aUniversity College London, London, UK bUniversidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil cThe University of California, San Francisco, San Francisco, California, USA dUniversity of New South Wales, Sydney, New South Wales, Australia eHIV Unit and irsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain fWojewodzki Szpital Zakazny, Warsaw, Poland gCopenhagen University Hospital, Copenhagen, Denmark.
AIDS. 2013 Mar 27;27(6):973-979. doi: 10.1097/QAD.0b013e32835cae9c.
Due to the success of antiretroviral therapy (ART), it is relevant to ask whether death rates in optimally treated HIV are higher than the general population. The objective was to compare mortality rates in well controlled HIV-infected adults in the SMART and ESPRIT clinical trials with the general population.
Non-IDUs aged 20-70 years from the continuous ART control arms of ESPRIT and SMART were included if the person had both low HIV plasma viral loads (≤400 copies/ml SMART, ≤500 copies/ml ESPRIT) and high CD4(+) T-cell counts (≥350 cells/μl) at any time in the past 6 months. Standardized mortality ratios (SMRs) were calculated by comparing death rates with the Human Mortality Database.
Three thousand, two hundred and eighty individuals [665 (20%) women], median age 43 years, contributed 12,357 person-years of follow-up. Sixty-two deaths occurred during follow up. Commonest cause of death was cardiovascular disease (CVD) or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%). Only two deaths (3%) were AIDS-related. Mortality rate was increased compared with the general population with a CD4(+) cell count between 350 and 499 cells/μl [SMR 1.77, 95% confidence interval (CI) 1.17-2.55]. No evidence for increased mortality was seen with CD4(+) cell counts greater than 500 cells/μl (SMR 1.00, 95% CI 0.69-1.40).
In HIV-infected individuals on ART, with a recent undetectable viral load, who maintained or had recovery of CD4(+) cell counts to at least 500 cells/μl, we identified no evidence for a raised risk of death compared with the general population.
由于抗逆转录病毒疗法（ART）的成功，人们有理由质疑在最佳治疗下的 HIV 感染者的死亡率是否高于普通人群。本研究旨在比较 SMART 和 ESPRIT 临床试验中经过良好控制的 HIV 感染者的死亡率与普通人群的死亡率。
从 ESPRIT 和 SMART 的连续 ART 对照组中纳入年龄在 20-70 岁之间、非 IDU 的个体，要求这些个体在过去 6 个月内的任何时候都有低 HIV 血浆病毒载量（SMART 组≤400 拷贝/ml，ESPRIT 组≤500 拷贝/ml）和高 CD4+T 细胞计数（≥350 个/μl）。通过与人类死亡率数据库比较死亡率来计算标准化死亡率比（SMR）。
3280 人[665 名（20%）女性]，中位年龄 43 岁，共随访 12357 人年。随访期间发生 62 例死亡。最常见的死因是心血管疾病（CVD）或猝死（19 例，31%），其次是非艾滋病恶性肿瘤（12 例，19%）。只有两例死亡（3%）与 AIDS 相关。与 CD4+细胞计数在 350 至 499 个/μl 之间的普通人群相比，死亡率增加[SMR 1.77，95%置信区间（CI）1.17-2.55]。在 CD4+细胞计数大于 500 个/μl 时，没有发现死亡率增加的证据[SMR 1.00，95%CI 0.69-1.40]。
在接受 ART 治疗、最近病毒载量不可检测、CD4+细胞计数维持或恢复至至少 500 个/μl 的 HIV 感染者中，与普通人群相比，我们没有发现死亡风险增加的证据。
