Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data
Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data
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DOI：
10.4102/sajhivmed.v20i1.963
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发表时间：
2019-01-01
影响因子：
1.7
通讯作者：
Peters, Remco P.H.
中科院分区：
文献类型：
--
作者：
Lilian, Rivka R.;Rees, Kate;Peters, Remco P.H.
背景技术背景：尽管抗逆转录病毒疗法（ART）在南非广泛使用，但人类免疫缺陷病毒（HIV）相关的发病率和死亡率仍然是一个相当大的负担。结论：描述ART的启动和结果趋势，重点关注晚期HIV感染的患者，以确定降低发病率和死亡率的干预措施。分析了2004年至2017年期间在约翰内斯堡或莫帕尼地区有记录的基线CD 4计数和新开始ART的HIV感染成年人的常规TIER.Net数据。基线CD 4计数和5年死亡率的趋势进行了调查，并开始ART与CD 4 < 200个细胞/mm 3的人口described.RESULTS：约翰内斯堡和Mopani数据集包括203 131和101 814记录，分别。尽管CD 4计数中位数随着时间的推移而增加，但2017年CD 4 < 200个细胞/mm 3的初始比例仍然很高（约翰内斯堡39%，Mopani 35%）。与基线计数较高的患者相比，CD 4 < 200的患者死亡率显著增加（p < 0.001）。尽管低CD 4患者的死亡率随着时间的推移而下降，可能是因为药物治疗方案的改善，但在2016-2017年，这些患者的死亡率仍然显着增加（p < 0.001）。2017年，向低CD 4患者提供复方新诺明预防性治疗的比例随着时间的推移下降至< 30%，并与临床分期相关。介绍与CD 4 < 200细胞/mm 3与年龄较大，男性性别和hospitalisation.CONCLUSION：一个令人担忧的大部分南非人仍然开始ART在低CD 4计数。这与死亡率增加有关，需要有针对性的干预措施，以改善预防方案的提供和早期护理。
BACKGROUND: Despite widespread availability of antiretroviral therapy (ART) in South Africa, there remains a considerable burden of human immunodeficiency virus (HIV)-related morbidity and mortality.OBJECTIVES: To describe ART initiation and outcome trends over time, with a focus on clients presenting with advanced HIV-infection, so as to identify interventions to reduce morbidity and mortality.METHODS: Routine TIER.Net data from HIV-infected adults who had a documented baseline CD4 count and were newly initiating ART in Johannesburg or Mopani districts from 2004 to 2017 were analysed. Trends in baseline CD4 count and 5-year mortality were investigated and the population initiating ART with CD4 < 200 cells/mm3 was described.RESULTS: The Johannesburg and Mopani data sets comprised 203 131 and 101 814 records, respectively. Although median CD4 count increased over time, the proportion of initiations at CD4 < 200 cells/mm3 in 2017 remained high (Johannesburg 39%, Mopani 35%). Mortality was significantly increased among clients with CD4 < 200 compared to those with higher baseline counts (p < 0.001). Even though mortality among clients with low CD4 declined over time, likely because of improved drug regimens, in 2016-2017 mortality was still significantly increased among these clients (p < 0.001). Delivery of cotrimoxazole prophylaxis to clients with low CD4 declined over time to < 30% in 2017 and was associated with clinical stage. Presentation with CD4 < 200 cells/mm3 was associated with older age, male gender and hospitalisation.CONCLUSION: A concerningly large proportion of South Africans still initiate ART at low CD4 counts. This is associated with increased mortality and requires targeted interventions to improve delivery of prophylactic regimens and early engagement in care.