Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus(HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survivaltrends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, andevaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. Materials and Methods: Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in theKorean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death amongthe enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratiosof mortality based on the time of ART initiation. Results: Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cellcounts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5–303] in 2001–2003 to 273 (IQR,108–399) in 2013–2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjustedhazard ratio, 3.71; 95% confidence interval (CI), 2.35–5.84] and low CD4 counts (<100 cells/mm3: adjusted hazard ratio,2.99; 95% CI, 1.44–6.23) were significant risk factors for mortality. Conclusion: Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ARTdid not improve between 2001 and 2015 in Korea.
Abstract
Purpose: In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus(HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survivaltrends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, andevaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. Materials and Methods: Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in theKorean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death amongthe enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratiosof mortality based on the time of ART initiation. Results: Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cellcounts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5–303] in 2001–2003 to 273 (IQR,108–399) in 2013–2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjustedhazard ratio, 3.71; 95% confidence interval (CI), 2.35–5.84] and low CD4 counts (<100 cells/mm3: adjusted hazard ratio,2.99; 95% CI, 1.44–6.23) were significant risk factors for mortality. Conclusion: Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ARTdid not improve between 2001 and 2015 in Korea.
참고문헌 (23)
- Antiretroviral Therapy Cohort Collaboration, "Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013 : a collaborative analysis of cohort studies", Lancet HIV, 4, pp.e349~e356 (2017)
- Sterne JA, "Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death : a prospective cohort study", Lancet, 366, pp.378~384 (2005)
- Mills EJ, "Life expectancy of persons receiving combination antiretroviral therapy in low-income countries : a cohort analysis from Uganda", Ann Intern Med, 155, pp.209~216 (2011)
- Poorolajal J, "Survival rate of AIDS disease and mortality in HIV-infected patients : a meta-analysis", Public Health, 139, pp.3~12 (2016)
- Aldaz P, "Mortality by causes in HIV-infected adults : comparison with the general population", BMC Public Health, 11, pp.300~ (2011)
- Smith CJ, "Trends in underlying causes of death in people with HIV from 1999 to 2011(D : A : D) : a multicohort collaboration", Lancet, 384, pp.241~248 (2014)
- Cobucci RN, "Assessing the impact of HAART on the incidence of defining and non-defining AIDS cancers among patients with HIV", AIDS : a systematic review, 2015, pp.8, 1~10
- Weber R, "Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study", HIV Med, 14, pp.195~207 (2013)
- "2017 Annual report on the notified HIV/AIDS in Korea"[URL]
- 위성헌, "The 2013 Clinical Guidelines for the Diagnosis and Treatment of HIV", AIDS in HIV-Infected Koreans, 2013, pp.45(4), 455~461[DOI]
- 김민정, "Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV", AIDS Cohort Study, 1992-2015, 2017, pp.49(2), 101~108[DOI]
- Ingle SM, "Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients", Clin Infect Dis, 59, pp.287~297 (2014)
- Centers for Disease Control and Prevention, "1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults", JAMA, 269, pp.729~730 (1993)
- Egger M, "Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy : a collaborative analysis of prospective studies", Lancet, 360, pp.119~129 (2002)
- Kiertiburanakul S, "Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients", J Int AIDS Soc, 17, pp.18804~ (2014)
- Jung IY, "Trends in mortality among ART-treated HIV-infected adults in the Asia-Pacific region between 1999 and 2017 : results from the TREAT Asia HIV Observational Database(TAHOD)and Australian HIV Observational Database(AHOD)of IeDEA Asia-Pacific", J Int AIDS Soc, 22, pp.e25219~ (2019)
- May M, "Impact of late diagnosis and treatment on life expectancy in people with HIV-1 : UK Collaborative HIV Cohort(UK CHIC)Study", BMJ, 343, pp.d6016~ (2011)
- Choe PG, "Late presentation of HIV disease and its associated factors among newly diagnosed patients before and after abolition of a government policy of mass mandatory screening", J Infect, 63, pp.60~65 (2011)
- Castilla J, "Late diagnosis of HIV infection in the era of highly active antiretroviral therapy : consequences for AIDS incidence", AIDS, 16, pp.1945~1951 (2002)
- Mugavero MJ, "Late diagnosis of HIV infection : the role of age and sex", Am J Med, 120, pp.370~373 (2007)
- Brännström J, "Patients unaware of their HIV infection until AIDS diagnosis in Sweden 1996-2002--a remaining problem in the highly active antiretroviral therapy era", Int J STD AIDS, 16, pp.702~706 (2005)
- "Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV"[URL]
- "Guidelines for the use of antiretroviral agents in adults and adolescents with HIV"[URL]