Price Alison J, Glynn Judith, Chihana Menard, Kayuni Ndoliwe, Floyd Sian, Slaymaker Emma, Reniers Georges, Zaba Basia, McLean Estelle, Kalobekamo Fredrick, Koole Olivier, Nyirenda Moffat, Crampin Amelia C
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Karonga Prevention Study, Chilumba, Karonga, Malawi.
Int J Epidemiol. 2017 Apr 1;46(2):479-491. doi: 10.1093/ije/dyw208.
Improved life expectancy in high HIV prevalence populations has been observed since antiretroviral therapy (ART) scale-up. However, it is unclear if the benefits are sustained, and the mortality among HIV-positive individuals not (yet) on ART is not well described. We assessed temporal change in mortality over 9 years in rural Malawi.
Within a demographic surveillance site in northern rural Malawi, we combined demographic, HIV and ART uptake data. We calculated life expectancy using Kaplan-Meier estimates, and compared mortality rates and rate ratios using Poisson regression, by period of ART availability (July 2005-June 2008, July 2008-June 2011 and July 2011-June 2014).
Among 32 664 individuals there were 1424 deaths; 1930 individuals were known HIV-positive, of whom 1382 started ART. Overall, life expectancy at age 15 years increased by 10 years within 5 years of ART introduction, and plateaued. Age-standardized adult mortality rates declined from 11.3/1000 to 7.5/1000 person-years between the first and last time period. In July 2011-June 2014 compared with July 2005-June 2008, mortality declined in HIV-positive individuals on ART (rate ratio adjusted (aRR) for age, sex, location and education, 0.3; 95% confidence interval (CI) 0.2-0.5) and in those not (yet) on ART (aRR 0.3; 95%CI 0.1-0.5) but not in HIV-negative individuals (aRR 1.1; 95%CI 0.7-1.9).
Total population adult life expectancy increased toward that of HIV-negative individuals by 2011 and remained raised. The reduction in all-cause and HIV-related mortality in HIV-positive individuals not (yet) on ART suggests ART uptake is occurring at an earlier disease stage, particularly in women.
自扩大抗逆转录病毒疗法（ART）以来，在艾滋病毒高流行人群中观察到预期寿命有所提高。然而，尚不清楚这些益处是否能持续，且尚未接受ART治疗的艾滋病毒阳性个体的死亡率情况也未得到充分描述。我们评估了马拉维农村地区9年间死亡率的时间变化情况。
在马拉维北部农村的一个人口监测点，我们整合了人口统计学、艾滋病毒及ART治疗接受情况的数据。我们使用Kaplan-Meier估计法计算预期寿命，并通过Poisson回归，按ART可及时间段（2005年7月 - 2008年6月、2008年7月 - 2011年6月和2011年7月 - 2014年6月）比较死亡率及率比。
在32664名个体中，有1424人死亡；1930人已知为艾滋病毒阳性，其中1382人开始接受ART治疗。总体而言，15岁时的预期寿命在引入ART治疗后的5年内增加了10岁，并趋于平稳。在第一个和最后一个时间段之间，年龄标准化的成人死亡率从11.3/1000人年降至7.5/1000人年。与2005年7月 - 2008年6月相比，在2011年7月 - 2014年6月期间，接受ART治疗的艾滋病毒阳性个体的死亡率下降（经年龄、性别、地点和教育调整后的率比（aRR）为0.3；95%置信区间（CI）为0.2 - 0.5），尚未接受ART治疗的个体死亡率也下降（aRR 0.3；95%CI 0.1 - 0.5），但艾滋病毒阴性个体死亡率未下降（aRR 1.1；95%CI 0.7 - 1.9）。
到2011年，总人口的成人预期寿命向艾滋病毒阴性个体的预期寿命水平提高，并保持在该水平。尚未接受ART治疗的艾滋病毒阳性个体的全因死亡率和与艾滋病毒相关的死亡率下降，表明ART治疗在疾病早期阶段的接受率有所提高，尤其是在女性中。
