Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98104, USA.
J Infect Dis. 2013 Jan 1;207(1):72-9. doi: 10.1093/infdis/jis635. Epub 2012 Oct 24.
Measuring the survival of human immunodeficiency virus-infected adult patients enrolled in antiretroviral therapy (ART) programs is complicated by short observation periods and loss to follow-up. We synthesized data from treatment cohorts in sub-Saharan Africa to estimate survival over 5 years after initiation of ART.
We used data on retention, mortality, and loss to follow-up from 34 cohorts, including a total of 102,306 adult patients from 18 sub-Saharan African countries. These data were augmented by data from 13 sub-Saharan African studies tracking death rates among adult patients who were lost to follow-up (LTFU). We used a Poisson regression model to estimate survival over time, incorporating predicted mortality among LTFU patients.
Across studies, the median CD4(+) cell count at ART initiation was 104 cells/mm(3), 65% of patients were female, and the median age was 37 years. Survival at 1 year and 5 years were estimated to be 0.87 (95% confidence interval [CI], 0.72-0.94) and 0.70 (95% CI, 0.36-0.86), respectively, after adjustment for loss to follow-up. The life-years gained by a patient during the 5-year period after starting ART were estimated at 2.1 (95% CI, 1.6-2.3) in the adjusted model, compared with 1.7 (95% CI, 1.1-2.0) if there was 100% mortality among LTFU patients and with 2.4 (1.7-2.7) if there was 0% mortality among LTFU patients.
Accounting for loss to follow-up produces substantial changes in the estimated life-years gained during the first 5 years of ART receipt.
在抗逆转录病毒疗法（ART）项目中，衡量感染人类免疫缺陷病毒的成年患者的生存情况比较复杂，因为观察期较短且随访流失率较高。我们对撒哈拉以南非洲地区的治疗队列数据进行了综合分析，以估计患者接受 ART 治疗后 5 年的生存情况。
我们使用了来自 34 个队列的保留率、死亡率和随访流失数据，这些队列共纳入了来自 18 个撒哈拉以南非洲国家的 102306 名成年患者。这些数据通过来自 13 个撒哈拉以南非洲研究的数据进行了扩充，这些研究跟踪了随访流失（LTFU）的成年患者的死亡率。我们使用泊松回归模型来估计随时间的生存情况，纳入了 LTFU 患者的预测死亡率。
在各项研究中，ART 起始时的 CD4(+)细胞计数中位数为 104 个细胞/mm(3)，65%的患者为女性，中位年龄为 37 岁。调整 LTFU 后，1 年和 5 年的生存率估计分别为 0.87（95%置信区间 [CI]，0.72-0.94）和 0.70（95% CI，0.36-0.86）。在调整模型中，接受 ART 治疗后 5 年内，患者获得的预期寿命为 2.1（95% CI，1.6-2.3），如果 LTFU 患者的死亡率为 100%，则为 1.7（95% CI，1.1-2.0），如果 LTFU 患者的死亡率为 0%，则为 2.4（1.7-2.7）。
考虑到随访流失，在接受 ART 治疗的前 5 年内，预计获得的寿命有了较大的变化。
