Clements Mark, Law Matthew, Pedersen Court, Kaldor John
HIV Med. 2003 Oct;4(4):332-7. doi: 10.1046/j.1468-1293.2003.00168.x.
To assess whether treatment with antiretroviral drugs within the first 3 months of infection with HIV affects medium-term health outcomes.
Data from 20 cohorts in Europe and Australia were used Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE). Analysis was restricted to persons seroconverting in 1988-1998 who started antiretroviral treatment in the first 3 months or 1-2 years from seroconversion. The relationship between times to low CD4 count, AIDS and death and time of initiation of treatment was estimated using proportional hazards models.
Seroconversion illness was more common in those who began antiretroviral treatment in the first 3 months (73%) than in those who started treatment within 1-2 years post-seroconversion (33%). Subjects receiving early antiretroviral treatment had times to AIDS and to CD4 counts <200 cells/microL that were intermediate between those of subjects starting treatment within 1-2 years and those of the subset of these subjects starting treatment within 1-2 years who also had a prior CD4 count of >350 cells/microL and no prior AIDS diagnosis.
On the basis of these analyses, the effect of antiretroviral treatment initiation during HIV seroconversion is uncertain. It may result in lower rates of progression compared with starting antiretroviral treatment at 1-2 years, but the early antiretroviral treatment group had a similar or even higher incidence of low CD4 counts and AIDS events than the group who started antiretroviral treatment within 1-2 years with CD4 counts over 350 cells/microL and no prior AIDS diagnosis. Estimates of the effect of early treatment are probably confounded with a number of factors, including, in particular, reasons for treatment initiation.
评估在感染HIV的头3个月内使用抗逆转录病毒药物治疗是否会影响中期健康结局。
使用了来自欧洲和澳大利亚20个队列的数据——欧洲血清转化为艾滋病和死亡协同行动（CASCADE）。分析仅限于在1988 - 1998年血清转化且在血清转化后的头3个月或1 - 2年内开始抗逆转录病毒治疗的人。使用比例风险模型估计低CD4细胞计数、艾滋病和死亡时间与开始治疗时间之间的关系。
在头3个月开始抗逆转录病毒治疗的患者中血清转化疾病更为常见（73%），高于在血清转化后1 - 2年内开始治疗的患者（33%）。接受早期抗逆转录病毒治疗的受试者发展为艾滋病以及CD4细胞计数<200个/微升的时间，介于在1 - 2年内开始治疗的受试者与这些在1 - 2年内开始治疗且之前CD4细胞计数>350个/微升且无艾滋病诊断史的受试者子集之间。
基于这些分析，在HIV血清转化期间开始抗逆转录病毒治疗的效果尚不确定。与在1 - 2年时开始抗逆转录病毒治疗相比，它可能导致较低的进展率，但早期抗逆转录病毒治疗组的低CD4细胞计数和艾滋病事件发生率与在1 - 2年内开始抗逆转录病毒治疗且CD4细胞计数超过350个/微升且无艾滋病诊断史的组相似，甚至更高。早期治疗效果的估计可能受到多种因素的混淆，特别是开始治疗的原因。
