Porter Kholoud, Babiker Abdel, Bhaskaran Krishnan, Darbyshire Janet, Pezzotti Patrizio, Porter Kholoud, Walker A Sarah
Clinical Trials Unit, 222 Euston Road, , London NW1 2DA, UK.
Lancet. 2003 Oct 18;362(9392):1267-74. doi: 10.1016/s0140-6736(03)14570-9.
Highly active antiretroviral therapy (HAART) was introduced in 1997. We aimed to assess the continuing effect of this treatment on survival and progression to AIDS after HIV-1 seroconversion.
We used Cox models to estimate the effect of calendar year on time to AIDS and death in 22 cohorts of people from Europe, Australia, and Canada who had seroconverted. Retrospective and prospective data were used. We compared the effects of age at seroconversion, exposure category, sex, and presentation during acute HIV-1 infection pre-1997 (pre-HAART), in 1997-98 (limited use of HAART), and 1999-2001 (widespread use of HAART).
Of 7740 seroconverters, 2000 (26%) had died. Compared with pre-1997 data, the hazard ratio (HR) for death fell sharply to 0.47 [95% CI 0.39-0.56] in 1997, dropping further to 0.16 [0.12-0.22] in 2001. Correspondingly, the proportion of person-time on HAART increased from 22% in 1997 to 57% in 2001. By contrast with the pre-HAART era, injecting drug users had significantly higher mortality in 1999-2001 than did men infected through sex with men (HR 4.28 [2.86-6.41]). However, whereas pre-1997 the risk of AIDS was higher in those aged 45 years or older at seroconversion than in people who were 16-24 years (2.03 [1.67-2.47]), in 1999-2001 there was little evidence of a difference in risk by age (HR=1.17 [0.60-2.30]; interaction p=0.06). No such attenuation in the effect of age on survival was observed (p=0.63).
Predicted survival for people with HIV-1 has continued to increase, since the introduction of HAART; however, the importance of age and exposure category as determinants of progression seems to have changed.
高效抗逆转录病毒疗法（HAART）于1997年开始应用。我们旨在评估这种治疗对HIV-1血清转化后生存及进展至艾滋病的持续影响。
我们使用Cox模型来估计年份对来自欧洲、澳大利亚和加拿大的22个已发生血清转化的队列人群发生艾滋病及死亡时间的影响。使用了回顾性和前瞻性数据。我们比较了血清转化时的年龄、暴露类别、性别以及1997年之前（HAART治疗前）、1997 - 1998年（HAART有限使用）和1999 - 2001年（HAART广泛使用）急性HIV-1感染期间的临床表现的影响。
在7740名血清转化者中，2000人（26%）已经死亡。与1997年之前的数据相比，1997年死亡的风险比（HR）急剧降至0.47[95%可信区间（CI）0.39 - 0.56]，到2001年进一步降至0.16[0.12 - 0.22]。相应地，接受HAART治疗的人时比例从1997年的22%增加到2001年的57%。与HAART治疗前时代相比，1999 - 2001年注射吸毒者的死亡率显著高于通过与男性发生性行为感染的男性（HR 4.28[2.86 - 6.41]）。然而，1997年之前血清转化时年龄在45岁及以上者进展至艾滋病的风险高于16 - 24岁者（2.03[1.67 - 2.47]），而在1999 - 2001年几乎没有证据表明年龄对风险有差异（HR = 1.17[0.60 - 2.30]；交互作用p = 0.06）。未观察到年龄对生存影响的这种减弱情况（p = 0.63）。
自HAART应用以来，HIV-1感染者预测的生存率持续提高；然而，年龄和暴露类别作为疾病进展决定因素的重要性似乎已经改变。
