Chan K C W, Wong K H, Lee S S
Integrated Treatment Centre, Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong.
HIV Med. 2006 Apr;7(3):186-92. doi: 10.1111/j.1468-1293.2006.00352.x.
Reductions in HIV/AIDS mortality associated with highly active antiretroviral therapy (HAART) have mainly been reported from Western countries. We studied the impact on survival of patients with advanced HIV disease after the introduction of HAART in Hong Kong.
The mortality pattern in a government clinic cohort of 511 adult HIV-1-infected patients with AIDS or CD4 count <200 cells/microL from 1993 to 2002 was examined. The number of deaths, the crude mortality rate (CMR) and the death rate per 1000 person-months were recorded.
Despite an increase in the patient population, 36 deaths occurred in the HAART era (1997-2002) as compared with 56 deaths in the pre-HAART era (1993-1996). The overall annual CMR fell significantly from a high, fluctuating level of 10.8-30.4 per 100 mid-year patient population pre-HAART to a low, steady level of 0.8-6.9 per 100 mid-year population in the HAART era (P=0.004, 1996 vs 1998; P<0.001, 1996 vs 2000; P<0.001, 1996 versus 2002). A fall in CMR was observed in all demographic subpopulations, categorized by sex, ethnicity, HIV exposure risk and age (P ranged from 0.012 to<0.001). Longitudinal tracking until mid-2003 revealed a death rate of 9.2 events/1000 person-months (52 deaths with 5661.5 person-months follow up) among patients first diagnosed as having advanced disease during 1993-1996, and a lower death rate of 2.4 events/1000 person-months (25 deaths with 10551.8 person-months follow up) in patients first diagnosed as having advanced disease during 1997-2001 (rate ratio 3.9; 95% confidence interval 2.4-6.2).
There was dramatic temporal decline in mortality in patients with advanced HIV disease in all demographic subpopulations with the advent of HAART. Notwithstanding confounding variables, one reason for the universal decline may be that there was no major disparity in access to HIV care across community groups.
与高效抗逆转录病毒疗法（HAART）相关的艾滋病毒/艾滋病死亡率下降情况主要是在西方国家报道的。我们研究了在香港引入HAART后对晚期艾滋病毒疾病患者生存情况的影响。
对1993年至2002年政府诊所队列中511名成人艾滋病病毒1型感染患者（患有艾滋病或CD4细胞计数<200个/微升）的死亡模式进行了研究。记录了死亡人数、粗死亡率（CMR）和每1000人月的死亡率。
尽管患者人数有所增加，但在HAART时代（1997 - 2002年）有36人死亡，而在HAART前时代（1993 - 1996年）有56人死亡。总体年度CMR从HAART前每100名年中患者人群中10.8 - 30.4的高波动水平显著降至HAART时代每100名年中人群0.8 - 6.9的低稳定水平（P = 0.004，1996年与1998年相比；P<0.001，1996年与2000年相比；P<0.001，1996年与2002年相比）。在按性别、种族、艾滋病毒暴露风险和年龄分类的所有人口亚组中均观察到CMR下降（P范围为0.012至<0.001）。对直至2003年年中的纵向跟踪显示，1993 - 1996年首次被诊断为患有晚期疾病的患者中，死亡率为9.2例/1000人月（52例死亡，随访5661.5人月），而1997 - 2001年首次被诊断为患有晚期疾病的患者中，死亡率较低，为2.4例/1000人月（25例死亡，随访10551.8人月）（率比3.9；95%置信区间2.4 - 6.2）。
随着HAART的出现，所有人口亚组中晚期艾滋病毒疾病患者的死亡率随时间显著下降。尽管存在混杂变量，但普遍下降的一个原因可能是不同社区群体在获得艾滋病毒治疗方面没有重大差异。
