高效抗逆转录病毒疗法（HAART）对一组1980 - 2006年垂直感染1型艾滋病毒儿童的艾滋病及死亡情况的影响

Impact of highly active antiretroviral therapy (HAART) on AIDS and death in a cohort of vertically HIV type 1-infected children: 1980-2006.

作者信息

Palladino Claudia, Bellón Jose M, Jarrín Inmaculada, Gurbindo Maria Dolores, De José M Isabel, Ramos José T, González-Iome M Isabel, Mellado Maria José, Beceiro José, Del Amo Julia, Muñoz-Fernández M Angeles

机构信息

Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

出版信息

AIDS Res Hum Retroviruses. 2009 Nov;25(11):1091-7. doi: 10.1089/aid.2009.0070.

DOI:10.1089/aid.2009.0070

PMID:19895191

Abstract

We evaluated the population effectiveness of highly active antiretroviral therapy (HAART) on the risk of AIDS and death in a multicenter cohort of 346 HIV-1 vertically infected children born between 1980 and 2006 in the Comunidad Autónoma de Madrid (CAM), Spain. Risks of AIDS and death in patients with the same duration of HIV infection were compared in different calendar periods [CP1: 1980-1989, CP2: 1990-1993 (reference), CP3: 1994-1996, CP4: 1997-1998, CP5: 1999-2006] through cumulative incidence curves and Cox proportional hazards models, allowing for late entry, that included the calendar period as the time-dependent covariate and adjusting for gender and mother's transmission category. The median follow-up was 11.8 years [interquartile range (IQR), 6.3-15.9]. Median CD4+ T cell percentage increased up to 26.5 in CP5 (IQR, 19.5-36.7) while the viral load decreased (median log(10) copies/ml in CP5, 3.66; IQR, 3.07-4.22). Multivariate analysis showed significant reduction in the risk of death since 1997 onward [CP4: adjusted hazard ratios (AHR), 0.29; 95% confidence interval (CI), 0.12-0.69; CP5: AHR, 0.06; 95% CI, 0.03-0.15]. Reduction in progression to AIDS reached borderline significance in CP4 (AHR, 0.49; 95% CI, 0.23-1.05) and was more marked in the last period (CP5: AHR, 0.30; 95% CI, 0.16-0.59). The reductions in the incidence of AIDS and death observed since 1996 were largely attributable to HAART.

摘要

我们评估了高效抗逆转录病毒疗法（HAART）对西班牙马德里自治区（CAM）346名1980年至2006年间出生的垂直感染HIV-1儿童组成的多中心队列中患艾滋病风险和死亡风险的总体有效性。通过累积发病率曲线和Cox比例风险模型，对不同日历时间段[CP1：1980 - 1989年，CP2：1990 - 1993年（参照），CP3：1994 - 1996年，CP4：1997 - 1998年，CP5：1999 - 2006年]中HIV感染持续时间相同的患者患艾滋病和死亡的风险进行了比较，该模型考虑了延迟进入情况，将日历时间段作为时间依存协变量，并对性别和母亲的传播类别进行了调整。中位随访时间为11.8年[四分位间距（IQR），6.3 - 15.9年]。在CP5中，CD4 + T细胞百分比中位数增至26.5（IQR，19.5 - 36.7），而病毒载量下降（CP5中对数（10）拷贝/毫升中位数为3.66；IQR，3.07 - 4.22）。多变量分析显示，自1997年起死亡风险显著降低[CP4：调整后风险比（AHR），0.29；95%置信区间（CI），0.12 - 0.69；CP5：AHR，0.06；95% CI，0.03 - 0.15]。在CP4中，进展为艾滋病的风险降低达到临界显著性（AHR，0.49；95% CI，0.23 - 1.05），在最后一个时间段更为明显（CP5：AHR，0.30；95% CI，0.16 - 0.59）。自1996年以来观察到的艾滋病和死亡发病率的降低在很大程度上归因于HAART。