Quelle: Medlinie Abstract
HIV-Infektionen (AIDS): Seit Einführung der modernen antiretroviral
wirkenden Medikamente hat sich das im Vergleich zur Gesamtbevölkerung
in der Vergangenheit dramatisch erhöhte zusätzliche Sterberisiko
bei HIV-Patienten deutlich vermindert.
In den Jahren 2004-2006 konnte in den ersten fünf Jahren nach
Serokonversion kein erhöhtes statistisches Sterberisiko festgestellt
werden. Über zehn Jahre wurde in der Altersgruppe von 15-24
Jahren lediglich ein erhöhtes Sterberisiko von 4,8% gefunden werden.


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Changes
in the risk of death after HIV seroconversion compared with mortality
in the general population.
JAMA.
2008 Jul 2;300(1):51-9. PMID: 18594040
Bhaskaran K, et al.
Abstract
CONTEXT: Mortality among human immunodeficiency virus (HIV)-infected
individuals has decreased dramatically in countries with good
access to treatment and may now be close to mortality in the general
uninfected population.
OBJECTIVE:
To evaluate changes in the mortality gap between HIV-infected
individuals and the general uninfected population.
DESIGN,
SETTING, AND POPULATION: Mortality following HIV seroconversion
in a large multinational collaboration of HIV seroconverter cohorts
(CASCADE) was compared with expected mortality, calculated by
applying general population death rates matched on demographic
factors. A Poisson-based model adjusted for duration of infection
was constructed to assess changes over calendar time in the excess
mortality among HIV-infected individuals. Data pooled in September
2007 were analyzed in March 2008, covering years at risk 1981-2006.
MAIN
OUTCOME MEASURE: Excess mortality among HIV-infected individuals
compared with that of the general uninfected population.
RESULTS:
Of 16,534 individuals with median duration of follow-up of 6.3
years (range, 1 day to 23.8 years), 2571 died, compared with 235
deaths expected in an equivalent general population cohort. The
excess mortality rate (per 1000 person-years) decreased from
40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess
deaths in 31,302 person-years) before the introduction of highly
active antiretroviral therapy (pre-1996) to
6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14,703 person-years)
in 2004-2006 (adjusted excess hazard
ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996).
By
2004-2006, no excess mortality was observed in the first 5 years
following HIV seroconversion among those infected sexually, though
a cumulative excess probability of death remained over the longer
term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those
aged 15-24 years).
CONCLUSIONS: Mortality rates for HIV-infected persons have
become much closer to general mortality rates since the introduction
of highly active antiretroviral therapy. In industrialized countries,
persons infected sexually with HIV now appear to experience mortality
rates similar to those of the general population in the first
5 years following infection, though a mortality excess remains
as duration of HIV infection lengthens.
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