Pinto Angie N, Grey Pat, Shaik Ansari, Cooper David A, Kelleher Anthony D, Petoumenos Kathy
The Kirby Institute , UNSW Sydney, Sydney, Australia .
AIDS Res Hum Retroviruses. 2018 Nov;34(11):936-941. doi: 10.1089/AID.2017.0284. Epub 2018 Jul 17.
The aim of this study was to understand factors associated with increased mortality in a cohort of primary HIV infection (PHI) in New South Wales (NSW) over three decades. Six hundred and two patients with PHI were enrolled from 1984 to 2009. Probabilistic data linkage was performed to NSW Registry of births deaths and marriages and Australian Bureau of Statistics mortality database. Mortality was measured by crude death rate. Pre highly active antiretroviral therapy (pre-HAART) era was defined as before January 1, 1997. A Cox proportional hazard model was used to identify factors associated with death. One hundred and thirty-eight deaths occurred during 6,223 person years (PY) follow-up. Overall crude death rate was 2.2 per 100 PY (95% confidence interval [CI], 1.9-2.6), 3.6 (95% CI, 3.1-4.3)in pre-HAART era and 0.20 (95% CI, 0.08-0.47) in post-HAART era. AIDS was the most frequent cause of death (52%, 72/138), all occurring in the pre-HAART era. Of non-AIDS deaths, the leading known cause was non-AIDS cancer 8% (11/138) followed by suicide 4% (6/138). On multivariate analysis, estimated date of infection in pre-HAART era and time to commencement of ART greater than 1 year post diagnosis were more likely to be associated with death (p < .05). Mortality in PHI has decreased significantly in the post-HAART era. Non-AIDS deaths due to malignancy and suicide are emerging as leading causes in this population in the post-HAART era. Time to starting ART greater than 1 year was associated with increased mortality.
本研究旨在了解新南威尔士州（NSW）三十年期间原发性HIV感染（PHI）队列中与死亡率增加相关的因素。1984年至2009年纳入了602例PHI患者。对新南威尔士州出生、死亡和婚姻登记处以及澳大利亚统计局死亡率数据库进行了概率数据链接。死亡率通过粗死亡率衡量。高效抗逆转录病毒治疗（HAART）前时代定义为1997年1月1日之前。使用Cox比例风险模型确定与死亡相关的因素。在6223人年（PY）的随访期间发生了138例死亡。总体粗死亡率为每100 PY 2.2例（95%置信区间[CI]，1.9 - 2.6），HAART前时代为3.6例（95% CI，3.1 - 4.3），HAART后时代为0.20例（95% CI，0.08 - 0.47）。艾滋病是最常见的死亡原因（52%，72/138），均发生在HAART前时代。在非艾滋病死亡中，已知的主要原因是非艾滋病癌症8%（11/138），其次是自杀4%（6/138）。多变量分析显示，HAART前时代的估计感染日期以及诊断后开始抗逆转录病毒治疗（ART）的时间超过1年更有可能与死亡相关（p < 0.05）。在HAART后时代，PHI的死亡率显著下降。在HAART后时代，恶性肿瘤和自杀导致的非艾滋病死亡正在成为该人群的主要死因。开始ART的时间超过1年与死亡率增加相关。
