Sungkanuparph Somnuek, Chakriyanuyok Taywin, Butthum Bodin
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok 10400, Thailand.
J Infect. 2008 Jan;56(1):40-3. doi: 10.1016/j.jinf.2007.10.005. Epub 2007 Nov 26.
To determine the impact of antiretroviral therapy (ART) on the long-term survival of AIDS patients with CMV disease and evaluate long-term outcomes of ART.
A retrospective cohort study was conducted among HIV-infected patients with CMV disease in a medical school hospital during 1996-2005 and followed-up until June 2007.
There were 154 patients, mean age 34.5 years and 57.8% were male. Organ involvement of CMV disease included retina (94.8%), central nervous system, lungs, and gastrointestinal tract. Median CD4 cell count was 20 cells/mm(3) and 99 patients received ART. During median follow-up of 32 months (interquartile range 23-96), 29.2% of patients died. From Kaplan-Meier analysis, median survival is significantly longer in patients receiving ART (>116.2 vs. 21.6 months, log-rank test, p<0.001). From Cox's proportional hazard model, ART (HR 0.6, p<0.001) and previous opportunistic infections (HR 3.5, p=0.025) were negatively and positively associated with death, respectively. At median time of 69 months (interquartile range 34-101) in patients who received ART, 80.8% had HIV-1 RNA <50 copies/mL and median CD4 was 421 cells/mm(3). One patient had immune reconstitution syndrome at 3 months after initiation of ART and resulted in permanent vision loss.
ART significantly improves long-term survival of AIDS patients with CMV disease. Long-term virological and immunological outcomes are durable.
确定抗逆转录病毒疗法（ART）对患有巨细胞病毒（CMV）疾病的艾滋病患者长期生存的影响，并评估ART的长期疗效。
对1996年至2005年在一所医学院附属医院中感染HIV且患有CMV疾病的患者进行回顾性队列研究，并随访至2007年6月。
共有154例患者，平均年龄34.5岁，57.8%为男性。CMV疾病的器官受累包括视网膜（94.8%）、中枢神经系统、肺部和胃肠道。CD4细胞计数中位数为20个/立方毫米，99例患者接受了ART。在中位随访32个月（四分位间距23 - 96个月）期间，29.2%的患者死亡。根据Kaplan-Meier分析，接受ART的患者中位生存期显著更长（>116.2个月对21.6个月，对数秩检验，p<0.001）。根据Cox比例风险模型，ART（风险比0.6，p<0.001）和既往机会性感染（风险比3.5，p = 0.025）分别与死亡呈负相关和正相关。在接受ART的患者中，中位时间69个月（四分位间距34 - 101个月）时，80.8%的患者HIV-1 RNA<50拷贝/毫升，CD4中位数为421个/立方毫米。1例患者在开始ART后3个月出现免疫重建综合征，导致永久性视力丧失。
ART显著提高了患有CMV疾病的艾滋病患者的长期生存率。长期病毒学和免疫学疗效持久。
