Lancet HIV. 2015 Mar;2(3):e92-7. doi: 10.1016/S2352-3018(15)00017-X.
Appropriate use of highly active antiretroviral therapy (ART) can substantially decrease the risk of progression to AIDS and of premature mortality. We aimed to characterise the trends between 1981 and 2013 in AIDS-defining illnesses (ADIs) and the number AIDS-related deaths in British Columbia, Canada, where ART has been fully subsidised since 1996.
We included data on HIV-positive individuals, aged 19 years or older, from four administrative databases in British Columbia: the British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, the British Columbia Vital Statistics Agency, the British Columbia Cancer Agency. We estimated the relative risk of developing an ADI over time by use of a negative binomial model, and we investigated trends in the proportion of all deaths associated with AIDS by use of generalised additive models.
Data were available for 3550 people with HIV. 6205 ADIs were recorded. In 2013, 84 ADIs occurred, the lowest number since 1990. The peak of the AIDS epidemic in the region happened in 1994 with 696 ADIs reported (42 ADIs per 100 person-years). Since 1997, the number of ADIs decreased from 253 (7 per 100 person-years) to 84 cases in 2013 (1 per 100 person-years; p<0·0001 for trend in number of ADIs). We have also shown that of 22 ADIs included, only Pneumocystis jirovecii pneumonia remained prominent (albeit with much reduced overall prevalence). 2828 deaths were from AIDS-related causes, peaking in 1996 with 241 (96%) of 252 deaths in people with HIV and declining to 44 (20%) of 218 in 2013.
Our results provide further evidence that integrated comprehensive free programmes that facilitate testing and deliver treatment and care can be eff ective in decreasing AIDS-related morbidity and mortality, thus suggesting that control of and eventually an end to AIDS are possible.
适当使用高效抗逆转录病毒疗法（ART）可以显著降低艾滋病进展和过早死亡的风险。我们旨在描述 1981 年至 2013 年间加拿大不列颠哥伦比亚省艾滋病定义疾病（ADIs）的趋势和与艾滋病相关的死亡人数，在那里，自 1996 年以来，ART 已得到全面补贴。
我们从不列颠哥伦比亚省的四个行政数据库中纳入了年龄在 19 岁及以上的 HIV 阳性个体的数据：不列颠哥伦比亚省艾滋病卓越中心、圣保罗医院、不列颠哥伦比亚省生命统计署和不列颠哥伦比亚省癌症署。我们使用负二项式模型估计随着时间的推移发生 ADI 的相对风险，并使用广义相加模型研究与艾滋病相关的所有死亡人数的比例趋势。
共有 3550 名 HIV 感染者的数据可用。共记录了 6205 例 ADI。2013 年发生了 84 例 ADI，是自 1990 年以来的最低数字。该地区艾滋病流行的高峰期发生在 1994 年，报告了 696 例 ADI（每 100 人年 42 例）。自 1997 年以来，ADI 的数量从 253 例（每 100 人年 7 例）减少到 2013 年的 84 例（每 100 人年 1 例；趋势的 p 值<0·0001）。我们还表明，在所包括的 22 例 ADI 中，仅卡氏肺孢子虫肺炎仍然突出（尽管总体流行率大大降低）。2828 人死于与艾滋病相关的原因，1996 年达到高峰，252 名 HIV 感染者中有 241 人（96%）死亡，2013 年下降至 218 人中有 44 人（20%）。
我们的结果进一步证明，综合全面的免费计划，促进检测和提供治疗和护理，可以有效地降低艾滋病相关发病率和死亡率，因此表明控制和最终消除艾滋病是可能的。
