例，CD4细胞计数低于100个/立方毫米时为每100人年77.9例。启动HAART后，最低CD4分层中的ID分别降至每100人年13.3例和16.3例。推断至发展中国家，向CD4细胞计数低于200个/立方毫米的HIV-1感染患者提供HAART，预计给药率为67%，而艾滋病发病率将从超过30%降至近10%。
在HIV-1感染晚期人群中引入HAART，当对CD4细胞计数低于200个/立方毫米的患者进行HAART治疗时，可使艾滋病发病率降低三倍。在资源匮乏环境中的医院环境下，这确保了有效的治疗分配。
