van Sighem Ard, Danner Sven, Ghani Azra C, Gras Luuk, Anderson Roy M, de Wolf Frank
HIV Monitoring Foundation, Academic Medical Centre of the University of Amsterdam, Amsterdam, The Netherlands.
J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):212-8. doi: 10.1097/01.qai.0000165911.97085.d0.
Mortality in HIV-infected patients has decreased dramatically since the introduction of highly active antiretroviral therapy (HAART). We analyzed progression to death in a population of 3678 antiretroviral treatment-naive patients from the ATHENA national observational cohort from 24 weeks after the start of HAART. Mortality was compared with that in the general population in the Netherlands matched by age and gender. Only log-transformed CD4 cell count (hazard ratio [HR] = 0.50, 95% confidence interval [CI]: 0.40 to 0.61 per unit increase) and plasma viral load (HR = 0.30, 95% CI: 0.15 to 0.60, HIV RNA level <100,000 vs. > or = 100,000 copies/mL) measured at 24 weeks and infection via intravenous drug use (IDU) (HR = 0.16, 95% CI: 0.10 to 0.26, non-IDU vs. IDU) were significantly associated with progression to death. For non-IDU patients with 600 x 10 CD4 cells/L and an HIV RNA level <100,000 copies/mL at 24 weeks, mortality was predicted to be 5.3 (95% CI: 3.5 to 8.4) and 10.4 (95% CI: 6.4 to 17.4) times higher than in the general population for 25-year-old men and women, respectively, and 1.15 (95% CI: 1.08 to 1.25) and 1.29 (95% CI: 1.16 to 1.50) times higher for 65-year-old men and women, respectively. Hence, mortality in HIV-infected patients with a good initial response to HAART is still higher than in the general population.
自高效抗逆转录病毒疗法（HAART）问世以来，HIV感染患者的死亡率已大幅下降。我们分析了ATHENA全国观察性队列中3678例初治抗逆转录病毒治疗患者自HAART开始24周后的死亡进展情况。将死亡率与荷兰按年龄和性别匹配的普通人群进行比较。仅24周时测量的对数转换后的CD4细胞计数（风险比[HR]=0.50，95%置信区间[CI]：每增加一个单位为0.40至0.61）、血浆病毒载量（HR=0.30，95%CI：0.15至0.60，HIV RNA水平<100,000与≥100,000拷贝/mL）以及静脉吸毒（IDU）感染（HR=0.16，95%CI：0.10至0.26，非IDU与IDU）与死亡进展显著相关。对于24周时CD4细胞计数为600×10/L且HIV RNA水平<100,000拷贝/mL的非IDU患者，预计25岁男性和女性的死亡率分别比普通人群高5.3倍（95%CI：3.5至8.4）和10.4倍（95%CI：6.4至17.4）；65岁男性和女性的死亡率分别比普通人群高1.15倍（95%CI：1.08至1.25）和1.29倍（95%CI：1.16至1.50）。因此，对HAART初始反应良好的HIV感染患者的死亡率仍高于普通人群。
