Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries

被引：155

作者：

Zwahlen, Marcel ^{[1
]}

Harris, Ross ^{[1
]}

May, Margaret ^{[1
]}

Hogg, Robert ^{[1
]}

Costagliola, Dominique ^{[1
]}

de Wolf, Frank ^{[1
]}

Gill, John ^{[1
]}

Faetkenheuer, Gerd ^{[1
]}

Lewden, Charlotte ^{[1
]}

Saag, Mike ^{[1
]}

Staszewski, Shlomo ^{[1
]}

Monforte, Antonella d'Arminio ^{[1
]}

Casabona, Jordi ^{[1
]}

Lampe, Fiona ^{[1
]}

Justice, Amy ^{[1
]}

von Wyl, Viktor ^{[1
]}

Egger, Matthias ^{[1
]}

Casabona, Jordi ^{[1
]}

Chene, Genevieve ^{[1
]}

Costagliola, Dominique ^{[1
]}

Dabis, Francois ^{[1
]}

Monforte, Antonella d'Arminio ^{[1
]}

de Wolf, Frank ^{[1
]}

Egger, Matthias ^{[1
]}

Faetkenheuer, Gerd ^{[1
]}

Gill, John ^{[1
]}

Hogg, Robert ^{[1
]}

Justice, Amy ^{[1
]}

Kitahata, Mari ^{[1
]}

Lampe, Fiona ^{[1
]}

Ledergerber, Bruno ^{[1
]}

Leport, Catherine ^{[1
]}

May, Margaret ^{[1
]}

Mocroft, Amanda ^{[1
]}

Phillips, Andrew ^{[1
]}

Reiss, Peter ^{[1
]}

Saag, Michael ^{[1
]}

Sabin, Caroline ^{[1
]}

Staszewski, Schlomo ^{[1
]}

Sterne, Jonathan ^{[1
]}

Harris, Ross ^{[1
]}

Beckthold, Brenda ^{[1
]}

Yip, Benita ^{[1
]}

Dauer, Brenda ^{[1
]}

Fusco, Jenifer ^{[1
]}

Darney, Emilie ^{[1
]}

Rickenbach, Martin ^{[1
]}

Lavignolle, Valerie ^{[1
]}

van Leth, Frank ^{[1
]}

Pereira, Edwige ^{[1
]}

机构：

[1] Univ Bern, ISPM, CH-3012 Bern, Switzerland

来源：

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY | 2009年 / 38卷 / 06期

基金：

加拿大健康研究院; 瑞士国家科学基金会; 英国医学研究理事会;

关键词：

HIV-infection; antiretroviral therapy; mortality; general population; standardized mortality ratio; meta-analysis; industrialized countries; VIROLOGICAL TREATMENT FAILURE; ALL-CAUSE MORTALITY; HEPATITIS-C VIRUS; COLLABORATIVE ANALYSIS; CHANGING PATTERNS; INITIAL RESPONSE; COHORT; EUROPE; TRENDS; ADULTS;

D O I：

10.1093/ije/dyp306

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Methods Eligible patients were enrolled in prospective cohort studies participating in the ART Cohort Collaboration. We calculated the ratio of observed to expected deaths from all causes [standardized mortality ratio (SMR)], measuring time from 6 months after starting ART, according to risk group, clinical stage at the start of ART and CD4 cell count and viral load at 6 months. Expected numbers of deaths were obtained from age-, sex- and country-specific mortality rates. Results Among 29 935 eligible patients, 1134 deaths were recorded in 131 510 person-years of follow-up. The median age was 37 years, 8162 (27%) patients were females, 4400 (15%) were injecting drug users (IDUs) and 6738 (23%) had AIDS when starting ART. At 6 months, 23 539 patients (79%) had viral load measurements < 500 copies/ml. The lowest SMR, 1.05 [95% confidence interval (CI) 0.82-1.35] was found for men who have sex with men (MSM) who started ART free of AIDS, reached a CD4 cell count of >= 350 cells/mu L and suppressed viral replication to < 500 copies/ml by the sixth month. In contrast, the SMR was 73.7 (95% CI 46.4-116.9) in IDUs who failed to suppress viral replication and had CD4 cell counts < 50 cells/mu L at 6 months. The percentage of patients with SMRs < 2 was 46% for MSM, 42% for heterosexually infected patients and 0% for patients with a history of injection drug use. Corresponding percentages for SMRs > 10 were 4, 14 and 47%. Conclusions In industrialized countries, the mortality experience of HIV-infected patients who start ART and survive the first 6 months continues to be higher than in the general population, but for many patients excess mortality is moderate and comparable with patients having other chronic conditions. Much of the excess mortality might be prevented by earlier diagnosis of HIV followed by timely initiation of ART.

引用

页码：1624 / 1633

页数：10

共 50 条

[1]

[Anonymous], WHO Mortality Database

[2]

[Anonymous], 1985, MMWR, V34, P373

[3]

Becker SL, 2001, J ACQ IMMUN DEF SYND, V26, P72, DOI 10.1097/00126334-200101010-00011

[4] Trends in AIDS-defining and non-AIDS-defining malignancies among HIV-infected patients: 1989-2002 [J].