■从1996年到2020年,欧洲的全因死亡率和艾滋病死亡率一直在下降。然而,地区差异及其驱动因素仍不清楚。这项研究调查了死亡率差异及其驱动因素,包括抗逆转录病毒疗法(ART)和活动性结核病(TB)的使用和反应,在欧洲各地的艾滋病毒感染者中。
■从2001年到2020年,在EuroSIDA注册的艾滋病毒感染者被跟踪。免疫病毒学状态(IVS)被归类为不良(CD4细胞计数≤350细胞/mm3和病毒载量(VL)>200拷贝/ml),良好(CD4≥500和VL<200),或中间(剩余组合)。缺乏CD4细胞计数或VL的参与者被归类为未知。使用多变量泊松回归分析了死亡率的地区差异,并进行了欧洲和IVS地区之间的相互作用分析。ART,或TB状态。
■包括20,364名HIV感染者:来自西方的13,715/20,346(67.3%),3020/20,364(14.8%)来自中东部,和3629/20,364(17.8%)来自东欧。在入学时,中位年龄为40岁(四分位数间距(IQR):33-48),中位CD4细胞计数449个细胞/mm3(IQR:291-638),大多数为男性14,993/20,346(73.3%)。在192,591人年的随访中,共有2639人死亡(粗死亡率13.7/1000人年,95%CI:13.2-14.2),519/2639(19.7%)来自艾滋病(2.7/1000人年,2.5-2.9)。随着时间的推移,全因死亡率和艾滋病死亡率有所下降,但在东欧,经过对混杂因素的调整后仍然较高。脱离ART(aIRR2.42;95%CI2.14-2.74),不良IVS(aIRR4.2;95%CI3.39~5.20)和既往TB(aIRR3.33;95%CI2.75~4.03)与较高的全因死亡率相关.对于全因死亡率,ART(交互作用检验:p<0.001)和IVS(p=0.02)的影响,但TB(p=0.5)不会在不同地区变化。
■总死亡率和艾滋病死亡率随时间下降,但在东欧仍然较高。可怜的IVS,停止ART和既往活动性结核病与较高的死亡率相关。东欧患有贫困或未知IVS的人口比例最高,强调继续需要改善艾滋病毒护理,重点是早期诊断,ART启动,和坚持。
■EuroSIDA已获得ViiVHealthcareLLC的资助,Janssen科学事务,Janssen研发,百时美施贵宝公司,默克夏普和多姆公司,吉利德科学和欧盟第七框架研究计划,根据EuroCoord赠款协议n54260694进行技术开发和示范。该研究还得到了丹麦国家研究基金会和国际传染病队列联合会(RESPOND)的资助。
UNASSIGNED: All-cause and AIDS-mortality in Europe has been decreasing between 1996 and 2020. However, regional differences as well as their drivers remain unclear. This study investigates mortality differences and their drivers, including usage of and response to antiretroviral therapy (ART) and active tuberculosis (TB), among people with HIV across Europe.
UNASSIGNED: People with HIV enrolled in EuroSIDA were followed from 2001 through 2020. Immunologic-virologic status (IVS) was categorized as poor (CD4-cell count ≤350 cells/mm3 and viral load (VL) > 200 copies/ml), good (CD4 ≥ 500 and VL < 200), or intermediate (remaining combinations). Participants missing either CD4-cell count or VL were categorized as unknown. Regional differences in mortality were analyzed using multivariable Poisson regression with interaction analyses between regions of Europe and IVS, ART, or TB status.
UNASSIGNED: 20,364 people with HIV were included: 13,715/20,346 (67.3%) from Western, 3020/20,364 (14.8%) from Central Eastern, and 3629/20,364 (17.8%) from Eastern Europe. At enrolment, median age was 40 years (inter-quartile range (IQR): 33-48), median CD4-cell count 449 cells/mm3 (IQR: 291-638), and most were male 14,993/20,346 (73.3%). A total of 2639 died during 192,591 person-years of follow-up (crude mortality rate 13.7/1000 person-years, 95% CI: 13.2-14.2), 519/2639 (19.7%) from AIDS (2.7/1000 person-years, 2.5-2.9). All-cause and AIDS-mortality rates decreased over time but remained higher in Eastern Europe after adjusting for confounders. Being off ART (aIRR 2.42; 95% CI 2.14-2.74), poor IVS (aIRR 4.2; 95% CI 3.39-5.20) and prior TB (aIRR 3.33; 95% CI 2.75-4.03) were associated with higher all-cause mortality. For all-cause mortality the effect of ART (test for interaction: p < 0.001) and IVS (p = 0.02), but not TB (p = 0.5) varied across regions.
UNASSIGNED: Overall mortality and AIDS-mortality rates decreased over time, but remained higher in Eastern Europe. A poor IVS, being off ART and prior active TB were related to higher mortality. Eastern Europe had the highest proportion of people with poor or unknown IVS, emphasizing the continued need to improve HIV care with a focus on early diagnosis, ART initiation, and adherence.
UNASSIGNED: EuroSIDA has received funding from ViiV Healthcare LLC, Janssen Scientific Affairs, Janssen R&D, Bristol-Myers Squibb Company, Merck Sharp & Dohme Corp, Gilead Sciences and the European Union\'s Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement n˚ 260694. The study is also supported by a grant from the Danish National Research Foundation and by the International Cohort Consortium of Infectious Disease (RESPOND).