开始联合抗逆转录病毒治疗的HIV阳性成年人的全因死亡率：校正失访情况。

All-cause mortality in HIV-positive adults starting combination antiretroviral therapy: correcting for loss to follow-up.

作者信息

Anderegg Nanina, Johnson Leigh F, Zaniewski Elizabeth, Althoff Keri N, Balestre Eric, Law Matthew, Nash Denis, Shepherd Bryan E, Yiannoutsos Constantin T, Egger Matthias

机构信息

aInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland bCentre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, South Africa cJohn Hopkins University, Baltimore, Maryland, USA dISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Université Bordeaux, Bordeaux Cedex, France eKirby Institute, UNSW, Sydney, New South Wales, Australia fInstitute for Implementation Science in Population Health, City University of New York, New York, USA gDepartment of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, New York, USA hDepartment of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA iDepartment of Biostatistics, Indiana University School of Public Health, Indianapolis, Indiana, USA.

出版信息

AIDS. 2017 Apr;31 Suppl 1(Suppl 1):S31-S40. doi: 10.1097/QAD.0000000000001321.

DOI:10.1097/QAD.0000000000001321

PMID:28296798

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5540664/

Abstract

OBJECTIVE

To estimate mortality in HIV-positive patients starting combination antiretroviral therapy (ART) and to discuss different approaches to calculating correction factors to account for loss to follow-up.

METHODS

A total of 222 096 adult HIV-positive patients who started ART 2009-2014 in clinics participating in the International epidemiology Databases to Evaluate AIDS collaboration in 43 countries in sub-Saharan Africa, Asia Pacific, Latin America, and North America were included. To allow for underascertainment of deaths due to loss to follow-up, two correction factors (one for the period 0-6 months on ART and one for later periods) or 168 correction factors (combinations of two sexes, three time periods after ART initiation, four age groups, and seven CD4 groups) based on tracing patients lost in Kenya and data linkages in South Africa were applied. Corrected mortality rates were compared with a worst case scenario assuming all patients lost to follow-up had died.

RESULTS

Loss to follow-up differed between regions; rates were lowest in central Africa and highest in east Africa. Compared with using two correction factors (1.64 for the initial ART period and 2.19 for later), applying 168 correction factors (range 1.03-4.75) more often resulted in implausible mortality rates that exceeded the worst case scenario. Corrected mortality rates varied widely, ranging from 0.2 per 100 person-years to 54 per 100 person-years depending on region and covariates.

CONCLUSION

Implausible rates were less common with the simpler approach based on two correction factors. The corrected mortality rates will be useful to international agencies, national programmes, and modellers.

摘要

目的

评估开始接受抗逆转录病毒联合疗法（ART）的HIV阳性患者的死亡率，并探讨计算校正因子以考虑失访情况的不同方法。

方法

纳入了2009年至2014年期间在撒哈拉以南非洲、亚太地区、拉丁美洲和北美的43个国家参与国际艾滋病流行病学数据库评估合作项目的诊所开始接受ART治疗的222096名成年HIV阳性患者。为了考虑因失访导致的死亡报告不足，基于在肯尼亚追踪失访患者以及南非的数据关联，应用了两个校正因子（一个用于ART治疗的0至6个月期间，另一个用于后续期间）或168个校正因子（两种性别、ART开始后的三个时间段、四个年龄组和七个CD4组的组合）。将校正后的死亡率与假设所有失访患者均已死亡的最坏情况进行比较。

结果

不同地区的失访情况有所不同；中部非洲的失访率最低，东部非洲的失访率最高。与使用两个校正因子（初始ART治疗期间为1.64，后续期间为2.19）相比，应用168个校正因子（范围为1.03至4.75）更常导致难以置信的死亡率，超过了最坏情况。校正后的死亡率差异很大，根据地区和协变量，范围从每100人年0.2例至每100人年54例不等。