Ewings Fiona M, Bhaskaran Krishnan, McLean Ken, Hawkins David, Fisher Martin, Fidler Sarah, Gilson Richard, Nock Demelza, Brettle Ray, Johnson Margaret, Phillips Andrew, Porter Kholoud
MRC Clinical Trials Unit, London, UK.
AIDS. 2008 Jan 2;22(1):89-95. doi: 10.1097/QAD.0b013e3282f3915e.
To estimate changes over calendar time in survival following HIV seroconversion in the era of HAART and to provide updated survival estimates.
Using data from a UK cohort of persons with well estimated dates of HIV seroconversion, we analysed time from seroconversion to death from any cause using Cox models, adjusted for prognostic factors. Kaplan-Meier methods were then used to determine the expected survival in each calendar period.
2275 seroconverters were included with 18 695 person-years of follow up. A total of 444 (20%) died. The relative risk of death, compared with pre-1996, decreased over time to 0.63 [95% confidence interval (CI), 0.48-0.81], 0.24 (0.17-0.34), 0.14 (0.10-0.21), 0.08 (0.05-0.13) and 0.03 (0.02-0.06) in 1996-1997, 1998-1999, 2000-2001, 2002-2003 and 2004-2006, respectively. An elevated risk of death was associated with older age at seroconversion [hazard ratio (HR), 1.49; 95% CI, 1.34-1.66 per 10-year increase] and HIV infection through injecting drug use (HR, 1.53; 95% CI, 1.17-2.00). In 2000-2006, the proportion of individuals expected to survive 5, 10 and 15 years following seroconversion was 99%, 94% and 89%, respectively.
Survival following HIV seroconversion has continued to improve over calendar time in our cohort, even in the more recent years of HAART availability. HIV seroconverters, by definition identified early in their infection, are likely to have the greatest opportunity for intervention; if similar high survival expectations are to be seen in the wider HIV-infected population, early diagnosis is likely to be crucial.
评估在高效抗逆转录病毒治疗（HAART）时代，从HIV血清转化至死亡的生存情况随日历时间的变化，并提供最新的生存估计。
利用英国一组血清转化日期估算准确的人群数据，我们使用Cox模型分析从血清转化至任何原因死亡的时间，并对预后因素进行校正。然后采用Kaplan-Meier方法确定每个日历时间段的预期生存率。
共纳入2275例血清转化者，随访18695人年。共有444例（20%）死亡。与1996年前相比，死亡相对风险随时间下降，在1996 - 1997年、1998 - 1999年、2000 - 2001年、2002 - 2003年和2004 - 2006年分别降至0.63 [95%置信区间（CI），0.48 - 0.81]、0.24（0.17 - 0.34）、0.14（0.10 - 0.21）、0.08（0.05 - 0.13）和0.03（0.02 - 0.06）。血清转化时年龄较大（风险比（HR），1.49；95%CI，每增加10岁为1.34 - 1.66）以及通过注射吸毒感染HIV（HR，1.53；95%CI，1.17 - 2.00）与死亡风险升高相关。在2000 - 2006年期间，血清转化后预期存活5年、10年和15年的个体比例分别为99%、94%和89%。
在我们的队列中，从HIV血清转化至死亡的生存情况随日历时间持续改善，即使在HAART应用多年后的近期也是如此。根据定义，血清转化者在感染早期被识别，很可能有最大的干预机会；若要在更广泛的HIV感染人群中看到类似的高生存预期，早期诊断可能至关重要。
