Vittinghoff E, Scheer S, O'Malley P, Colfax G, Holmberg S D, Buchbinder S P
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94105, USA.
J Infect Dis. 1999 Mar;179(3):717-20. doi: 10.1086/314623.
The reasons for recent declines in AIDS incidence and mortality may include advances in treatment, but these may be confounded by earlier declines in the incidence of human immunodeficiency virus (HIV) infection. To determine whether the declines in AIDS and mortality may, in part, stem from wider use of combination antiretroviral therapy, 622 HIV-positive men with well-characterized dates of seroconversion were followed. In this group, combination therapy came into widespread use in only 1996. In a Cox proportional hazards model, the 1996 calendar period was significantly associated with slower progression to AIDS (relative hazard [RH]=0. 19, 95% confidence interval [CI], 0.05-0.69, P=.01) and death (RH=0. 45, 95% CI, 0.21-0.95, P=.04). Declines in incidence of HIV infection, changes in HIV virulence, and end-point underreporting cannot fully explain the decline in AIDS and death in 1996. The introduction of combination antiretroviral therapy as the standard of care may already have had measurable effects.
近期艾滋病发病率和死亡率下降的原因可能包括治疗方面的进展，但这些可能因人类免疫缺陷病毒（HIV）感染率的早期下降而混淆。为了确定艾滋病和死亡率的下降是否部分源于联合抗逆转录病毒疗法的更广泛使用，对622名血清转化日期明确的HIV阳性男性进行了随访。在这组人群中，联合疗法直到1996年才广泛使用。在Cox比例风险模型中，1996年这一时期与艾滋病进展缓慢（相对风险[RH]=0.19，95%置信区间[CI]，0.05 - 0.69，P = 0.01）和死亡（RH = 0.45，95% CI，0.21 - 0.95，P = 0.04）显著相关。HIV感染率的下降、HIV毒力的变化以及终点报告不足不能完全解释1996年艾滋病和死亡人数的下降。将联合抗逆转录病毒疗法作为标准治疗方法的引入可能已经产生了可衡量的效果。
