van Asten Liselotte, Zangerle Robert, Hernández Aguado Ildefonso, Boufassa Faroudy, Broers Barbara, Brettle Raymond P, Roy Robertson J, McMenamin Jim, Coutinho Roel A, Prins Maria
Municipal Health Service, Cluster Infectious Diseases, Amsterdam, The Netherlands.
Eur J Epidemiol. 2005;20(9):795-804. doi: 10.1007/s10654-005-1049-0.
Prior to HAART availability, there was no evidence of a geographical variation in HIV disease progression among injecting drug users (IDU) from different European regions. Nowadays, factors of importance regarding HIV disease progression in the face of HAART availability, such as HAART access, adherence, and the organization of care for IDU may differ across Europe. Therefore we studied HIV disease progression in a European study of IDU with known dates of HIV-seroconversion. Results show that with ongoing HAART availability, the risk of HIV disease progression has continued to decrease. When accounting for pre-AIDS death (in AIDS analyses) and non-natural deaths (suicide, overdose, accidents and homicide, in analyses of death) which are common among IDU, the risk of AIDS and death has decreased by as much as 65% and 75%, respectively, in 2000/2001. Results show little geographic variation in progression to AIDS. All-cause mortality was higher in IDU from Glasgow than elsewhere, while in the Valencian region (Spain) IDU were at a significantly lower risk of non-natural deaths. The timing of HAART initiation by treatment-naïve IDU likewise differed across Europe: IDU in Amsterdam, Innsbruck, and Edinburgh started at significantly lower CD4 counts than IDU in Paris, Geneva, Glasgow, and the Valencian region, but the subsequent short-term immune response was similar. In conclusion, the risk in progression to AIDS or natural death is similar across western Europe although IDU across Europe differ in other factors, such as the risk of non-natural death and the timing of HAART initiation.
在高效抗逆转录病毒治疗（HAART）出现之前，没有证据表明来自欧洲不同地区的注射吸毒者（IDU）在HIV疾病进展方面存在地域差异。如今，面对HAART的可及性，与HIV疾病进展相关的重要因素，如HAART的可及性、依从性以及针对IDU的护理组织情况，在欧洲各地可能有所不同。因此我们在一项针对已知HIV血清转化日期的欧洲IDU研究中，对HIV疾病进展情况进行了研究。结果显示，随着HAART的持续可及，HIV疾病进展的风险持续下降。在考虑到IDU中常见的艾滋病前期死亡（在艾滋病分析中）和非自然死亡（自杀、过量用药、事故和凶杀，在死亡分析中）后，在2000/2001年，艾滋病和死亡的风险分别降低了多达65%和75%。结果显示进展至艾滋病方面几乎没有地域差异。格拉斯哥的IDU全因死亡率高于其他地方，但在巴伦西亚地区（西班牙），IDU非自然死亡的风险显著较低。初治IDU开始HAART的时间在欧洲各地也有所不同：阿姆斯特丹、因斯布鲁克和爱丁堡的IDU开始治疗时的CD4细胞计数显著低于巴黎、日内瓦、格拉斯哥和巴伦西亚地区的IDU，但随后的短期免疫反应相似。总之，尽管欧洲各地的IDU在其他因素上存在差异，如非自然死亡风险和开始HAART的时间，但西欧在进展至艾滋病或自然死亡方面的风险相似。
