Decline in the AIDS and death rates in the EuroSIDA study: an observational study

被引:1003
作者
Mocroft, A
Ledergerber, B
Katlama, C
Kirk, O
Reiss, P
Monforte, AD
Knsyz, B
Dietrich, M
Phillips, AN
Lundgren, JD
机构
[1] UCL Royal Free & UCL Med Sch, Royal Free Ctr HIV Med, London NW3 2PF, England
[2] UCL Royal Free & UCL Med Sch, Dept Primary Care & Populat Sci, London NW3 2PF, England
[3] Univ Hosp, Zurich, Switzerland
[4] Hop La Pitie Salpetriere, Paris, France
[5] Univ Copenhagen, Hvidovre Hosp, DK-2650 Hvidovre, Denmark
[6] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
[7] Osped L Sacco, Milan, Italy
[8] Univ Wroclaw, Dept Infect Dis, PL-50138 Wroclaw, Poland
[9] Bernhard Nocht Inst Trop Med, Hamburg, Germany
关键词
D O I
10.1016/S0140-6736(03)13802-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Since the introduction of highly active antiretroviral therapy (HAART), little is known about whether changes in HIV-1-mortality and morbidity rates have been sustained. We aimed to assess possible changes in these rates across Europe. Methods We analysed data for 9803 patients in 70 European HIV centres including ones in Israel and Argentina. Incidence rates of AIDS or death were calculated for overall and most recent CD4 count in 6-monthly periods and in three treatment eras (pre-HAART, 1994-1995; early-HAART, 1996-1997; and late-HAART, 1998-2002). Findings The incidence of AIDS or death fell after September, 1998, by 8% per 6-month period (rate ratio 0.92, 95% CI 0.88-0.95, p<0.0001). When AIDS and death were analysed separately, the incidence of all deaths during the late-HAART era was significantly lower than that during the early-HAART era in patients whose latest CD4 count was 20 cells/mu L or less (0.43, 0.35-0.53, p<0.0001), but at higher CD4 counts, did not differ between early-HAART and late-HAART. Incidence of AIDS was about 50% lower in late-HAART than in early-HAART, irrespective of latest CD4 count (p<0.0001). In multivariate Cox's models, with early-HAART as the reference, there was an increased risk of AIDS (relative hazard 1.39; 95% CI 1.16-1.67, p=0.0004) and all deaths (1.29; 1.08-1.56, p=0.0065) in the pre-HAART era, and a reduced risk of AIDS (0.62; 0.50-0.77, p<0.0001) and all deaths (0.66; 0.53-0.82, p=0.0002) in the late-HAART era. Interpretation The initial drop in mortality and morbidity after the introduction of HAART has been sustained. Potential long-term adverse effects associated with HAART have not altered its effectiveness in treating AIDS.
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页码:22 / 29
页数:8
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