高效抗逆转录病毒疗法及其依从性对带状疱疹发病率的影响：一项纵向队列研究。
Effects of highly active antiretroviral therapy and its adherence on herpes zoster incidence: a longitudinal cohort study.
机构信息
Department of Medicine, Georgetown University, 2115 Wisconsin Avenue NW, Suite 130, Washington, DC 20007, USA.
出版信息
AIDS Res Ther. 2013 Dec 27;10(1):34. doi: 10.1186/1742-6405-10-34.
BACKGROUND
Herpes zoster (HZ) is common among HIV-infected individuals, but the impacts of highly active antiretroviral therapy (HAART) and HAART adherence on HZ risk have not been well studied.
METHODS
The effects of HAART and HAART adherence on HZ incidence were evaluated by comparing HIV-infected women on HAART (HAART use group) with the HIV-infected women remaining HAART naïve (HAART naïve group) in the Women's Interagency HIV Study (WIHS). A 1:1 matching with propensity score for predicting HAART initiation was conducted to balance background covariates at index visit, including HIV disease stage. Kaplan-Meier method was used to compare the risk of HZ development between the matched pairs. Cox proportional hazard models were used to assess the effects of HAART and HAART adherence on HZ incidence.
RESULTS
Through propensity score matching, 389 pairs of participants were identified and they contributed 3,909 person years after matching. The background covariates were similar between the matched pairs at the index visit. The participants had a mean age around 39 years old, and about 61% of them were Black and 22% were Latina. No significant difference in HZ risk was observed between the HAART use group and the HAART naïve group during the first year of follow-up in any analyses. In the univariate analysis, the HAART use group had marginally lower HZ risk (Hazard Ratio (HR): 0.72; 95% Confidence Interval (CI): 0.48-1.1) over the entire follow-up period. However, women with a HAART adherence level of ≥95% had significantly lower HZ risk (HR: 0.54; 95% CI: 0.31, 0.94) compared to the HAART naïve women. The association remained significant after adjusting for quality of life score and acyclovir use, but it attenuated and was no longer statistically significant after adjusting for an intermediate variable, either CD4+ T cell counts or HIV viral load.
CONCLUSIONS
Among adult women, we observed a significant preventive effect of long-term HAART use on HZ incidence when a HAART adherence level of ≥95% was attained, and this effect was mediated through reduction of HIV viral load and improvement of CD4+ T cell counts.
背景
带状疱疹（HZ）在 HIV 感染者中很常见，但高效抗逆转录病毒治疗（HAART）和 HAART 依从性对 HZ 风险的影响尚未得到很好的研究。
方法
通过比较接受 HAART（HAART 使用组）和未接受 HAART（HAART 未使用组）的 HIV 感染女性，在妇女艾滋病研究机构（WIHS）中评估 HAART 和 HAART 依从性对 HZ 发病率的影响。通过预测 HAART 起始的倾向评分进行 1:1 匹配，以平衡指数就诊时的背景协变量，包括 HIV 疾病阶段。使用 Kaplan-Meier 方法比较匹配对之间 HZ 发展的风险。使用 Cox 比例风险模型评估 HAART 和 HAART 依从性对 HZ 发病率的影响。
结果
通过倾向评分匹配，确定了 389 对参与者，匹配后共提供了 3909 人年。匹配时，匹配对在指数就诊时的背景协变量相似。参与者的平均年龄约为 39 岁，约 61%为黑人，22%为拉丁裔。在任何分析中，在随访的第一年，HAART 使用组与 HAART 未使用组之间的 HZ 风险均无显著差异。在单变量分析中，HAART 使用组在整个随访期间 HZ 风险略低（风险比（HR）：0.72；95%置信区间（CI）：0.48-1.1）。然而，HAART 依从性水平≥95%的女性 HZ 风险显著降低（HR：0.54；95%CI：0.31，0.94），与 HAART 未使用的女性相比。调整生活质量评分和阿昔洛韦使用后，该关联仍然显著，但在调整中间变量，即 CD4+ T 细胞计数或 HIV 病毒载量后，该关联减弱且不再具有统计学意义。
结论
在成年女性中，我们观察到当达到 HAART 依从性水平≥95%时，长期 HAART 使用对 HZ 发病率有显著的预防作用，这种作用通过降低 HIV 病毒载量和改善 CD4+ T 细胞计数来介导。
Zotero 插件