Bhaskaran Krishnan, Hamouda Osamah, Sannes Mette, Boufassa Faroudy, Johnson Anne M, Lambert Paul C, Porter Kholoud
MRC Clinical Trials Unit, 222 Euston Rd, London NW1 2DA, United Kingdom.
JAMA. 2008 Jul 2;300(1):51-9. doi: 10.1001/jama.300.1.51.
Mortality among human immunodeficiency virus (HIV)-infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population.
To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population.
DESIGN, SETTING, AND POPULATION: Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006.
Excess mortality among HIV-infected individuals compared with that of the general uninfected population.
Of 16,534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31,302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14,703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years).
Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens.
在能很好地获得治疗的国家，感染人类免疫缺陷病毒（HIV）个体的死亡率已大幅下降，目前可能已接近未感染普通人群的死亡率。
评估HIV感染个体与未感染普通人群之间死亡率差距的变化。
设计、地点和人群：在一项大型跨国HIV血清转化者队列合作研究（CASCADE）中，将HIV血清转化后的死亡率与预期死亡率进行比较，预期死亡率通过应用根据人口统计学因素匹配的普通人群死亡率来计算。构建了一个基于泊松分布且针对感染持续时间进行调整的模型，以评估HIV感染个体超额死亡率随时间的变化。对2007年9月汇总的数据于2008年3月进行分析，涵盖1981 - 2006年的风险年份。
HIV感染个体与未感染普通人群相比的超额死亡率。
在16534名随访时间中位数为6.3年（范围为1天至23.8年）的个体中，有2571人死亡，而在同等规模的普通人群队列中预期死亡235人。超额死亡率（每1000人年）从高效抗逆转录病毒治疗引入前（1996年前）的40.8（95%置信区间[CI]，38.5 - 43.0；31302人年中有1275.9例超额死亡）降至2004 - 2006年的6.1（95% CI，4.8 - 7.4；14703人年中有89.6例超额死亡）（2004 - 2006年与1996年前相比，调整后的超额风险比为0.05[95% CI，0.03 - 0.09]）。到2004 - 2006年，性传播感染HIV的个体在血清转化后的前5年未观察到超额死亡率，尽管从长期来看仍存在累积超额死亡概率（15 - 24岁人群在最初10年中的累积超额死亡概率为4.8%[95% CI，2.5% - 8.6%]）。
自引入高效抗逆转录病毒治疗以来，HIV感染个体的死亡率已更接近一般死亡率。在工业化国家，性传播感染HIV的个体在感染后的前5年死亡率似乎与普通人群相似，不过随着HIV感染持续时间延长，仍存在超额死亡率。
