Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Epidemiology and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Lancet HIV. 2021 May;8(5):e266-e273. doi: 10.1016/S2352-3018(20)30358-1. Epub 2021 Apr 20.
There are few data on life expectancy gains among people living with HIV in low-income and middle-income settings where antiretroviral therapy (ART) is increasingly available. We aimed to analyse life expectancy trends from 2003 to 2017 among people with HIV beginning treatment with ART within the Caribbean, central America, and South America.
We did a multisite retrospective cohort study and included people with HIV who had started treatment with ART and were aged 16 years or older between Jan 1, 2003, and Dec 31, 2017, from Caribbean, Central and South America network for HIV epidemiology (CCASAnet) sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru, who contributed person-time data from the age of 20 years until date of death, last contact, database closure, or Dec 31, 2017. We used the Chiang method of abridged life tables to estimate life expectancy at age 20 years for three eras (2003-08, 2009-12, and 2013-17) overall and by demographic and clinical characteristics at ART initiation. We used Poisson regression models to weight mortality rates to account for informative censoring.
30 688 people with HIV were included in the study; 17 491 (57·0%) were from the Haiti site and 13 197 (43·0%) were from all other sites. There were 2637 deaths during the study period: 1470 in Haiti and 1167 in other sites. Crude and weighted mortality rates decreased among all age groups over calendar eras. From 2003-08 to 2013-17, overall life expectancy for people with HIV at age 20 years increased from 13·9 years (95% CI 12·5-15·2) to 61·2 years (59·0-63·4) in Haiti and from 31·0 years (29·3-32·8) to 69·5 years (67·2-71·8) in other sites. Life expectancies at the end of the study period were within 10 years of those of the general population (69·9 years in Haiti and 78·0 years in all other sites in 2018). Disparities in life expectancy among people with HIV by sex or HIV transmission risk factor, CD4 cell count, level of education, and history of tuberculosis at or before ART initiation persisted across calendar eras.
Life expectancy among people with HIV receiving ART has significantly improved in Latin America and the Caribbean. Persistent disparities in life expectancy among people with HIV by demographic and clinical factors at ART initiation highlight vulnerable populations in the region.
National Institutes of Health.
For the Spanish translation of the abstract see Supplementary Materials section.
在抗逆转录病毒疗法（ART）日益普及的低收入和中等收入国家/地区，关于艾滋病毒感染者预期寿命增加的数据很少。我们旨在分析 2003 年至 2017 年间在加勒比、中美洲和南美洲开始接受 ART 治疗的艾滋病毒感染者的预期寿命趋势。
我们进行了一项多地点回顾性队列研究，纳入了 2003 年 1 月 1 日至 2017 年 12 月 31 日期间在加勒比、中美洲和南美洲艾滋病毒流行病学网络（CCASAnet）的阿根廷、巴西、智利、海地、洪都拉斯、墨西哥和秘鲁的艾滋病毒感染者，他们在 20 岁时开始接受 ART 治疗，且年龄在 16 岁或以上，并在该年龄直至死亡、最后一次联系、数据库关闭或 2017 年 12 月 31 日为止，提供了个人时间数据。我们使用 Chiang 法缩短寿命表来估计三个时期（2003-08 年、2009-12 年和 2013-17 年）的 20 岁时的预期寿命，并按开始 ART 时的人口统计学和临床特征进行分层。我们使用泊松回归模型对死亡率进行加权，以考虑到信息性删失。
共有 30688 名艾滋病毒感染者纳入研究；其中 17491 名（57.0%）来自海地，13197 名（43.0%）来自其他所有站点。研究期间共发生 2637 例死亡：海地 1470 例，其他站点 1167 例。所有年龄组的粗死亡率和加权死亡率均随日历时代而下降。从 2003-08 年到 2013-17 年，20 岁艾滋病毒感染者的总体预期寿命从海地的 13.9 岁（95%CI 12.5-15.2）增加到 61.2 岁（59.0-63.4），从其他站点的 31.0 岁（29.3-32.8）增加到 69.5 岁（67.2-71.8）。在研究结束时的预期寿命与普通人群相差 10 年以内（2018 年海地为 69.9 岁，所有其他站点为 78.0 岁）。在接受 ART 治疗的艾滋病毒感染者中，按性别或艾滋病毒传播风险因素、CD4 细胞计数、教育程度和 ART 开始时或之前的结核病史划分的预期寿命差异在整个日历时代仍然存在。
在拉丁美洲和加勒比地区，接受抗逆转录病毒治疗的艾滋病毒感染者的预期寿命显著提高。在开始接受 ART 时，人口统计学和临床因素导致艾滋病毒感染者之间的预期寿命持续存在差异，这突显了该地区的弱势群体。
美国国立卫生研究院。
