Palella Frank J, Baker Rose K, Moorman Anne C, Chmiel Joan S, Wood Kathleen C, Brooks John T, Holmberg Scott D
Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
J Acquir Immune Defic Syndr. 2006 Sep;43(1):27-34. doi: 10.1097/01.qai.0000233310.90484.16.
AIDS-related death and disease rates have declined in the highly active antiretroviral therapy (HAART) era and remain low; however, current causes of death in HAART-treated patients remain ill defined.
To describe mortality trends and causes of death among HIV-infected patients in the HAART era.
Prospective, multicenter, observational cohort study of participants in the HIV Outpatient Study who were treated from January 1996 through December 2004.
Rates of death, opportunistic disease, and other non-AIDS-defining illnesses (NADIs) determined to be primary or secondary causes of death.
Among 6945 HIV-infected patients followed for a median of 39.2 months, death rates fell from 7.0 deaths/100 person-years of observation in 1996 to 1.3 deaths/100 person-years in 2004 (P=0.008 for trend). Deaths that included AIDS-related causes decreased from 3.79/100 person-years in 1996 to 0.32/100 person-years in 2004 (P=0.008). Proportional increases in deaths involving liver disease, bacteremia/sepsis, gastrointestinal disease, non-AIDS malignancies, and renal disease also occurred (P=or<0.001, 0.017, 0.006, <0.001, and 0.037, respectively.) Hepatic disease was the only reported cause of death for which absolute rates increased over time, albeit not significantly, from 0.09/100 person-years in 1996 to 0.16/100 person-years in 2004 (P=0.10). The percentage of deaths due exclusively to NADI rose from 13.1% in 1996 to 42.5% in 2004 (P<0.001 for trend), the most frequent of which were cardiovascular, hepatic, and pulmonary disease, and non-AIDS malignancies in 2004. Mean CD4 cell counts closest to death (n=486 deaths) increased from 59 cells/microL in 1996 to 287 cells/microL in 2004 (P<0.001 for trend). Patients dying of NADI causes were more HAART experienced and initiated HAART at higher CD4 cell counts than those who died with AIDS (34.5% vs 16.8%, respectively, received HAART for 4 of more years, P<0.0001; 22.4% vs 7.8%, respectively, initiated HAART with CD4 cell counts of more than 350 cells/microL, P<0.001).
Although overall death rates remained low through 2004, the proportion of deaths attributable to non-AIDS diseases increased and prominently included hepatic, cardiovascular, and pulmonary diseases, as well as non-AIDS malignancies. Longer time spent receiving HAART and higher CD4 cell counts at HAART initiation were associated with death from non-AIDS causes. CD4 cell count at time of death increased over time.
在高效抗逆转录病毒治疗（HAART）时代，与艾滋病相关的死亡率和发病率有所下降，且目前仍维持在较低水平；然而，接受HAART治疗患者当前的死亡原因仍不明确。
描述HAART时代HIV感染患者的死亡率趋势及死亡原因。
对1996年1月至2004年12月接受治疗的HIV门诊研究参与者进行前瞻性、多中心、观察性队列研究。
确定为主要或次要死亡原因的死亡率、机会性疾病及其他非艾滋病定义疾病（NADI）的发生率。
在6945例接受随访的HIV感染患者中，随访时间中位数为39.2个月，死亡率从1996年的7.0例/100人年观察期降至2004年的1.3例/100人年（趋势P = 0.008）。包括艾滋病相关原因的死亡从1996年的3.79/100人年降至2004年的0.32/100人年（P = 0.008）。涉及肝病、菌血症/败血症、胃肠道疾病、非艾滋病相关恶性肿瘤和肾病的死亡比例也出现了相应增加（分别为P =或<0.001、0.017、0.006、<0.001和0.037）。肝病是唯一报告的死亡原因，其绝对发生率随时间增加，尽管不显著，从1996年的0.09/100人年增至2004年的0.16/100人年（P = 0.10）。仅由NADI导致的死亡比例从1996年的13.1%升至2004年的42.5%（趋势P<0.001），2004年最常见的是心血管、肝脏和肺部疾病以及非艾滋病相关恶性肿瘤。最接近死亡时（n = 486例死亡）的平均CD4细胞计数从1996年的59个/微升增至2004年的287个/微升（趋势P<0.001）。死于NADI原因的患者比死于艾滋病的患者接受HAART的经验更丰富，且开始接受HAART时的CD4细胞计数更高（分别为34.5%对16.8%接受HAART超过4年，P<0.0001；分别为22.4%对7.8%开始接受HAART时CD4细胞计数超过350个/微升，P<0.001）。
尽管到2004年总体死亡率仍维持在较低水平，但非艾滋病疾病导致的死亡比例增加，主要包括肝脏、心血管和肺部疾病以及非艾滋病相关恶性肿瘤。接受HAART的时间延长以及开始接受HAART时较高的CD4细胞计数与非艾滋病原因导致的死亡相关。死亡时的CD4细胞计数随时间增加。
