Hogg R S, Heath K V, Yip B, Craib K J, O'Shaughnessy M V, Schechter M T, Montaner J S
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
JAMA. 1998 Feb 11;279(6):450-4. doi: 10.1001/jama.279.6.450.
Clinical trials have established the efficacy of antiretroviral therapy with double- and triple-drug regimens for individuals infected with the human immunodeficiency virus (HIV), but the effectiveness of these regimens in the population of patients not enrolled in clinical trials is unknown.
To characterize survival following the initiation of antiretroviral therapy among HIV-infected individuals in the province of British Columbia.
Prospective, population-based cohort study of patients with antiretroviral therapy available free of charge (median follow-up, 21 months).
Province of British Columbia, Canada.
All HIV-positive men and women 18 years of age or older in the province who were first prescribed any antiretroviral therapy between October 1992 and June 1996 and whose CD4+ cell counts were less than 0.350 x 10(9)/L.
Rates of progression from initiation of antiretroviral therapy to death or a primary acquired immunodeficiency syndrome (AIDS) diagnosis for subjects who initially received zidovudine-, didanosine-, or zalcitabine-based therapy (ERA-I) and for those who initially received therapy regimens including lamivudine or stavudine (ERA-II).
A total of 1178 patients (951 ERA-I, 227 ERA-II) were eligible. A total of 390 patients died (367 ERA-I, 23 ERA-II), yielding a crude mortality rate of 33.1%. ERA-I group subjects were almost twice as likely to die as ERA-II group subjects, with a mortality risk ratio of 1.86 (95% confidence interval [CI], 1.21 -2.86; P=.005). After adjusting for Pneumocystis carinii and Mycobacterium avium prophylaxis use, AIDS diagnosis, CD4+ cell count, sex, and age, ERA-I participants were 1.93 times (95% CI, 1.25-2.97; P=.003) more likely to die than ERA-II participants. Among patients without AIDS when treatment was started, ERA-I participants were 2.50 times (95% CI, 1.59-3.93; P<.001) more likely to progress to AIDS or death than ERA-II participants.
The HIV-infected individuals who received initial therapy with regimens including stavudine or lamivudine had significantly lower mortality and longer AIDS-free survival than those who received initial therapy with regimens limited to zidovudine, didanosine, and zalcitabine.
临床试验已证实，使用双药和三药方案的抗逆转录病毒疗法对感染人类免疫缺陷病毒（HIV）的个体有效，但这些方案在未参加临床试验的患者群体中的有效性尚不清楚。
描述不列颠哥伦比亚省HIV感染个体开始抗逆转录病毒治疗后的生存情况。
对可免费获得抗逆转录病毒治疗的患者进行前瞻性、基于人群的队列研究（中位随访时间为21个月）。
加拿大不列颠哥伦比亚省。
该省所有18岁及以上的HIV阳性男性和女性，他们在1992年10月至1996年6月期间首次接受任何抗逆转录病毒治疗，且CD4 +细胞计数低于0.350×10⁹/L。
最初接受基于齐多夫定、去羟肌苷或扎西他滨治疗的受试者（ERA-I）以及最初接受包括拉米夫定或司他夫定治疗方案的受试者（ERA-II）从开始抗逆转录病毒治疗到死亡或首次获得性免疫缺陷综合征（AIDS）诊断的进展率。
共有1178例患者符合条件（951例ERA-I，227例ERA-II）。共有390例患者死亡（367例ERA-I，23例ERA-II），粗死亡率为33.1%。ERA-I组受试者死亡的可能性几乎是ERA-II组受试者的两倍，死亡风险比为1.86（95%置信区间[CI]，1.21 - 2.86；P = 0.005）。在调整卡氏肺孢子虫和鸟分枝杆菌预防用药、AIDS诊断、CD4 +细胞计数、性别和年龄后，ERA-I参与者死亡的可能性是ERA-II参与者的1.93倍（95%CI，1.25 - 2.97；P = 0.003）。在开始治疗时没有AIDS的患者中，ERA-I参与者进展为AIDS或死亡的可能性是ERA-II参与者的2.50倍（95%CI，1.59 - 3.93；P < 0.001）。
与最初接受仅限于齐多夫定、去羟肌苷和扎西他滨方案治疗的HIV感染个体相比，最初接受包括司他夫定或拉米夫定方案治疗的个体死亡率显著降低，无AIDS生存期更长。
