2000 年至 2008 年美国艾滋病毒感染者抗逆转录病毒治疗使用、HIV RNA 血浆病毒载量和 CD4 淋巴细胞计数的趋势。

U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons, 2000 to 2008.

机构信息

Johns Hopkins University, Baltimore, Maryland, USA.

出版信息

Ann Intern Med. 2012 Sep 4;157(5):325-35. doi: 10.7326/0003-4819-157-5-201209040-00005.

DOI:10.7326/0003-4819-157-5-201209040-00005

PMID:22944874

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3534765/

Abstract

BACKGROUND

The U.S. National HIV/AIDS Strategy targets for 2015 include "increasing access to care and improving health outcomes for persons living with HIV in the United States" (PLWH-US).

OBJECTIVE

To demonstrate the utility of the NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) for monitoring trends in the HIV epidemic in the United States and to present trends in HIV treatment and related health outcomes.

DESIGN

Trends from annual cross-sectional analyses comparing patients from pooled, multicenter, prospective, clinical HIV cohort studies with PLWH-US, as reported to national surveillance systems in 40 states.

SETTING

U.S. HIV outpatient clinics.

PATIENTS

HIV-infected adults with 1 or more HIV RNA plasma viral load (HIV VL) or CD4 T-lymphocyte (CD4) cell count measured in any calendar year from 1 January 2000 to 31 December 2008.

MEASUREMENTS

Annual rates of antiretroviral therapy use, HIV VL, and CD4 cell count at death.

RESULTS

45 529 HIV-infected persons received care in an NA-ACCORD-participating U.S. clinical cohort from 2000 to 2008. In 2008, the 26 030 NA-ACCORD participants in care and the 655 966 PLWH-US had qualitatively similar demographic characteristics. From 2000 to 2008, the proportion of participants prescribed highly active antiretroviral therapy increased by 9 percentage points to 83% (P < 0.001), whereas the proportion with suppressed HIV VL (≤2.7 log10 copies/mL) increased by 26 percentage points to 72% (P < 0.001). Median CD4 cell count at death more than tripled to 0.209 × 109 cells/L (P < 0.001).

LIMITATION

The usual limitations of observational data apply.

CONCLUSION

The NA-ACCORD is the largest cohort of HIV-infected adults in clinical care in the United States that is demographically similar to PLWH-US in 2008. From 2000 to 2008, increases were observed in the percentage of prescribed HAART, the percentage who achieved a suppressed HIV VL, and the median CD4 cell count at death.

PRIMARY FUNDING SOURCE

National Institutes of Health; Centers for Disease Control and Prevention; Canadian Institutes of Health Research; Canadian HIV Trials Network; and the government of British Columbia, Canada.

摘要

背景

美国国家艾滋病战略的目标包括“增加在美国生活的艾滋病毒感染者获得护理和改善健康结果的机会”（PLWH-US）。

目的

展示北美艾滋病队列合作研究与设计（NA-ACCORD）在监测美国艾滋病毒流行趋势以及报告艾滋病毒治疗和相关健康结果趋势方面的实用性。

设计

比较 2000 年 1 月 1 日至 2008 年 12 月 31 日期间在 40 个州的国家监测系统中报告的来自 pooled、多中心、前瞻性、临床艾滋病毒队列研究的患者与 PLWH-US 的年度横断面分析趋势。

地点

美国艾滋病毒门诊诊所。

患者

接受过 1 次或多次艾滋病毒 RNA 血浆病毒载量（HIV VL）或 CD4 淋巴细胞（CD4）细胞计数测量的 HIV 感染成年人，在任何日历年中测量。

测量

每年接受抗逆转录病毒治疗的比例、HIV VL 和死亡时的 CD4 细胞计数。

结果

2000 年至 2008 年期间，45529 名 HIV 感染者在参加北美合作的美国临床队列中接受了治疗。2008 年，26030 名参加护理的北美合作参与者和 655966 名 PLWH-US 的人口统计学特征相似。2000 年至 2008 年间，接受高效抗逆转录病毒治疗的参与者比例增加了 9 个百分点，达到 83%（P < 0.001），而 HIV VL 抑制率（≤2.7 log10 拷贝/mL）增加了 26 个百分点，达到 72%（P < 0.001）。死亡时的中位 CD4 细胞计数增加了两倍多，达到 0.209×109 个细胞/L（P < 0.001）。