Delpierre C, Cuzin L, Lauwers-Cances V, Datta G D, Berkman L, Lang T
Harvard School of Public Health, Department of Society, Human Development and Health, Landmark Center, 401 Park Drive, Boston MA, USA.
Sex Transm Infect. 2008 Jun;84(3):183-6. doi: 10.1136/sti.2007.027961. Epub 2008 Jan 11.
To assess the association between social situation and disease progression among patients diagnosed with HIV infection since the advent of highly active antiretroviral therapy (HAART), taking late testing into account.
Prospective cohort study of adults diagnosed with HIV since 1996 in six large HIV reference centres in France. Associations between social situation and death, disease progression and treatment initiation were assessed using Cox regression model. Analysis was restricted to 5302 patients (77.9% of the sample) for whom the status at HIV diagnosis (late or not late) was known.
134 people (2.5%) died and 400 presented with a new AIDS defining event (7.5%). In multivariate analysis, probabilities of death (HR 3.75, 95% CI 2.11 to 6.66) and disease progression (HR 1.59, 95% CI 1.17 to 2.15) were higher for non-working patients and for late testers (HR 9.18, 95% CI 4.32 to 19.48 for death) and lower for treated patients (HR 0.18, 95% CI 0.08 to 0.41 for death and HR 0.29, 95% CI 0.20 to 0.42 for disease progression). The probability of receiving antiretroviral treatment was not associated with employment status but was higher for late testers, for those living in a stable relationship and lower for those diagnosed after 2000.
Among patients diagnosed for HIV infection in the HAART era, poor social situation is an independent risk factor of mortality and morbidity, and is not explained by delayed access to diagnosis or treatment.
评估自高效抗逆转录病毒疗法（HAART）出现以来确诊感染艾滋病毒的患者的社会状况与疾病进展之间的关联，并考虑到检测延迟的情况。
对1996年以来在法国六个大型艾滋病毒参考中心确诊感染艾滋病毒的成年人进行前瞻性队列研究。使用Cox回归模型评估社会状况与死亡、疾病进展和开始治疗之间的关联。分析仅限于5302名患者（占样本的77.9%），这些患者在艾滋病毒诊断时的状态（是否延迟检测）已知。
134人（2.5%）死亡，400人出现新的艾滋病定义事件（7.5%）。在多变量分析中，无工作的患者和检测延迟的患者死亡概率（风险比[HR]3.75，95%置信区间[CI]2.11至6.66）和疾病进展概率（HR 1.59，95%CI 1.17至2.15）较高（死亡的HR为9.18，95%CI 4.32至19.48），接受治疗的患者则较低（死亡的HR为0.18，95%CI 0.08至0.41；疾病进展的HR为0.29，95%CI 0.20至0.42）。接受抗逆转录病毒治疗的概率与就业状况无关，但检测延迟的患者、处于稳定关系中的患者概率较高，2000年后确诊的患者概率较低。
在HAART时代确诊感染艾滋病毒的患者中社会状况不佳是死亡和发病的独立危险因素，且不能用诊断或治疗延迟来解释。
