普遍获得医疗保健背景下高效抗逆转录病毒疗法的结果：美国军事艾滋病毒自然史研究。

Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study.

机构信息

Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

出版信息

AIDS Res Ther. 2010 May 27;7:14. doi: 10.1186/1742-6405-7-14.

DOI:10.1186/1742-6405-7-14

PMID:20507622

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2894737/

Abstract

BACKGROUND

To examine the outcomes of highly-active antiretroviral therapy (HAART) for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007.

METHODS

Outcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes.

RESULTS

Among patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase ≥ 50% (1.2, 1.0-1.4), but was not significant for VF.

CONCLUSIONS

In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.

摘要

背景

为了研究在免费获得医疗保健的情况下，高效抗逆转录病毒治疗（HAART）对个体的治疗效果，我们对 1996 年至 2007 年底期间接受 HAART 治疗的军队人员和 HIV 感染者队列研究中的 2327 名患者进行了评估。

方法

分析的结果包括病毒学抑制（VS）和失败（VF）、CD4 计数变化、艾滋病和死亡。VF 定义为从未抑制或至少有一次反弹事件。对 HAART 起始年份（2000 年前或后）进行分层的多变量（MV）分析，以确定与这些结果相关的危险因素。

结果

在 2000 年后开始接受 HAART 的患者中，1 年后（N=1759）有 81%达到 VS，5 年后（N=1061）有 85%达到 VS，8 年后（N=735）有 82%达到 VS。HAART 后 5 年，中位 CD4 增加 247 个细胞/ml，34%发生 VF。5 年时艾滋病和死亡率分别为 2%和 0.3%。在调整与治疗反应相关的已知危险因素的 MV 模型中，HAART 开始时现役（而非退休）与艾滋病（HR=0.6，95%CI 0.4-1.0）和死亡率（0.6，0.3-0.9）风险降低相关，CD4 增加≥50%的可能性增加（1.2，1.0-1.4），但与 VF 无关。