Marcus Julia L, Chao Chun R, Leyden Wendy A, Xu Lanfang, Quesenberry Charles P, Klein Daniel B, Towner William J, Horberg Michael A, Silverberg Michael J
*Division of Research, Kaiser Permanente Northern California, Oakland, CA; †Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA; ‡Kaiser Permanente San Leandro Medical Center, Kaiser Permanente Northern California, San Leandro, CA; §Department of Research and Evaluation, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; and ‖Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic, Rockville, MD.
J Acquir Immune Defic Syndr. 2016 Sep 1;73(1):39-46. doi: 10.1097/QAI.0000000000001014.
It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care.
We conducted a cohort study within Kaiser Permanente California during 1996-2011, using abridged life tables to estimate the expected years of life remaining ("life expectancy") at age 20.
Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996-1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9-14.8 years) in 2011. In 2008-2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008-2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1-10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors.
Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
在可获得治疗的情况下，感染艾滋病毒者与未感染艾滋病毒者之间是否仍存在生存差距尚不清楚。
我们于1996年至2011年期间在加利福尼亚州凯撒医疗集团开展了一项队列研究，使用简略寿命表来估计20岁时的预期剩余寿命（“预期寿命”）。
在24768名感染艾滋病毒者和257600名未感染艾滋病毒者中，分别有2229例和4970例死亡，死亡率分别为每10万人年1827例和326例。1996 - 1997年，20岁时感染艾滋病毒者和未感染艾滋病毒者的预期寿命分别为19.1岁和63.4岁，差距为44.3岁（95%置信区间：38.4至50.2）。2008年，感染艾滋病毒者20岁时的预期寿命增至47.1岁，到2011年为53.1岁，2011年差距缩小至11.8岁（8.9 - 14.8岁）。在2008 - 2011年期间，感染艾滋病毒者20岁时的预期寿命，黑人最低为45.8岁，有注射吸毒史者为46.0岁，西班牙裔最高为52.2岁。在2008 - 2011年期间，CD4每微升≥500个细胞时开始接受抗逆转录病毒治疗的感染艾滋病毒者20岁时的预期寿命为54.5岁，与未感染艾滋病毒者的差距缩小至7.9岁（5.1 - 10.6岁）。对于这些感染艾滋病毒者，在无乙肝或丙肝感染史、不吸烟、无药物/酒精滥用或无任何这些风险因素的亚组中，差距进一步缩小。
即使能早期治疗并获得医疗服务，感染艾滋病毒者与未感染艾滋病毒者相比，预期寿命仍有8岁的差距。
