Ferreros Inmaculada, Hurtado Isabel, del Amo Julia, Muga Roberto, del Romero Jorge, García Patricia, Alastrué Ignacio, Belda Josefina, Guevara Marcela, Pérez Santiago
Centro Superior de Investigación en Salud Pública, Valencia, España.
Enferm Infecc Microbiol Clin. 2011 Mar;29(3):179-84. doi: 10.1016/j.eimc.2010.10.005. Epub 2011 Feb 17.
Several observational studies support the protective effect of combined antiretroviral therapy (cART) on time to first AIDS-defining event, but the effect on multiple AIDS defining illnesses remains unclear.The aim of this study is to analyse whether the protective effect of cART persists beyond the first AIDS-defining illness.
A total of 1938 subjects from GEMES seroconverter cohort have been included. To analyse cART effectiveness, calendar time has been divided into three periods according to antiretroviral availability. A population-averaged proportional hazard model with staggered entries that counted the gap time, and had event-specific baseline risks, was fitted.
During follow-up, 1524 (78.6%), 259 (13.4%), 83 (4.3%) and 72 (3.7%) subjects incurred 0, 1, 2, and 3 or more AIDS-defining illnesses, respectively. After adjustment for sex, age at seroconversion and exposure category, the Relative Risk (RR) of AIDS in the cART period was 0.38 (95%CI 0.30-0.48) compared with the 1992-95 period. The RR of the first, second and third AIDS-defining illness in the cART period were 0.40 (95% CI: 0.32-0.50), 0.27 (95% CI: 0.15-0.50) and 0.41 (95% CI: 0.18-0.96) respectively, relative to the reference calendar period when we allowed the odds ratios to vary by the number of prior AIDS-defining events. The relative risk of AIDS, taking all events into account, was 0.32 (95% CI: 0.25-0.40). Intravenous drug users have a higher risk of developing a first episode of AIDS than homosexuals, RR: 2.14 (95% CI: 1.48-3.10).
Results indicate that the relative effect of cART appears to be both protective and stable over multiple AIDS-defining illnesses. Analysis of multiple AIDS-defining illnesses improves the precision of the estimated relative risk.
多项观察性研究支持联合抗逆转录病毒疗法（cART）对首次出现艾滋病定义事件时间的保护作用，但对多种艾滋病定义疾病的影响仍不明确。本研究的目的是分析cART的保护作用在首次出现艾滋病定义疾病之后是否仍然存在。
纳入了来自GEMES血清转化者队列的1938名受试者。为了分析cART的有效性，根据抗逆转录病毒药物的可获得情况将日历时间分为三个时期。拟合了一个具有交错进入的总体平均比例风险模型，该模型计算间隔时间，并具有特定事件的基线风险。
在随访期间，分别有1524名（78.6%）、259名（13.4%）、83名（4.3%）和72名（3.7%）受试者发生了0、1、2和3种或更多种艾滋病定义疾病。在对性别、血清转化时的年龄和暴露类别进行调整后，与1992 - 1995年期间相比，cART时期艾滋病的相对风险（RR）为0.38（95%置信区间0.30 - 0.48）。当我们允许比值比随先前艾滋病定义事件的数量而变化时，相对于参考日历时期，cART时期首次、第二次和第三次艾滋病定义疾病的RR分别为0.40（95%置信区间：0.32 - 0.50）、0.27（95%置信区间：0.15 - 0.50）和0.41（95%置信区间：0.18 - 0.96）。考虑所有事件后，艾滋病的相对风险为0.32（95%置信区间：0.25 - 0.40）。静脉吸毒者发生首次艾滋病发作的风险高于同性恋者，RR：2.14（95%置信区间：1.48 - 3.10）。
结果表明，cART的相对作用在多种艾滋病定义疾病中似乎具有保护作用且稳定。对多种艾滋病定义疾病的分析提高了估计相对风险的精确度。
