Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland.
HIV Med. 2011 May;12(5):279-88. doi: 10.1111/j.1468-1293.2010.00880.x. Epub 2010 Oct 18.
The long-term outcome of antiretroviral therapy (ART) is not assessed in controlled trials. We aimed to analyse trends in the population effectiveness of ART in the Swiss HIV Cohort Study over the last decade.
We analysed the odds of stably suppressed viral load (ssVL: three consecutive values <50 HIV-1 RNA copies/mL) and of CD4 cell count exceeding 500 cells/μL for each year between 2000 and 2008 in three scenarios: an open cohort; a closed cohort ignoring the influx of new participants after 2000; and a worst-case closed cohort retaining lost or dead patients as virological failures in subsequent years. We used generalized estimating equations with sex, age, risk, non-White ethnicity and era of starting combination ART (cART) as fixed co-factors. Time-updated co-factors included type of ART regimen, number of new drugs and adherence to therapy.
The open cohort included 9802 individuals (median age 38 years; 31% female). From 2000 to 2008, the proportion of participants with ssVL increased from 37 to 64% [adjusted odds ratio (OR) per year 1.16 (95% CI 1.15-1.17)] and the proportion with CD4 count >500 cells/μL increased from 40 to >50% [OR 1.07 (95% CI 1.06-1.07)]. Similar trends were seen in the two closed cohorts. Adjustment did not substantially affect time trends.
There was no relevant dilution effect through new participants entering the open clinical cohort, and the increase in virological/immunological success over time was not an artefact of the study design of open cohorts. This can partly be explained by new treatment options and other improvements in medical care.
抗逆转录病毒疗法（ART）的长期疗效并未在对照试验中得到评估。我们旨在分析过去十年间瑞士艾滋病毒队列研究中人群接受 ART 的疗效趋势。
我们分析了 2000 年至 2008 年期间三种情况下的稳定病毒载量抑制（ssVL：三次连续值<50 HIV-1 RNA 拷贝/ml）和 CD4 细胞计数超过 500 个/μl 的几率：开放队列；忽略 2000 年后新入组参与者的封闭队列；保留作为随后年份病毒学失败的失访或死亡患者的最差情况封闭队列。我们使用广义估计方程，将性别、年龄、风险、非白人种族和开始联合抗逆转录病毒治疗（cART）的时代作为固定协变量。时间更新的协变量包括 ART 方案类型、新药物数量和治疗依从性。
开放队列包括 9802 名参与者（中位年龄 38 岁；31%为女性）。2000 年至 2008 年，ssVL 患者的比例从 37%增加到 64%[每年调整后的比值比（OR）为 1.16（95%可信区间 1.15-1.17）]，CD4 计数>500 个/μl 的比例从 40%增加到>50%[OR 1.07（95%可信区间 1.06-1.07）]。两个封闭队列也观察到类似的趋势。调整并没有实质性地影响时间趋势。
新参与者进入开放临床队列并没有造成明显的稀释效应，随着时间的推移，病毒学/免疫学成功率的提高也不是开放队列研究设计的人为因素。这部分可以解释为新的治疗选择和其他医疗保健的改善。
