Mocroft A, Vella S, Benfield T L, Chiesi A, Miller V, Gargalianos P, d'Arminio Monforte A, Yust I, Bruun J N, Phillips A N, Lundgren J D
Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, UK.
Lancet. 1998 Nov 28;352(9142):1725-30. doi: 10.1016/s0140-6736(98)03201-2.
The introduction of combination antiretroviral therapy and protease inhibitors has led to reports of falling mortality rates among people infected with HIV-1. We examined the change in these mortality rates of HIV-1-infected patients across Europe during 1994-98, and assessed the extent to which changes can be explained by the use of new therapeutic regimens.
We analysed data from EuroSIDA, which is a prospective, observational, European, multicentre cohort of 4270 HIV-1-infected patients. We compared death rates in each 6 month period from September, 1994, to March, 1998.
By March, 1998, 1215 patients had died. The mortality rate from March to September, 1995, was 23.3 deaths per 100 person-years of follow-up (95% CI 20.6-26.0), and fell to 4.1 per 100 person-years of follow-up (2.3-5.9) between September, 1997, and March, 1998. From March to September, 1997, the death rate was 65.4 per 100 person-years of follow-up for those on no treatment, 7.5 per 100 person-years of follow-up for patients on dual therapy, and 3.4 per 100 person-years of follow-up for patients on triple-combination therapy. Compared with patients who were followed up from September, 1994, to March, 1995, patients seen between September, 1997, and March, 1998, had a relative hazard of death of 0.16 (0.08-0.32), which rose to 0.90 (0.50-1.64) after adjustment for treatment.
Death rates across Europe among patients infected with HIV-1 have been falling since September, 1995, and at the beginning of 1998 were less than a fifth of their previous level. A large proportion of the reduction in mortality could be explained by new treatments or combinations of treatments.
联合抗逆转录病毒疗法和蛋白酶抑制剂的引入使得有报告称感染HIV-1的人群死亡率下降。我们研究了1994年至1998年期间欧洲HIV-1感染患者死亡率的变化，并评估了新治疗方案的使用在多大程度上可以解释这些变化。
我们分析了来自欧洲艾滋病临床数据库（EuroSIDA）的数据，该数据库是一个前瞻性、观察性的欧洲多中心队列，包含4270名HIV-1感染患者。我们比较了1994年9月至1998年3月期间每6个月的死亡率。
到1998年3月，已有1215名患者死亡。1995年3月至9月的死亡率为每100人年随访23.3例死亡（95%置信区间20.6 - 26.0），在1997年9月至1998年3月期间降至每100人年随访4.1例死亡（2.3 - 5.9）。在1997年3月至9月期间，未接受治疗的患者死亡率为每100人年随访65.4例，接受双重疗法的患者为每100人年随访7.5例，接受三联联合疗法的患者为每100人年随访3.4例。与1994年9月至1995年3月期间接受随访的患者相比，1997年9月至1998年3月期间就诊的患者死亡相对风险为0.16（0.08 - 0.32），在调整治疗因素后升至0.90（0.50 - 1.64）。
自1995年9月以来，欧洲HIV-1感染患者的死亡率一直在下降，到1998年初已降至此前水平不到五分之一。死亡率的大幅下降很大程度上可以归因于新的治疗方法或治疗组合。
