抗逆转录病毒治疗启动后 HIV 感染者病毒抑制不完全与死亡率。
Incomplete viral suppression and mortality in HIV patients after antiretroviral therapy initiation.
机构信息
aDepartment of Epidemiology bCenter for AIDS Research cDepartment of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina dDivision of Epidemiology, Ohio State University, Columbus, Ohio eJohns Hopkins University, Baltimore, Maryland fUniversity of Washington, Seattle, Washington gUniversity of California, San Diego, California hHarvard University, Cambridge, Massachusetts iUniversity of California, San Francisco, California jDivision of Infectious Diseases, Department of Medicine, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois kDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
出版信息
AIDS. 2017 Sep 10;31(14):1989-1997. doi: 10.1097/QAD.0000000000001573.
OBJECTIVE
To determine whether there is a threshold of detectable HIV RNA under 1000 copies/ml after antiretroviral therapy initiation associated with 10-year all-cause mortality.
DESIGN
This study included nearly 8000 patients from a US-based multicenter clinical cohort who started antiretroviral therapy between 1 January 1998 and 31 December 2013. Viral load was assessed 6 months after initiation of therapy. Patients were followed from 6 months after therapy initiation (between 1 July 1998 and 30 June 2014) until death, and data were administratively censored after 10 years or on 31 December 2014.
METHODS
We used nonparametric multiple imputation to account for left-censored viral load measurements, Cox proportional hazards models to estimate all-cause mortality hazard ratios, Nelson-Aalen cumulative hazard estimates to construct risk curves, and inverse probability of exposure weights to standardize estimated hazard ratios and risk curves to the total study population.
RESULTS
Plots of standardized hazard ratio estimates and 95% confidence intervals indicated there was no demonstrable viral load threshold between 30 and 500 copies/ml associated with a marked increase in 10-year mortality. The standardized 10-year risk of mortality among patients with viral loads between 400 and 999 copies/ml 6 months after starting treatment was comparable with the risk of mortality among patients with viral loads between 1000 and 4 million copies/ml (20 vs. 23%).
CONCLUSION
Incomplete suppression of plasma HIV RNA 6 months after starting therapy is associated with substantial 10-year all-cause mortality risk, highlighting the importance of rapid viral load suppression after therapy initiation.
目的
确定在开始抗逆转录病毒治疗后，HIV RNA 可检测下限是否低于 1000 拷贝/毫升与 10 年全因死亡率相关。
设计
本研究纳入了来自美国多中心临床队列的近 8000 名患者，他们于 1998 年 1 月 1 日至 2013 年 12 月 31 日期间开始接受抗逆转录病毒治疗。在治疗开始后 6 个月评估病毒载量。患者从治疗开始后 6 个月（1998 年 7 月 1 日至 2014 年 6 月 30 日）开始随访，直至死亡，并且在 10 年或 2014 年 12 月 31 日行政截止数据。
方法
我们使用非参数多次插补来解释左删失的病毒载量测量值，使用 Cox 比例风险模型来估计全因死亡率风险比，使用 Nelson-Aalen 累积风险估计来构建风险曲线，并使用暴露反概率加权来标准化估计的风险比和风险曲线到整个研究人群。
结果
标准化风险比估计值和 95%置信区间的图表明，在开始治疗后 6 个月时，30 至 500 拷贝/毫升之间没有明显的病毒载量阈值与 10 年死亡率的显著增加相关。治疗开始后 6 个月时病毒载量在 400 至 999 拷贝/ml 之间的患者的 10 年死亡率标准化风险与病毒载量在 1000 至 400 万拷贝/ml 之间的患者的死亡率风险相当（20%与 23%）。
结论
在开始治疗后 6 个月时未能完全抑制血浆 HIV RNA 与 10 年全因死亡率风险显著相关，这突出了治疗开始后快速病毒载量抑制的重要性。
Zotero 插件