HIV-positive adults in high income countries face a substantially reduced risk of death from AIDS-related causes， cardiovascular disease， and liver disease compared with a decade ago， according to a large international study published in Lancet.

据柳叶刀发表的一项大型国际研究表明，与十年前相比，高收入国家的HIV阳性成年人在艾滋病相关疾病、心血管疾病以及肝脏疾病等方面的死亡风险明显降低。

The study which involved nearly 50 000 HIV-positive adults receiving care and antiretroviral therapy (ART) at more than 200 clinics across Europe， USA， and Australia found that overall death rates have almost halved since 1999， while deaths due to AIDS-related causes and cardiovascular disease have declined by around 65% and liver-related deaths by more than 50%.

这项研究纳入了来自欧洲、美国和澳大利亚超过200家医院的近50，000名接受抗逆转录病毒治疗(ART)和护理的HIV阳性成年人。结果发现，自1999年以来其总体死亡率已减少一半。其中源于艾滋病相关疾病和心血管疾病的死亡率下降约65%，与肝脏疾病相关的死亡率下降超过50%。

Although deaths from most causes declined over the study period， there was no reduction in death rates from non-AIDS cancers which remained stable over time (1.6 deaths per 1000 years 1999–2000 to 2.1 in 2009–2011). Non-AIDS cancers are now the leading cause of non-AIDS deaths in people with HIV， accounting for 23% of all deaths.

虽然在研究期间多致病因素导致的死亡在下降，但非艾滋病相关性癌症的死亡率并没有降低，仍然保持着稳定水平(1999-2000年为1.6‰，2009-2011年为2.1‰)。非艾滋病相关性癌症目前是HIV患者非艾滋病性死亡的首要原因，占全部死亡的23%。

Using data from the Data collection on Adverse events of anti-HIV Drugs (D：A：D) study， the researchers looked at trends in underlying causes of death in people with HIV between 1999 and 2011， who were followed-up for a median of 6 years.

研究者利用抗HIV病毒药物不良反应(DAD)研究中收集的数据资料，观察从1999到2011年间平均随访6年的HIV人群潜在死亡原因的趋势。

Of the 3909 deaths that occurred over the study period， around 29% of individuals died from an AIDS-related cause， which remains the most common cause of death. Cancers (15%； mainly lung cancer) were the most frequent causes of non-AIDS deaths， followed by liver disease (13%； mainly due to hepatitis)， and cardiovascular disease (11%).

研究期间共发生的3909例死亡中，约29%个体死于艾滋病相关疾病--这依然是最常见的死亡原因，癌症(占15%，主要是肺癌)是非艾滋病性死亡的最常见原因，继之是肝脏疾病(占13%，主要是肝炎)和心血管疾病(占11%)。

Mortality decreased from about 17.5 deaths per 1000 person-years in 1999–2000 to 9.1 deaths per 1000 years in 2009–2011—a drop of around 50%. Similar decreases in deaths related to AIDS (5.9 deaths per 1000 person-years to 2.0)， liver disease (2.7 to 0.9)， and cardiovascular disease (1.8 to 0.9) were also seen. The proportion of all deaths due to AIDS (34% to 23%) and liver disease (16% to 10%) declined over the decade， while the proportion of deaths due to cardiovascular disease remained constant at 10%.

总死亡率从1999-2000年的17.5‰下降至2009-2011年的9.1%，降幅接近50%。与艾滋病(从5.9‰降至2.0‰)、肝脏疾病(从2.7‰降至0.9‰)和心血管疾病(从1.8‰降至0.9‰)相关的死亡率情况也有类似降低。

The researchers note that substantially reduced death rates from liver and cardiovascular disease cannot be fully explained by changes in patient demographics or improvements in viral suppression or CD4 count， and might result from the better management of traditional risk factors such as smoking， alcohol use， and hepatitis， or the use of less toxic ART regimens.

研究者注意到，与肝脏疾病和心血管疾病相关的死亡率显着降低无法完全用患者人口资料差异、病毒抑制改善或CD4计数的好转等解释，而可能与对吸烟、饮酒、肝炎或应用更小毒性的ART疗法等传统风险因素的管理加强有关。

They conclude by calling for further research to gain a clearer understanding of why the risk of dying from a non-AIDS cancer remains high and to assess the effect of specific antiretroviral drugs on non-AIDS cancer rates.

研究者认为，基于非艾滋病性癌症相关的死亡风险居高不下，还需要进一步研究以获取对其原因的更清晰理解，并评估特定抗逆转录病毒药物对非艾滋病性癌症死亡率的影响。

According to study leader Dr Colette Smith from University College London in the UK， “These recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 count andprovide further evidence of the substantial net benefits of ART. But despite these positive results， AIDS-related disease remains the leading cause of death in this population. Continued efforts to ensure good ART adherence and to diagnose more individuals at an earlierstage before the development of severe immunodeficiencyare important to ensure that the low death rate fromAIDS is sustained and potentially decreased even further.”

该项研究的首席研究者、英国伦敦大学Colette Smith 博士认为，近年艾滋病相关死亡率的降低与CD4计数的持续改善相关，并为ART治疗的实质性获益提供了更多的证据。尽管结果呈阳性，但艾滋病相关性疾病仍然是这些人群的首要死亡原因。在发展至严重的免疫缺陷之前，持续努力以确保ART良好的依从性和对更多个体进行早期诊断，这对确保维持艾滋病死亡率处于低位甚至进一步减少至关重要。

Writing in a linked Comment， Steven Deeks and Peter Hunt from the University of California in San Francisco， USA， say， “The benefits of ART are unquestioned， and their beneficial effect on the HIV epidemic continues to grow. Still， clear limitations exist because many patients are not accessing treatment， and some problems persist even in those on ART， including a higher than expected risk of non-AIDS cancers and other morbidities. Finally， it needs to be emphasised that we are still early in the ART era. In the absence of a cure， most patients will need to continue on ART for decades. Continued monitoring for unexpected consequences of treatment will be needed indefinitely.”

在随后的评论中，来自美国旧金山加州大学的Steven Deeks和 Peter Hunt认为，ART的益处毋庸置疑，且对控制HIV流行的效果在继续扩大。因许多患者并未获得治疗，局限性仍很明显，甚至在应用ART的患者中也存在很多问题，包括比非艾滋病性癌症和其他疾病的发病预期风险更高。最后需要强调的是，我们仍然处在ART时代的早期阶段，需要对大多数未治愈的患者持续数十年的ART，也需对治疗的不确定后果进行长期持续监测。