van Sighem Ard I, van de Wiel Mark A, Ghani Azra C, Jambroes Mariëlle, Reiss Peter, Gyssens Inge C, Brinkman Kees, Lange Joep M A, de Wolf Frank
HIV Monitoring Foundation, Academic Medical Centre of the University of Amsterdam, Amsterdam, The Netherlands.
AIDS. 2003 Oct 17;17(15):2227-36. doi: 10.1097/00002030-200310170-00011.
To examine survival and progression to AIDS among HIV-infected patients after starting highly active antiretroviral therapy (HAART).
The study population consisted of 3724 patients from the ATHENA observational cohort who initiated HAART. We considered progression to either an AIDS-defining disease or death, distinguishing HIV-related and non-related (including therapy-related) deaths. A time-dependent multivariate hazards model was fitted to the patient data and 5-year survival probabilities under various therapy scenarios estimated.
A total of 459 patients developed AIDS and 346 died during 12 503 person-years of follow-up. HIV-related mortality decreased from 3.8 to 0.7 per 100 person-years between 1996 and 2000 whereas non-HIV-related mortality did not change (0.4 and 0.9, respectively, P = 0.25). For asymptomatic and symptomatic therapy naive patients younger than 50 years with CD4 counts above 10 x 10(6) and 150 x 10(6) cells/l, respectively, predicted 5-year survival probabilities were above 90% when HAART was used continuously. This limit was 450 x 10(6) cells/l when HAART was used during 20 weeks in each 24 week-period of follow-up, and 110 x 10(6) cells/l when patients delayed initiation of HAART for 1 year after becoming eligible for treatment.
Survival probabilities were high among HIV-infected patients initiating HAART at an early stage of infection. The best therapy strategy is therefore to start HAART at this stage of infection. However, deferring HAART in patients with high CD4 cell counts may be clinically more appropriate given toxicity and adherence problems. The lack of any change in non-HIV-related mortality suggests that toxicity has not yet become a major risk factor for death.
研究开始高效抗逆转录病毒治疗（HAART）后，HIV感染患者的生存情况及进展为艾滋病的情况。
研究人群包括3724名来自ATHENA观察队列且开始HAART治疗的患者。我们考虑进展为艾滋病定义疾病或死亡情况，区分与HIV相关和非相关（包括治疗相关）的死亡。对患者数据拟合时间依赖多变量风险模型，并估计不同治疗方案下的5年生存概率。
在12503人年的随访期间，共有459名患者发展为艾滋病，346人死亡。1996年至2000年期间，与HIV相关的死亡率从每100人年3.8降至0.7，而非HIV相关死亡率未改变（分别为0.4和0.9，P = 0.25）。对于无症状和有症状的初治患者，年龄小于50岁，CD4细胞计数分别高于10×10⁶和150×10⁶个/升，当持续使用HAART时，预测的5年生存概率高于90%。在随访的每24周期间，HAART使用20周时，该界限为450×10⁶个/升；患者在符合治疗条件1年后延迟开始HAART时，该界限为110×10⁶个/升。
在感染早期开始HAART的HIV感染患者中，生存概率较高。因此，最佳治疗策略是在感染这一阶段开始HAART。然而，考虑到毒性和依从性问题，对于CD4细胞计数高的患者推迟HAART在临床上可能更合适。非HIV相关死亡率没有任何变化表明毒性尚未成为死亡的主要危险因素。
