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首页> 外文期刊>JAIDS: Journal of acquired immune deficiency syndromes >Trends in AIDS and mortality in HIV-infected subjects with hemophilia from 1985 to 2003: the competing risks for death between AIDS and liver disease.
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Trends in AIDS and mortality in HIV-infected subjects with hemophilia from 1985 to 2003: the competing risks for death between AIDS and liver disease.

机译：1985年至2003年期间艾滋病毒感染的血友病患者的艾滋病和死亡率趋势：艾滋病与肝病之间的死亡竞争风险。

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OBJECTIVE: To study trends in progression to AIDS, all-cause mortality, and cause-specific mortality (AIDS-related, liver disease, and hemorrhagic complications) over calendar periods with different exposure to highly active antiretroviral therapy (HAART) in a cohort of hemophiliacs in Spain, taking into account the competing risks of the causes of death. METHODS: Multicenter cohort of HIV-infected hemophiliacs. HIV seroconversion was estimated using mathematic techniques for interval-censored data from 1979 through 1985. Rates of AIDS and cause-specific death were calculated by Poisson regression, allowing for late entry, for the periods 1985 through 1992, 1993 through 1996, 1997 through 2000 (early HAART), and 2001 through 2003 (late HAART), also allowing for competing risks. RESULTS: Of 585 subjects, 44% were younger than 15 years of age, 82% had severe hemophilia, 86% had type A hemophilia, and the median seroconversion date was October 1982. Calendar period and age at HIV seroconversion strongly influenced AIDS and death rates. Compared with 1993 through 1996, decreases of 75% (relative risk [RR] = 0.25, 95% confidence interval [CI]: 0.14 to 0.43) and 72% (RR = 0.28, 95% CI: 0.12 to 0.63) in the RR of AIDS were observed in early and late HAART. For all-cause mortality, 72% (RR = 0.28, 95% CI: 0.18 to 0.42) and 83% (RR = 0.17, 95% CI: 0.09 to 0.33) decreases were observed by 1997 through 2000 and 2001 through 2003. For liver-related deaths, increases were observed in the late-HAART period (RR = 2.80, 95% CI: 0.94 to 8.36) compared with 1993 through 1996, but using competing risks, this RR was substantially reduced (RR = 1.70, 95% CI: 0.57 to 5.04). DISCUSSION: Major reductions in AIDS and death rates were observed from 1997 to 2003 in hemophiliacs. These survival improvements are largely attributable to decreases in AIDS-related deaths and have been accompanied by increases in liver disease death rates, which are overestimated if competing risks are not taken into account.
机译：目的：研究在不同人群中，在不同时间接触高活性抗逆转录病毒治疗（HAART）的历程中，艾滋病，全因死亡率和特定原因死亡率（与艾滋病相关的疾病，肝病和出血性并发症）的进展趋势西班牙的血友病患者，考虑到死因的竞争风险。方法：HIV感染血友病的多中心队列。使用数学技术对1979年至1985年的间隔检查数据进行了HIV血清学转换的估计。通过Poisson回归计算AIDS和特定原因死亡的比率，允许在1985年至1992年，1993年至1996年，1997年至2000年期间延迟进入（HAART较早），以及2001年至2003年（HAART较晚）也考虑了竞争风险。结果：在585名受试者中，有44％的人年龄小于15岁，有82％的人患有严重血友病，有86％的人患有A型血友病，并且血清学转换的中位数是1982年10月。费率。与1993年到1996年相比，RR下降了75％（相对风险[RR] = 0.25，95％置信区间[CI]：0.14至0.43）和72％（RR = 0.28，95％CI：0.12至0.63）在早期和晚期HAART中观察到艾滋病的发生。对于全因死亡率，到1997年至2000年以及2001年至2003年，观察到降低了72％（RR = 0.28，95％CI：0.18至0.42）和83％（RR = 0.17，95％CI：0.09至0.33）。与1993年至1996年相比，在HAART晚期肝脏相关的死亡发生率有所增加（RR = 2.80，95％CI：0.94至8.36），但是使用竞争风险，该RR显着降低（RR = 1.70，95％ CI：0.57至5.04）。讨论：从1997年到2003年，血友病患者的艾滋病和死亡率大大降低。这些存活率的提高在很大程度上归因于与艾滋病相关的死亡人数的减少，并伴随着肝脏疾病死亡率的增加，如果不考虑竞争风险，这是被高估的。

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