The Kirby Institute, UNSW Sydney, Kensington, NSW, Australia.
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Antivir Ther. 2020;25(3):131-142. doi: 10.3851/IMP3358.
This study investigated survival in people living with HIV being followed-up from 5 and 10 years after antiretroviral therapy (ART) initiation in a multi-country Asian cohort.
We included patients in follow-up >5 years after ART initiation. Factors associated with mortality beyond 5 and 10 years on ART were analysed using competing risk regression with time-updated variables.
Of 13,495 patients retained after 5 years on ART, 279 subsequently died (0.56/100 person-years). Increased mortality was associated with age >50 years (sub-hazard ratio [sHR] 2.24, 95% CI 1.58, 3.15, compared with ≤40 years), HIV exposure through injecting drug use (sHR 2.17, 95% CI 1.32, 3.56), HIV viral load ≥1,000 copies/ml: sHR 1.52, 95% CI 1.05, 2.21, compared with <400), regimen (second-line regimen: sHR 2.11, 95% CI 1.52, 2.94, and third-line regimen: sHR 2.82, 95% CI 2.00, 3.98, compared with first-line regimen), HBV coinfection (sHR 2.23, 95% CI 1.49, 3.33), fasting plasma glucose ≥126 mg/dl (sHR 1.98, 95% CI 1.22, 3.21, compared with <100 mg/dl) and estimated glomerular filtration rate <60 ml/min/1.73 m (sHR 2.57, 95% CI 1.56, 4.22). Decreased mortality was associated with transmission through male-to-male sexual contact (sHR 0.44, 95% CI 0.22, 0.88, compared with heterosexual transmission) and higher CD4 T-cell count (200-349 cells/µl: sHR 0.27, 95% CI 0.20, 0.38, 350-499 cells/µl: sHR 0.10, 95% CI 0.07, 0.16 and ≥500 cells/µl: sHR 0.09, 95% CI 0.06, 0.13, compared with <200 cells/µl). Results after 10 years were similar, but most associations were weaker due to limited power.
Next to preventing ART failure, HIV programmes should carefully monitor and treat comorbidities, including hepatitis, kidney disease and diabetes, to optimize survival after long-term ART exposure.
本研究调查了在亚洲多国队列中，接受抗逆转录病毒治疗（ART）5 年和 10 年后随访的 HIV 感染者的生存情况。
我们纳入了在接受 ART 治疗 5 年后仍在随访的患者。使用时间更新变量的竞争风险回归分析，探讨了 5 年和 10 年以上 ART 治疗后死亡的相关因素。
在接受 ART 治疗 5 年后仍存活的 13495 例患者中，有 279 例随后死亡（0.56/100人年）。与年龄≤40 岁相比，年龄>50 岁（亚危险比[SHR] 2.24，95%CI 1.58，3.15）、通过注射吸毒感染 HIV（SHR 2.17，95%CI 1.32，3.56）、HIV 病毒载量≥1000 拷贝/ml（SHR 1.52，95%CI 1.05，2.21）、方案（二线方案：SHR 2.11，95%CI 1.52，2.94；三线方案：SHR 2.82，95%CI 2.00，3.98）、HBV 合并感染（SHR 2.23，95%CI 1.49，3.33）、空腹血糖≥126mg/dl（SHR 1.98，95%CI 1.22，3.21）和估算肾小球滤过率<60ml/min/1.73m（SHR 2.57，95%CI 1.56，4.22）与较高的死亡率相关。与异性传播相比，通过男男性接触传播（SHR 0.44，95%CI 0.22，0.88）和较高的 CD4 T 细胞计数（200-349 个细胞/µl：SHR 0.27，95%CI 0.20，0.38；350-499 个细胞/µl：SHR 0.10，95%CI 0.07，0.16；≥500 个细胞/µl：SHR 0.09，95%CI 0.06，0.13）与较低的死亡率相关。10 年后的结果相似，但由于效力有限，大多数关联较弱。
除了预防 ART 失败外，HIV 规划还应仔细监测和治疗合并症，包括肝炎、肾脏疾病和糖尿病，以优化长期 ART 暴露后的生存。
