高效抗逆转录病毒治疗首个十年中欧洲和北美的HIV治疗反应与预后：一项合作分析

HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis.

作者信息

May Margaret T, Sterne Jonathan A C, Costagliola Dominique, Sabin Caroline A, Phillips Andrew N, Justice Amy C, Dabis François, Gill John, Lundgren Jens, Hogg Robert S, de Wolf Frank, Fätkenheuer Gerd, Staszewski Schlomo, d'Arminio Monforte Antonella, Egger Matthias

机构信息

Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.

出版信息

Lancet. 2006 Aug 5;368(9534):451-8. doi: 10.1016/S0140-6736(06)69152-6.

DOI:10.1016/S0140-6736(06)69152-6

PMID:16890831

Abstract

BACKGROUND

Highly active antiretroviral therapy (HAART) for the treatment of HIV infection was introduced a decade ago. We aimed to examine trends in the characteristics of patients starting HAART in Europe and North America, and their treatment response and short-term prognosis.

METHODS

We analysed data from 22,217 treatment-naive HIV-1-infected adults who had started HAART and were followed up in one of 12 cohort studies. The probability of reaching 500 or less HIV-1 RNA copies per mL by 6 months, and the change in CD4 cell counts, were analysed for patients starting HAART in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of HAART, which were estimated using Cox regression.

RESULTS

The proportion of heterosexually infected patients increased from 20% in 1995-96 to 47% in 2002-03, and the proportion of women from 16% to 32%. The median CD4 cell count when starting HAART increased from 170 cells per muL in 1995-96 to 269 cells per muL in 1998 but then decreased to around 200 cells per muL. In 1995-96, 58% achieved HIV-1 RNA of 500 copies per mL or less by 6 months compared with 83% in 2002-03. Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-03. Corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51).

INTERPRETATION

Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.

摘要

背景

十年前开始采用高效抗逆转录病毒疗法（HAART）治疗HIV感染。我们旨在研究欧洲和北美的初治HAART患者的特征趋势、治疗反应及短期预后。

方法

我们分析了22217例初治的HIV-1感染成人的数据，这些患者开始接受HAART治疗，并在12项队列研究之一中接受随访。分析了1995 - 1996年、1997年、1998年、1999年、2000年、2001年以及2002 - 2003年开始HAART治疗的患者在6个月时HIV-1 RNA拷贝数降至每毫升500或更少的概率，以及CD4细胞计数的变化。主要终点是HAART治疗第一年发生艾滋病和各种原因死亡的风险比，采用Cox回归进行估计。

结果

异性传播感染患者的比例从1995 - 1年的20%增至2002 - 2003年的47%，女性患者比例从16%增至32%。开始HAART治疗时的CD4细胞计数中位数从1995 - 1996年的每微升170个细胞增至1998年的每微升269个细胞，但随后降至每微升约200个细胞。1995 - 1996年，58%的患者在6个月时HIV-1 RNA降至每毫升500拷贝或更少，而2002 - 2003年这一比例为83%。与1998年相比，1995 - 1996年艾滋病的校正风险比为1.07（95%可信区间0.84 - 1.36），2002 - 2003年为1.35（1.06 - 1.71）。死亡死亡的相应数字分别为0.87（0.56 - 1.36）和0.96（0.61 - 1.51）。