Suligoi Barbara, Zucchetto Antonella, Grande Enrico, Camoni Laura, Dal Maso Luigino, Frova Luisa, Virdone Saverio, Boros Stefano, Pappagallo Marilena, Taborelli Martina, Regine Vincenza, De Paoli Paolo, Serraino Diego
Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
BMC Infect Dis. 2015 Jun 12;15:229. doi: 10.1186/s12879-015-0960-6.
Despite the dramatically improved survival due to combination antiretroviral therapies (cART), life expectancy of people with HIV/AIDS remains lower than that of the general population. This study aimed to estimate, at a population level, the survival experience of Italian people with AIDS (PWA) and to quantify the prognostic role of selected factors at diagnosis in the risk of early mortality (i.e., within six months from AIDS diagnosis).
A population-based, retrospective-cohort study was conducted among Italian PWA diagnosed between 1999 and 2009 and recorded in the national AIDS registry. The vital status, up to December 2010, of 14,552 PWA was ascertained through a record linkage procedure with the Italian mortality database. Survival probabilities were estimated through Kaplan-Meier method. To identify risk factors for early mortality from any cause, odds ratios (ORs) and corresponding 95% confidence intervals (CIs), adjusted for major confounders, were computed using multivariate logistic regression models.
Of the 5,706 deaths registered among the 14,552 PWA included in the study, 2,757 (18.9%) occurred within six months from AIDS diagnosis. The probability of surviving six months increased from 81.2% in PWA diagnosed in 1999-2000 to 82.9% in 2009, while the 5-year survival augmented from 60.7% in PWA diagnosed in 1999-2000 to 65.4% for PWA diagnosed in 2005-2006. Elevated risks of early mortality were associated to older age (OR = 5.28; 95% CI: 4.41-6.32 for age ≥60 vs. <35 years), injecting drug use (OR = 1.71; 95% CI: 1.53-1.91 vs. heterosexual intercourse), and CD4 count <50 cells/mm(3) at AIDS diagnosis (OR = 1.87, 95% CI: 1.55-2.27 vs. ≥350). Elevated ORs for early mortality also emerged for PWA diagnosed with primary brain lymphoma (OR = 11.66, 95% CI: 7.32-18.57), or progressive multifocal leukoencephalopathy (OR = 4.21, 95% CI: 3.37-5.27).
Our study documented, among Italian PWA, the high - though slightly decreasing - frequency of early mortality in the full cART era. These findings indicate the need for enduring and ameliorating preventive actions aimed at timely HIV testing among all individuals at risk for HIV infection and/or those who present diseases known to be related with HIV infection.
尽管联合抗逆转录病毒疗法（cART）显著提高了生存率，但艾滋病毒/艾滋病患者的预期寿命仍低于普通人群。本研究旨在在人群层面评估意大利艾滋病患者（PWA）的生存经历，并量化诊断时选定因素在早期死亡风险（即艾滋病诊断后六个月内）中的预后作用。
对1999年至2009年间诊断并记录在国家艾滋病登记处的意大利PWA进行了一项基于人群的回顾性队列研究。通过与意大利死亡率数据库的记录链接程序确定了14,552名PWA截至2010年12月的生命状态。通过Kaplan-Meier方法估计生存概率。为了确定任何原因导致的早期死亡的危险因素，使用多变量逻辑回归模型计算了调整主要混杂因素后的优势比（OR）和相应的95%置信区间（CI）。
在纳入研究的14,552名PWA中登记的5,706例死亡中，2,757例（18.9%）发生在艾滋病诊断后六个月内。存活六个月的概率从1999 - 2000年诊断的PWA中的81.2%增加到2009年的82.9%，而5年生存率从1999 - 2000年诊断的PWA中的60.7%增加到2005 - 2006年诊断的PWA中的65.4%。早期死亡风险升高与年龄较大（年龄≥60岁与<35岁相比，OR = 5.28；95% CI：4.41 - 6.32）、注射吸毒（OR = 1.71；95% CI：1.53 - 1.91与异性性行为相比）以及艾滋病诊断时CD4细胞计数<50个/mm³（OR = 1.87，95% CI：1.55 - 2.27与≥350相比）有关。诊断为原发性脑淋巴瘤（OR = 11.66，95% CI：7.32 - 18.57）或进行性多灶性白质脑病（OR = 4.21，95% CI：3.37 - 5.27）的PWA早期死亡的OR值也升高。
我们的研究记录了在意大利PWA中，在整个cART时代早期死亡的高频率——尽管略有下降。这些发现表明需要持久且改善预防性行动，旨在对所有有感染艾滋病毒风险的个体和/或那些患有已知与艾滋病毒感染相关疾病的人及时进行艾滋病毒检测。
