Lancet. 2008 Jul 26;372(9635):293-9. doi: 10.1016/S0140-6736(08)61113-7.
Combination antiretroviral therapy has led to significant increases in survival and quality of life, but at a population-level the effect on life expectancy is not well understood. Our objective was to compare changes in mortality and life expectancy among HIV-positive individuals on combination antiretroviral therapy.
The Antiretroviral Therapy Cohort Collaboration is a multinational collaboration of HIV cohort studies in Europe and North America. Patients were included in this analysis if they were aged 16 years or over and antiretroviral-naive when initiating combination therapy. We constructed abridged life tables to estimate life expectancies for individuals on combination antiretroviral therapy in 1996-99, 2000-02, and 2003-05, and stratified by sex, baseline CD4 cell count, and history of injecting drug use. The average number of years remaining to be lived by those treated with combination antiretroviral therapy at 20 and 35 years of age was estimated. Potential years of life lost from 20 to 64 years of age and crude mortality rates were also calculated.
18 587, 13 914, and 10 854 eligible patients initiated combination antiretroviral therapy in 1996-99, 2000-02, and 2003-05, respectively. 2056 (4.7%) deaths were observed during the study period, with crude mortality rates decreasing from 16.3 deaths per 1000 person-years in 1996-99 to 10.0 deaths per 1000 person-years in 2003-05. Potential years of life lost per 1000 person-years also decreased over the same time, from 366 to 189 years. Life expectancy at age 20 years increased from 36.1 (SE 0.6) years to 49.4 (0.5) years. Women had higher life expectancies than did men. Patients with presumed transmission via injecting drug use had lower life expectancies than did those from other transmission groups (32.6 [1.1] years vs 44.7 [0.3] years in 2003-05). Life expectancy was lower in patients with lower baseline CD4 cell counts than in those with higher baseline counts (32.4 [1.1] years for CD4 cell counts below 100 cells per muL vs 50.4 [0.4] years for counts of 200 cells per muL or more).
Life expectancy in HIV-infected patients treated with combination antiretroviral therapy increased between 1996 and 2005, although there is considerable variability between subgroups of patients. The average number of years remaining to be lived at age 20 years was about two-thirds of that in the general population in these countries.
联合抗逆转录病毒疗法已使生存率和生活质量显著提高，但在人群层面，其对预期寿命的影响尚不清楚。我们的目标是比较接受联合抗逆转录病毒疗法的HIV阳性个体的死亡率和预期寿命的变化。
抗逆转录病毒疗法队列协作研究是欧洲和北美的HIV队列研究的跨国合作项目。如果患者年龄在16岁及以上，且开始联合治疗时未接受过抗逆转录病毒治疗，则纳入本分析。我们构建了简略生命表，以估计1996 - 1999年、2000 - 2002年和2003 - 2005年接受联合抗逆转录病毒疗法的个体的预期寿命，并按性别、基线CD4细胞计数和注射吸毒史进行分层。估计了20岁和35岁接受联合抗逆转录病毒疗法治疗者剩余的平均存活年数。还计算了20至64岁的潜在寿命损失年数和粗死亡率。
分别有18587例、13914例和10854例符合条件的患者在1996 - 1999年、2000 - 2002年和2003 - 2005年开始联合抗逆转录病毒疗法。研究期间观察到2056例（4.7%）死亡，粗死亡率从1996 - 1999年的每1000人年16.3例死亡降至2003 - 2005年的每1000人年10.0例死亡。每1000人年的潜在寿命损失年数在同一时期也有所下降，从366年降至189年。20岁时的预期寿命从36.1（标准误0.6）年增加到49.4（0.5）年。女性的预期寿命高于男性。推测通过注射吸毒传播的患者的预期寿命低于其他传播组的患者（2003 - 2005年为32.6 [1.1]年对44.7 [0.3]年）。基线CD4细胞计数较低的患者的预期寿命低于基线计数较高的患者（每微升低于100个细胞的CD4细胞计数者为32.4 [1.1]年，每微升200个细胞或更多计数者为50.4 [0.4]年）。
1996年至2005年期间，接受联合抗逆转录病毒疗法治疗的HIV感染患者的预期寿命有所增加，尽管不同亚组患者之间存在相当大的差异。在这些国家，20岁时剩余的平均存活年数约为一般人群的三分之二。
