Drechsler Henning, Zhang Song, Holodniy Mark, Bedimo Roger
North Texas VA Health Care Center, Dallas, TX, USA.
J Int Assoc Provid AIDS Care. 2014 Mar-Apr;13(2):120-6. doi: 10.1177/2325957413512153. Epub 2013 Dec 30.
We used the Veterans Health Administration (VA) HIV Clinical Case Registry (CCR) to evaluate the association between annual CD4 averages and all-cause mortality in HIV-infected veterans during their initial episode of suppressive highly active antiretroviral therapy (HAART). We observed 1083 deaths in 14 769 patients. Unadjusted mortality rates in the top and bottom CD4 quintiles differed significantly from the mid CD4 strata. Mortality in the top CD4 quintile (≥720 cells/mm(3)) was 14.1/1000 patient-years, 95% confidence interval (CI): 10.1-18.2, compared with 20.4 (CI: 15.5-25.3) in the next lower CD4 stratum (530-719 cells/mm(3)). This difference was significant in Cox proportional hazards model, controlling for demographics, hepatitis co-infections, low-level viremia, HAART adherence, and refill rates of individual antiretrovirals (HR: 1.4, CI: 1.13-1.73). Our results support early HAART initiation as advocated by the current US treatment guidelines for HIV infection.
我们利用退伍军人健康管理局（VA）的HIV临床病例登记系统（CCR），评估在接受抑制性高效抗逆转录病毒疗法（HAART）的初始阶段，HIV感染退伍军人的年度CD4平均水平与全因死亡率之间的关联。我们观察了14769名患者中的1083例死亡情况。CD4最高和最低五分位数组的未调整死亡率与CD4中间分层有显著差异。CD4最高五分位数组（≥720个细胞/mm³）的死亡率为14.1/1000患者年，95%置信区间（CI）：10.1 - 18.2，而下一个较低CD4分层（530 - 719个细胞/mm³）的死亡率为20.4（CI：15.5 - 25.3）。在控制了人口统计学因素、肝炎合并感染、低水平病毒血症、HAART依从性以及各抗逆转录病毒药物的再填充率后，这种差异在Cox比例风险模型中具有显著性（风险比：1.4，CI：1.13 - 1.73）。我们的结果支持美国当前HIV感染治疗指南所倡导的尽早开始HAART治疗。
