Wandel Simon, Egger Matthias, Rangsin Ram, Nelson Kenrad E, Costello Caroline, Lewden Charlotte, Lutalo Tom, Ndyanabo Anthony, Todd Jim, Van der Paal Lieve, Minga Albert, Zwahlen Marcel
Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
Sex Transm Infect. 2008 Aug;84 Suppl 1(Suppl_1):i31-i36. doi: 10.1136/sti.2008.029793.
Estimation of the number of people in need of antiretroviral therapy (ART) in resource-limited settings requires information on the time from seroconversion to ART eligibility and from ART eligibility to death.
To estimate duration from seroconversion to different ART eligibility criteria and from ART eligibility to death in HIV-infected adults in low-income and middle-income countries.
Participants with documented seroconversion from five cohorts (two cohorts from Uganda, two from Thailand and one from Côte d'Ivoire) were analysed. We used Weibull survival models and Bayesian simulation methods to model true (unobserved) first time of treatment eligibility. We set a consistency constraint so that the mean duration from seroconversion to death was equal to the mean from seroconversion to ART eligibility plus the mean from eligibility to death.
We analysed data from 2072 participants, 16 157 person-years of follow-up and 794 deaths. For the criterion CD4 T-lymphocyte count <200 cells x10(6)/l, the median duration from seroconversion to ART eligibility was 6.1 years (95% credibility interval 3.3-10.4) for all studies and 7.6 years (95% credibility interval 3.4-15.2) for all but the Thai cohorts. Corresponding estimates for the time from CD4 T-lymphocyte count <200 cells x10(6)/l to death were 2.1 years (0.7-4.8) and 2.7 years (0.8-8.4). When including all cohorts, the mean time from serconversion to CD4 T-lymphocyte count <200 cells x10(6)/l and from CD4 T-lymphocyte count <200 cells x10(6)/l to death represented 66% (38-87%) and 34% (13-62%), respectively of the total survival time.
The duration of different ART eligibility criteria to death was longer than the estimates used in previous calculations of the number of people needing ART. However, uncertainty in estimates was considerable and heterogeneity across cohorts important.
在资源有限的环境中，估计需要抗逆转录病毒治疗（ART）的人数需要有关从血清转化到符合ART治疗标准以及从符合ART治疗标准到死亡的时间信息。
估计低收入和中等收入国家HIV感染成年人从血清转化到不同ART治疗标准以及从符合ART治疗标准到死亡的持续时间。
对来自五个队列（两个来自乌干达，两个来自泰国，一个来自科特迪瓦）有记录血清转化的参与者进行分析。我们使用威布尔生存模型和贝叶斯模拟方法对真正（未观察到的）首次符合治疗标准的时间进行建模。我们设置了一个一致性约束，使得从血清转化到死亡的平均持续时间等于从血清转化到符合ART治疗标准的平均时间加上从符合标准到死亡的平均时间。
我们分析了2072名参与者的数据，16157人年的随访以及794例死亡。对于CD4 T淋巴细胞计数<200个细胞×10⁶/L的标准，所有研究中从血清转化到符合ART治疗标准的中位持续时间为6.1年（95%可信区间3.3 - 10.4），除泰国队列外所有队列的相应估计值为7.６年（95%可信区间3.4 - 15.2）。从CD4 T淋巴细胞计数<200个细胞×10⁶/L到死亡的相应估计值为2.1年（0.7 - 4.8）和2.7年（0.8 - 8.4）。当纳入所有队列时，从血清转化到CD4 T淋巴细胞计数<200个细胞×10⁶/L以及从CD4 T淋巴细胞计数<200个细胞×10⁶/L到死亡的平均时间分别占总生存时间的66%（38 - 87%）和34%（13 - 62%）。
不同ART治疗标准到死亡的持续时间长于先前计算需要ART治疗人数时所使用的估计值。然而，估计值的不确定性相当大，且各队列之间的异质性很重要。
