Lohse Nicolai, Hansen Ann-Brit Eg, Pedersen Gitte, Kronborg Gitte, Gerstoft Jan, Sørensen Henrik Toft, Vaeth Michael, Obel Niels
Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
Ann Intern Med. 2007 Jan 16;146(2):87-95. doi: 10.7326/0003-4819-146-2-200701160-00003.
The expected survival of HIV-infected patients is of major public health interest.
To estimate survival time and age-specific mortality rates of an HIV-infected population compared with that of the general population.
Population-based cohort study.
All HIV-infected persons receiving care in Denmark from 1995 to 2005.
Each member of the nationwide Danish HIV Cohort Study was matched with as many as 99 persons from the general population according to sex, date of birth, and municipality of residence.
The authors computed Kaplan-Meier life tables with age as the time scale to estimate survival from age 25 years. Patients with HIV infection and corresponding persons from the general population were observed from the date of the patient's HIV diagnosis until death, emigration, or 1 May 2005.
3990 HIV-infected patients and 379,872 persons from the general population were included in the study, yielding 22,744 (median, 5.8 y/person) and 2,689,287 (median, 8.4 years/person) person-years of observation. Three percent of participants were lost to follow-up. From age 25 years, the median survival was 19.9 years (95% CI, 18.5 to 21.3) among patients with HIV infection and 51.1 years (CI, 50.9 to 51.5) among the general population. For HIV-infected patients, survival increased to 32.5 years (CI, 29.4 to 34.7) during the 2000 to 2005 period. In the subgroup that excluded persons with known hepatitis C coinfection (16%), median survival was 38.9 years (CI, 35.4 to 40.1) during this same period. The relative mortality rates for patients with HIV infection compared with those for the general population decreased with increasing age, whereas the excess mortality rate increased with increasing age.
The observed mortality rates are assumed to apply beyond the current maximum observation time of 10 years.
The estimated median survival is more than 35 years for a young person diagnosed with HIV infection in the late highly active antiretroviral therapy era. However, an ongoing effort is still needed to further reduce mortality rates for these persons compared with the general population.
HIV感染患者的预期生存情况是重大的公共卫生关注点。
估计HIV感染人群的生存时间和特定年龄死亡率，并与普通人群进行比较。
基于人群的队列研究。
1995年至2005年在丹麦接受治疗的所有HIV感染者。
丹麦全国HIV队列研究的每个成员根据性别、出生日期和居住市镇与多达99名普通人群成员进行匹配。
作者以年龄为时间尺度计算Kaplan-Meier生命表，以估计25岁起的生存情况。从患者HIV诊断日期开始观察HIV感染患者及普通人群中的相应人员，直至死亡、移民或2005年5月1日。
研究纳入了3990名HIV感染患者和379872名普通人群，分别产生了22744人年（中位数，每人5.8年）和2689287人年（中位数，每人8.4年）的观察时间。3%的参与者失访。从25岁起，HIV感染患者的中位生存时间为19.9年（95%CI，18.5至21.3），普通人群为51.1年（CI，50.9至51.5）。对于HIV感染患者，2000年至2005年期间生存时间增至32.5年（CI，29.4至34.7）。在排除已知丙型肝炎合并感染患者（16%）的亚组中，同期中位生存时间为38.9年（CI，35.4至40.1）。与普通人群相比，HIV感染患者的相对死亡率随年龄增长而降低，而超额死亡率随年龄增长而增加。
观察到的死亡率假定适用于当前最长10年的观察时间之外。
在高效抗逆转录病毒治疗晚期被诊断为HIV感染的年轻人，估计中位生存时间超过35年。然而，与普通人群相比，仍需持续努力进一步降低这些人的死亡率。
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