Johnson Leigh F, Keiser Olivia, Fox Matthew P, Tanser Frank, Cornell Morna, Hoffmann Chris J, Prozesky Hans, Boulle Andrew, Davies Mary-Ann
aCentre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa bInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland cDepartment of Epidemiology, Boston University, Boston dDepartment of Global Health and Development, Boston University, Boston eHealth Economics and Epidemiology Research Office, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg fAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Durban gAurum Institute, Johannesburg, South Africa hDivision of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA iDivision of Infectious Diseases, Department of Medicine, University of Stellenbosch jTygerberg Academic Hospital, Cape Town, South Africa.
AIDS. 2016 Oct 23;30(16):2545-2550. doi: 10.1097/QAD.0000000000001197.
Previous studies have reported improvements in life expectancies of patients on antiretroviral treatment (ART) over time, but it is not clear whether these improvements are explained by changes in baseline clinical characteristics, longer duration on ART or changes in clinical practices.
Two parametric survival models were fitted to mortality data from South African ART cohorts that had linked patient records to the national vital registration system. The first model estimated mortality by age, sex, cohort, baseline CD4 cell count, time since ART initiation and period of ART initiation; the second model included only age, sex, cohort and period of follow-up. Life expectancies were calculated from the estimated mortality rates.
The first model estimated little change in mortality over time: women starting ART at age 35 years, at CD4 cell counts of 200 cells/μl or higher, had life expectancies of 32.7 years [95% confidence interval (CI): 31.6-33.6], 32.4 years (95% CI: 31.3-33.4) and 33.0 years (95% CI: 32.0-34.1) in the 2001-2006, 2007-2009 and 2010-2014 periods, respectively. However, the second model estimated a significant improvement in life expectancy; for all women on ART at age 35 years, corresponding life expectancies were 13.0 years (95% CI: 12.1-14.2), 20.4 years (95% CI: 19.5-21.4) and 26.1 years (95% CI: 25.2-26.9), respectively.
Although life expectancies in South African ART patients have improved over time, these improvements are not observed after controlling for changes in baseline CD4 cell count and ART duration. This suggests that changes in clinical practice and programme scale have had little impact on ART mortality in South Africa.
以往研究报告称，接受抗逆转录病毒治疗（ART）的患者的预期寿命随时间有所提高，但尚不清楚这些改善是由基线临床特征的变化、ART治疗时间延长还是临床实践的变化所导致。
对南非ART队列的死亡率数据拟合了两个参数生存模型，这些队列已将患者记录与国家人口动态登记系统相链接。第一个模型根据年龄、性别、队列、基线CD4细胞计数、开始ART后的时间以及开始ART的时期来估计死亡率；第二个模型仅包括年龄、性别、队列和随访时期。根据估计的死亡率计算预期寿命。
第一个模型估计死亡率随时间变化不大：35岁开始接受ART治疗、CD4细胞计数为200个/μl或更高的女性，在2001 - 2006年、2007 - 2009年和2010 - 2014年期间的预期寿命分别为32.7岁[95%置信区间（CI）：31.6 - 33.6]、32.4岁（95% CI：31.3 - 33.4）和33.0岁（95% CI：32.0 - 34.1）。然而，第二个模型估计预期寿命有显著改善；对于所有35岁接受ART治疗的女性，相应的预期寿命分别为13.0岁（95% CI：12.1 - 14.2）、20.4岁（95% CI：19.5 - 21.4）和26.1岁（95% CI：25.2 - 26.9）。
尽管南非接受ART治疗的患者的预期寿命随时间有所提高，但在控制基线CD4细胞计数和ART治疗时间的变化后，未观察到这些改善。这表明临床实践和项目规模的变化对南非ART治疗的死亡率影响不大。
