Bozzette Samuel A, Ake Christopher F, Tam Henry K, Phippard Alba, Cohen David, Scharfstein Daniel O, Louis Thomas A
Veterans Medical Research Foundation, Veterans Affairs Quality Enhancement Research Initiative for HIV at the Veterans Affairs San Diego Health Care System, San Diego, CA, USA.
J Acquir Immune Defic Syndr. 2008 Mar 1;47(3):338-41. doi: 10.1097/QAI.0b013e31815e7251.
There is continuing interest in the longer term effects of highly active antiretroviral therapy (HAART) on the risk of cardiopulmonary events. We assessed this using updated administrative data from an open retrospective cohort of HIV-infected persons receiving care from the US Veterans Affairs (VA). Information on 41,213 HIV-infected patients receiving VA care between January 1993 and December 2003 was included. Patients were followed for an average of 4 years or 168,213 person-years of follow-up. The death rate fell from 20.9 deaths per 100 patient-years of observation in 1995 to 5.2 deaths per 100 patient-years in 2003. In patient-level analysis, adjusted hazard ratios for death dropped precipitously for all races to a low of 0.18 (95% confidence interval: 0.15 to 0.23) at 72 months of exposure to HAART. Hazards for serious cardiovascular events remained near 1.0 for exposure to HAART, and hazards for serious cardiovascular events, stroke, or death were only slightly higher than for death alone. No selection effects or secular trends were found. The benefits of HAART continued to increase in the 8 years after introduction and with 6 years of individual use. The risk of serious cardiovascular events should be factored into individual patient management but does not pose an important public health risk.
高效抗逆转录病毒疗法（HAART）对心肺事件风险的长期影响一直备受关注。我们利用来自美国退伍军人事务部（VA）接受治疗的HIV感染者开放回顾性队列的最新管理数据对此进行了评估。纳入了1993年1月至2003年12月期间接受VA治疗的41213名HIV感染患者的信息。患者平均随访4年或168213人年。死亡率从1995年每100患者年观察期20.9例死亡降至2003年每100患者年5.2例死亡。在患者层面分析中，在接受HAART治疗72个月时，所有种族的死亡调整风险比急剧下降至0.18的低点（95%置信区间：0.15至0.23）。接受HAART治疗的严重心血管事件风险仍接近1.0，严重心血管事件、中风或死亡的风险仅略高于单独死亡的风险。未发现选择效应或长期趋势。HAART的益处引入后8年以及个人使用6年时持续增加。严重心血管事件的风险应纳入个体患者管理，但不构成重要的公共卫生风险。
