University of Minnesota, Minneapolis, Minnesota, USA.
AIDS. 2010 Mar 13;24(5):697-706. doi: 10.1097/QAD.0b013e3283365356.
Among patients with HIV, the risk of death associated with different AIDS events has been quantified, but the risk of death associated with non-AIDS events has not been examined. We compared the risk of all-cause mortality following AIDS versus serious non-AIDS (SNA) events in the Strategies for Management of Antiretroviral Therapy (SMART) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT).
Data from 9583 HIV-infected participants, 5472 with a CD4 cell count more than 350 cells/microl enrolled in SMART and 4111 with a CD4 cell count 300 cells/microl or more enrolled in ESPRIT, were analyzed.
Cumulative mortality 6 months after AIDS and SNA events (cardiovascular, renal, hepatic disease, and malignancies) was estimated using the Kaplan-Meier method. Cox models were used to estimate hazard ratios associated with AIDS and SNA events on the risk of death overall and by treatment group within study.
AIDS and SNA events occurred in 286 and 435 participants with 47 (16%) and 115 (26%) subsequent deaths, respectively. Six-month cumulative mortality was 4.7% [95% confidence interval (CI) 2.8-8.0] after experiencing an AIDS event and 13.4% (95% CI 10.5-17.0) after experiencing an SNA event. The adjusted hazard ratio for all-cause mortality for those who experienced AIDS versus those who did not was 4.9 (95% CI 3.6-6.8). The corresponding hazard ratio for SNA was 11.4 (95% CI 9.0-14.5) (P < 0.001 for difference in hazard ratios). Findings were similar for both treatment groups in SMART and both treatment groups in ESPRIT.
Among HIV-infected persons with higher CD4 cell counts, SNA events occur more frequently and are associated with a greater risk of death than AIDS events. Future research should be aimed at comparing strategies to reduce morbidity and mortality associated with SNA events for HIV-infected persons.
在 HIV 感染者中，已对不同 AIDS 事件相关的死亡风险进行了量化，但尚未对非 AIDS 事件相关的死亡风险进行研究。我们在 SMART 研究和 ESPRIT 试验中比较了 AIDS 与严重非 AIDS（SNA）事件后全因死亡率的风险。
分析了 9583 例 HIV 感染者的数据，其中 SMART 研究中 CD4 细胞计数>350 个/微升的 5472 例和 CD4 细胞计数为 300 个/微升或更高的 ESPRIT 研究中的 4111 例。
采用 Kaplan-Meier 法估计 AIDS 和 SNA 事件后 6 个月的累积死亡率。Cox 模型用于估计 AIDS 和 SNA 事件对整体死亡率的风险比以及按研究内治疗组分层的死亡率。
286 例和 435 例患者发生了 AIDS 和 SNA 事件，分别有 47 例（16%）和 115 例（26%）发生了后续死亡。经历 AIDS 事件后 6 个月累积死亡率为 4.7%（95%CI 2.8-8.0），经历 SNA 事件后为 13.4%（95%CI 10.5-17.0）。经历 AIDS 与未经历 AIDS 的患者全因死亡率的调整风险比为 4.9（95%CI 3.6-6.8）。SNA 的相应风险比为 11.4（95%CI 9.0-14.5）（P<0.001）。在 SMART 研究中的两个治疗组和 ESPRIT 研究中的两个治疗组中均发现了相似的结果。
在 CD4 细胞计数较高的 HIV 感染者中，SNA 事件比 AIDS 事件更常见，且与死亡风险增加相关。未来的研究应旨在比较降低 HIV 感染者 SNA 事件相关发病率和死亡率的策略。
