50岁及以上HIV阳性个体立即开始抗逆转录病毒治疗的效果。
Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older.
作者信息
Lodi Sara, Costagliola Dominique, Sabin Caroline, Del Amo Julia, Logan Roger, Abgrall Sophie, Reiss Peter, van Sighem Ard, Jose Sophie, Blanco Jose-Ramon, Hernando Victoria, Bucher Heiner C, Kovari Helen, Segura Ferran, Ambrosioni Juan, Gogos Charalambos A, Pantazis Nikos, Dabis Francois, Vandenhende Marie-Anne, Meyer Laurence, Seng Rémonie, Gill M John, Krentz Hartmut, Phillips Andrew N, Porter Kholoud, Grinsztejn Beatriz, Pacheco Antonio G, Muga Roberto, Tate Janet, Justice Amy, Hernán Miguel A
机构信息
1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; 2Sorbonne Universités, INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France; 3Institute of Global Health, University College London, London, United Kingdom; 4Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain; 5CIBERESP, Instituto de Salud Carlos III, Madrid, Spain; 6AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France; 7Stichting HIV Monitoring, Amsterdam, the Netherlands; 8Academic Medical Centre, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, Amsterdam, the Netherlands; 9Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands; 10Hospital San Pedro-CIBIR, Logroño, Spain; 11Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland; 12Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 13Infectious Disease Department, Hospital Parc Tauli, Sabadell, Spain; 14Hospital Clinic-IDIBAPS, Barcelona, Spain; 15Division of Infectious Diseases, Patras University Hospital, Patras, Greece; 16Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece; 17Université de Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France; 18Centre INSERM U1219- Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Bordeaux, France; 19Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France; 20Université Paris Sud, UMR 1018, le Kremlin Bicêtre, Paris, France; 21Inserm, UMR 1018, le Kremlin Bicêtre, Paris, France; 22AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, Paris, France; 23Southern Alberta Clinic, Calgary, AB, Canada; 24Department of Medicine, University of Calgary, Calgary, AB, Canada; 25Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil; 26Programa de Computação Científica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil; 27Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 28Department of Internal Medicine, Yale University School of Medicine, New Haven; 29VA Connecticut Healthcare System, West Haven, CT; 30Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston; and 31Harvard-MIT Division of Health Sciences and Technology, Boston, MA.
出版信息
J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):311-318. doi: 10.1097/QAI.0000000000001498.
BACKGROUND
Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants.
METHODS
We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm, and (3) <350 cells/mm. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality.
RESULTS
The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm. The 5-year risk of non-AIDS mortality was 0.17% (95% CI: -0.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm.
CONCLUSIONS
Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years.
背景
临床指南建议对所有HIV阳性个体立即启动联合抗逆转录病毒治疗。然而，这些指南是基于相对年轻参与者的试验制定的。
方法
我们纳入了2004年后年龄在50 - 70岁、未接受过抗逆转录病毒治疗且无艾滋病的HIV阳性个体，参与HIV - CAUSAL协作研究。我们使用参数化g公式来估计在以下三种情况下5年全因死亡率和非艾滋病死亡率的风险：（1）基线时立即启动治疗以及CD4细胞计数分别为（2）<500个细胞/mm³和（3）<350个细胞/mm³时启动治疗。结果分别针对一般HIV人群和死亡率较高的美国退伍军人队列呈现。
结果
该研究纳入了9596名个体（28%为美国退伍军人），基线时年龄中位数（四分位间距）为55岁（52 - 60岁），CD4细胞计数为336个/ mm³（182 - 513个/mm³）。在一般HIV人群中，与CD4细胞计数<350个/mm³时启动治疗相比，立即启动治疗的5年全因死亡率低0.40%（95%置信区间（CI）：0.10至0.71）；在美国退伍军人中，低1.61%（95%CI：0.79至2.67）。在一般HIV人群中，与CD4细胞计数<350个/mm³时启动治疗相比，立即启动治疗的5年非艾滋病死亡率低0.17%（95%CI： - 0.07至0.43）；在美国退伍军人中，低1%（95%CI：0.31至2.00）。
结论
立即启动治疗似乎可降低50 - 70岁患者的全因死亡率和非艾滋病死亡率。
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