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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.
Die vollständige englischsprachige
Kurzversion dieser Studie (sog. MEDLINE
Abstract) finden Sie
hier
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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