Long-term HIV/AIDS survival estimation in the highly active antiretroviral therapy era.

BACKGROUND: Highly active antiretroviral therapy (HAART) prolongs short-term survival in patients with HIV/AIDS. HAART has only been available since 1996; thus, no long-term survival data are available. Computer simulation models extrapolating short-term survival data can provide estimates of long-term survival. These survival estimates may assist patients and clinicians in HAART treatment planning. The authors construct a computer simulation model based on observational data to estimate long-term survival in a cohort of HIV/AIDS patients undergoing treatment with HAART. METHODS: The authors use data from the Collaboration in HIV Outcomes Research-US (CHORUS) observational cohort (N = 4791), the published literature, and US Life Tables to specify a computer simulation model of expected survival accounting for baseline CD4 cell count, progressive HAART treatment failure, progressive risk of HAART on treatment mortality, and age-associated mortality. Time to treatment failure for each of three rounds of HAART and risk of mortality on-treatment were estimated using parametric survival models with censoring of follow-up fit to CHORUS data. Off-treatment survival after HAART failure was estimated from the pre-HAART literature. Age-associated mortality was taken from US Life Tables. RESULTS: Median projected survivals stratified by baseline CD4 cell count subgroups were CD4 > 200 cells/mm3, 15.4 years; CD4 < or = 200 cells/mm3, 8.5 years; and CD4 < or = 50 cells/mm3, 5.5 years. These values are 4 to 6 years longer than pre-HAART cohorts. The sensitivity analyses showed that the model survival predictions were most sensitive to the treatment failure rate, the on-treatment mortality rate, and the number of treatment rounds. CONCLUSIONS: Computer simulation modeling of long-term survival of patients with HIV/AIDS on HAART--accounting for differential treatment failure and death rates stratified by CD4 cell count and age-associated mortality--suggests a relatively consistent 4- to 6-year survival benefit over pre-HAART therapies.     

HIV/AIDS患者高效抗逆转录病毒治疗依从性的研究进展

高效抗逆转录病毒治疗(HAART)可以有效地延缓HIV/AIDS患者的疾病进程,改善生活质量,但HAART要求近乎完美的依从性。其依从性的研究在西方发达国家开展较多,但在我国的相关研究不多。文章就国际上HIV/AIDS患者HAART依从性的评价方法及影响因素的研究进展进行了综述。     

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

Background  This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil.
Methods  This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety.
Results  Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight ( P  = 0.003), who were also more likely to achieve dietary goals for dairy products ( P  = 0.039) and grains ( P  = 0.005).
Conclusion  Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.     

HAART治疗1年对HIV/AIDS患者免疫重建效果观察

目的研究高效抗反转录病毒治疗（HAART）1年,对HIV/AIDS患者免疫重建效果的影响。方法确认人免疫缺陷病毒(HIV)感染者35例,检测CD4+T淋巴细胞<350/μL,开始HAART治疗,并于治疗0、6、12个月时分别检测其病毒载量及CD4+T淋巴细胞、CD8+T淋巴细胞、CD4+童贞细胞、CD4+记忆细胞、CD8+激活细胞计数。结果治疗前,HIV RNA处于高复制水平,平均(4.62±1.09)×106copies/mL,HAART治疗6个月及12个月时均低于检测下限。患者的CD4+T淋巴细胞、CD4+童贞细胞和CD4+记忆细胞均明显增加,12个月时,各组细胞计数［分别为(312±109.22) /μL、（150±57.34）/μL、（212±48.06）/μL］与基线［分别为（183±83.73）/μL、（73±20.40）/μL、（119±30.42）/μL］比较,差异有统计学意义(P<0.01),但仍低于健康对照组 ［分别为（768±146.41）/μL、（424±87.06）/μL、（442±61.40）/μL］（P<0.05）;CD8+T淋巴细胞计数（427±99.79）/μL较基线（597±111.43）/μL明显下降（P<0.05）,但仍高于健康对照组（208±37.39）/μL（P<0.05）。结论HAART能快速抑制HIV复制,治疗1年能部分恢复HIV/AIDS患者免疫功能。     

湖北省接受艾滋病抗病毒治疗的老年患者生存情况分析

目的 分析湖北省接受艾滋病抗病毒治疗的老年患者基本情况及生存情况。 方法 回顾性分析年龄≥50岁的艾滋病患者主要流行病学特征和生存情况,并以年龄＜50岁艾滋病患者为对照,进行相关分析,寿命表法计算累积生存率,Kaplan-Meier法绘制年龄≥50岁和＜50岁两组艾滋病患者的生存曲线,Cox比例风险模型分析影响死亡的主要危险因素。 结果 ≥50岁的艾滋病患者有2 643例,开始治疗的平均年龄为(58.49±7.1)岁,年龄＜50岁的艾滋病患者有7 725例,开始治疗的平均年龄为(34.43±8.68)岁。两组艾滋病患者主要以男性、已婚或同居、异性性传播、初中及以下文化、基线CD4值在0~200个/μl之间、WHO临床分期为Ⅰ期、初始治疗方案为齐多夫定/司他夫定 + 拉米夫定 + 依非韦伦/奈韦拉平为主;寿命表法显示年龄≥50岁组老年艾滋病患者累积生存率从第1年的82.06%下降到第10年的53.63%,年龄＜50岁组艾滋病患者累积生存率从第1年的97.48%下降到第10年的94.2%。Log-Rank检验显示年龄≥50岁组的死亡风险高于＜50岁组(χ²=209.74,P＜0.001)。多因素Cox比例风险模型分析显示,文化程度、WHO临床分期、基线CD4数、初始治疗方案是年龄≥50岁组艾滋病患者死亡的危险因素(P＜0.05);文化程度、婚姻状况、感染途径、WHO临床分期、基线CD4数、初始治疗方案是年龄＜50岁组艾滋病患者死亡的危险因素(P＜0.05)。 结论 湖北省接受艾滋病抗病毒治疗的老年艾滋病患者生存率低,应结合本省特点,根据老年人群的特征和死亡危险因素采取针对措施,降低老年艾滋病患者的死亡风险,提高生存率。     

遵义市首次接受抗病毒治疗的HIV/AIDS患者的流行病学特征分析

摘要:目的 了解2006 - 2014年遵义市首次接受免费抗病毒治疗的HIV/AIDS患者的流行病学特征。方法 在国家艾滋病综合防治信息系统中,收集2006 - 2014年遵义市首次接受抗病毒治疗的HIV/AIDS的基础数据,运用Excel2003和SPSS17.0对数据进行描述性流行病学分析构成比以及运用趋势χ2分析年度变化趋势。结果 2006 - 2014年遵义市首次接受治疗的HIV/AIDS共1 187人,男性843例(占71.02%),女性344例(占28.98%),年龄中位数38岁（P25 = 29,P75 = 51）,以已婚或同居为主,共689例(占58.19%),治疗机构以医疗机构最多,共1 161例(97.81%),感染途径主要为性传播(占89.22%),基线CD4+T淋巴细胞中位数为226.00 cell/mm3,从确认HIV阳性到首次接受抗病毒治疗的时间中位数为2.70(P25 = 0.90,P75 = 10.67)个月。每年新增治疗HIV/AIDS人数呈逐年上升趋势,≤50 cell/mm3的HIV/AIDS比例呈下降趋势,≥ 199 cell/mm3的比例呈上升趋势。结论 遵义市HIV/AIDS接受抗病毒治疗的覆盖面逐渐扩大且开始治疗的时机已有所提前,但仍存在相当部分HIV/AIDS接受治疗较晚,遵义市HIV/AIDS早治疗的能力仍需进一步加强。     

上海市2005—2017年艾滋病抗病毒治疗患者生存情况分析

目的 了解上海市接受抗病毒治疗的艾滋病病毒感染者和病人生存情况及其影响因素,评估上海市艾滋病抗病毒治疗效果。 方法 采用回顾性队列方法,收集上海市2005—2017年开始抗病毒治疗的艾滋病病毒感染者和病人的随访信息,随访截止时间为2018年12月31日,用寿命表法计算治疗对象的生存率,用Cox比例风险模型进行生存分析。结果 9 251例纳入队列的治疗对象平均年龄(38.2±13.2)岁,以男性(8 447例,91.3%)和同性性传播(5 536例,59.8%)为主。生存时间中位数为21.9个月,因艾滋病死亡194人,治疗1、3、5、10年的累计生存率分别为0.983、0.979、0.972、0.963。多因素Cox分析发现,年龄、基线CD4⁺T细胞计数、初始治疗方案、是否更换治疗方案、传播途径是治疗对象生存时间的影响因素(P<0.05)。 结论 上海市艾滋病抗病毒治疗效果显著,应在扩大治疗覆盖面的基础上,尽早开始抗病毒治疗,及时进行必要的治疗方案调整,改善生存质量。     

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi

Background  

Twelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals.     

艾滋病高效抗逆转录治疗的耐药发生与控制研究进展

随着高效抗逆转录疗法的运用与推广,HIV感染者的寿命得到延长。HIV是反转录病毒,其反转录酶在HIV复制时可进行DNA复制但无校正能力,导致出错率高,加之药物选择压力等因素,其耐药问题成为治疗失败的主要原因。阐明抗逆转录治疗耐药发生发展过程,对艾滋病控制与治疗具有重要意义,本文就HIV耐药产生途径与趋势、耐药相关影响因素以及降低耐药率策略进行综述。     

长沙市180例接受艾滋病抗病毒治疗患者抑郁症患病现状及影响因素研究

目的 了解目前接受艾滋病抗病毒治疗患者中抑郁症的患病率,初步探索影响抑郁症产生的因素。方法 2015年6-12月对长沙市传染病医院艾滋病门诊接受艾滋病抗病毒治疗的180例患者开展横断面研究,采用问卷调查的方法评估患者合并抑郁症的情况。利用宗氏抑郁自评量表(SDS)筛查调查对象的抑郁症状(SDS得分≥50分),应用心理疾病专家诊断系统(心理CT)确诊是否患抑郁症,并用logistic回归分析影响抑郁症产生的因素。结果 初筛检出有抑郁症状者48例(26.67%),确诊抑郁症者33例(18.33%)。多因素分析,艾滋病相关羞辱和歧视状况量表得分20~40分(OR=0.093,95%CI:0.020~0.431)是接受艾滋病抗病毒治疗患者抑郁症形成的保护因素,独居(OR=5.062,95%CI:1.626~15.764)、近3个月出现艾滋病相关的疾病(OR=3.778,95%CI:1.113~12.826)是接受艾滋病抗病毒治疗患者抑郁症形成的危险因素。结论 接受艾滋病抗病毒治疗患者抑郁症患病率应该引起关注,临床应加大对艾滋病患者的心理关怀。     

Association of highly active antiretroviral treatment with incident tuberculosis in people living with HIV/AIDS

PurposeTo determine the short-term and long-term effects of highly active antiretroviral therapy (HAART) on incident tuberculosis (TB) in people living with HIV/AIDS (PLWHA).MethodsFrom 2000 to 2012, we identified adult PLWHA from Taiwan Centers for Disease Control HIV Surveillance System. All PLWHA were followed up until December 31, 2012, and observed for TB occurrence. Time-dependent Cox proportional hazards models were used to determine the short-term and long-term effects of HAART on incident TB.ResultsOf 20,072 PLWHA, 628 (3.13%) had incident TB, corresponding to an incident rate of 701/100,000 person-years. After adjusting for potential confounders, PLWHA receiving HAART were more likely to develop TB than those not receiving the drugs (adjusted hazard ratio [AHR] 1.56; 95% confidence interval [CI] 1.18–2.05). While the short-term and long-term effects of HAART on incident TB were considered, HAART was a risk factor for TB development within the first 90 days (AHR 6.06; 95% CI 4.58–8.01) and between 90 and 180 days of treatment (AHR 1.80; 95% CI 1.11–2.94) but was a protective factor after 180 days of HAART use (AHR 0.51; 95% CI 0.39–0.66).ConclusionsHAART is a risk factor for the development of TB in the short term but a protective factor in the long term.     

成都市HCV合并感染对HIV/AIDS抗病毒治疗效果的影响

目的  了解艾滋病病毒(human immunodeficiency virus, HIV)-丙型肝炎病毒(hepatitis C virus, HCV)合并感染者和HIV感染者艾滋病(acquired immunedeficiency syndrome, AIDS)抗病毒治疗(Antiretroviral therapy, ART)的效果,并进一步分析HCV合并感染对艾滋病ART效果的影响。方法  利用国家艾滋病综合防治信息系统选取成都市2010年1月1日至2018年12月31日确诊的HIV/AIDS病例信息,随访时间截至2019年12月31日。采用Cox比例风险模型分析HCV感染对艾滋病ART病毒学失败的影响。结果  符合纳入标准的HIV-HCV合并感染者共555例,另匹配HIV感染者555例。在接受艾滋病抗病毒治疗4年内,HIV感染组和HIV-HCV合并感染组CD4⁺T淋巴细胞计数(简称CD4)的中位数年均分别升高45.9个/mm³、37.1个/mm³。两组病例累计随访2 393.1人年,病毒学失败率为7.15/100人年(171/2 393.1)。多因素Cox分析结果显示,HIV-HCV合并感染组发生病毒学失败的风险是HIV感染组的1.512(1.042~2.195)倍(P=0.030)。结论  合并HCV感染可能是影响HIV/AIDS艾滋病抗病毒治疗效果的危险因素。     

Employment loss following HIV infection in the era of highly active antiretroviral therapies

BACKGROUND: Employment is a major factor in maintaining living conditions of patients with chronic diseases. This study aimed to quantify the frequency and to identify the determinants of employment loss during the first years of HIV disease in the era of highly active antiretroviral therapies (HAART). METHODS: The French PRIMO multicentre prospective cohort of 319 patients enrolled during primary HIV-1 infection between 1996 and 2002. Employment loss was defined as moving from employment to inactivity between two visits. Characteristics associated with employment loss were assessed using generalized estimating equations. RESULTS: During a median follow-up time of 2.5 years, 56 employment losses occurred among 51 patients (18.0%). In multivariate analysis, female gender (adjusted odds ratio 3.1; 95% confidence interval 1.1-8.5), non-permanent job (3.8; 1.5-9.3) and poor accommodation (4.2; 1.6-11.2) constituted independent risk factors for employment loss; subjects with a high occupational position had a decreased risk of job loss. Moreover, an updated HIV viral load above 10 000 copies/ml either persistent (2.4; 1.1-5.0) or incident (3.7; 1.0-13.9) and hospitalization in the preceding 6 months (3.9; 1.6-9.7) constituted independent risk factors for employment loss, as tended to be a baseline CD4 cell count <350/mm(3) (1.9; 0.9-4.3) and chronic comorbidity (1.8; 0.9-3.6). CONCLUSIONS: In the HAART era, employment loss is frequent from the first months of HIV infection. Employment loss occurs especially in women and in patients with adverse socioeconomic conditions, severe HIV infection and/or comorbidity. Social interventions should seek to prevent HIV-infected patients from leaving their job from the earliest times of the disease.     

Longitudinal relationships between use of highly active antiretroviral therapy and satisfaction with care among women living with HIV/AIDS

OBJECTIVES: We used longitudinal data to examine the roles of 4 dimensions of patient satisfaction as both predictors and outcomes of use of highly active antiretroviral therapy (HAART) among women in the United States with HIV/AIDS. METHODS: Generalized estimating equations were used to analyze time-lagged satisfaction-HAART relationships over 8 years in the Women's Interagency HIV Study. RESULTS: Multivariate models showed that, over time, HAART use was associated with higher patient satisfaction with care in general, with providers, and with access/convenience of care; however, patient satisfaction was not associated with subsequent HAART use. Symptoms of depression and poor health-related quality of life were associated with less satisfaction with care on all 4 dimensions assessed, whereas African American race/ethnicity, illegal drug use, and fewer primary care visits were associated with less HAART use. CONCLUSIONS: Our findings suggest that dissatisfaction with care is not a reason for underuse of HAART among women with HIV and that providers should not be discouraged from recommending HAART to dissatisfied patients. Rather, increasing women's access to primary care could result in both increased HAART use and greater patient satisfaction.     

艾滋病高效抗反转录病毒治疗5年免疫学效果评价

目的探讨艾滋病高效抗反转录病毒治疗(HAART)5年的免疫学疗效,为艾滋病的治疗提供依据。方法选择2010年1月-2016年5月在广西壮族自治区龙潭医院规律随诊、完成HAART满5年的145例患者,按CD_4细胞数将患者分为A、B、C三组,A组29例CD_4细胞数>200个/μl,B组31例CD_4细胞数200~100个/μl,C组85例CD_4细胞数<100个/μl;比较三组HAART后各年份的CD_4细胞数变化,对治疗后CD_4细胞数>200个/μl、CD_4细胞数>500个/μl的构成比进行统计分析。结果三组治疗后各年份的CD_4细胞数均显著增高,与基线比较差异有统计学意义(P<0.05);A、B两组第3、4、5年CD_4细胞数组内比较,差异无统计学意义;C组第3、4、5年CD_4细胞数逐年增高,差异有统计学意义(P<0.05);CD_4细胞增幅第1年最大,三组分别为150、111、157个/μl,显著高于组内其他时段改变(P<0.05);5年间A组29例CD_4细胞数持续>200个/μl,B、C两组CD_4>200个/μl构成比逐年增高(P<0.05),三组CD_4>500个/μl的构成比逐渐增高(P<0.05);治疗第5年,CD_4>200个/μl的构成比A组为100.0%、B组93.55%、C组83.53%,CD_4>500个/μl的构成比三组分别为65.52%、32.26%、27.06%。结论艾滋病5年HAART后,CD_4细胞数达到并维持在远高于治疗前的水平,但基线CD_4<200个/μl的部分患者仍存在免疫重建不良,多数患者CD_4细胞数难以恢复到>500个/μl,而基线CD_4>200个/μl的患者半数以上CD_4细胞数恢复到正常水平;早期启动并维持长期抗病毒治疗可获得更好的免疫学疗效。