Effectiveness of antiretroviral therapy among patients who attend public HIV clinics in Rio de Janeiro, Brazil
Effectiveness of antiretroviral therapy among patients who attend public HIV clinics in Rio de Janeiro, Brazil
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DOI：
10.1097/00126334-200408010-00011
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发表时间：
2004-08-01
影响因子：
3.6
通讯作者：
Harrison, LH
中科院分区：
文献类型：
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作者：
Hofer, CB;Schechter, M;Harrison, LH
目标：巴西免费向艾滋病毒感染者提供抗逆转录病毒疗法。本研究的目的是调查与ART失败的患者接受免费的ART在公共clinicsinBrazil.Methods：这是一个横断面研究的成人ART 6至24个月在5个公共诊所在里约热内卢。患者接受了采访，并审查了他们的图表。使用以下6个月时对治疗的应答定义：病毒学应答者（VR），血浆病毒载量（VL）减少大于或等于1个对数;免疫学应答者（IR），增加大于或等于50个CD 4（+）细胞/mL;完全应答者（CR），VR和IR;和无应答者（NR），既不是VR也不是IR。在入组的211例患者中，173例（82%）为VR、IR或CR，38例（18%）为NR。在应答者中，28例（13%）为IR，32例（15%）为VR，113例（53%）为CR。在多变量分析中，与NR相关的因素是依从性低于80（OR = 8.6; 95% CI，2.9-25.7），基线CD 4（+）计数（OR = 0.5/50个细胞/mL; 95% CI，0.2-1.1），开始ART和首次VL/CD 4（+）检测之间的间隔（每个月的OR = 1.4; 95% CI，1.1-1.8），开始ART后的机会性疾病（OR = 6.8; 95% CI，1.4-34.0），无法阅读处方（OR = 3.9; 95% CI，1.4-10.9），不相信医生了解HIV（OR = 4.0; 95%CI，1.1-15.0），无HIV感染者朋友（OR = 6.1; 95%CI，1.7-21.8），认为ART会使自己患病（OR = 5.6; 95%CI，1.7-18.8），并认为ART将延缓HIV进展（OR = 0.001; 95%CI，0.0-0.2）。巴西对抗逆转录病毒疗法作出反应的患者比例与发达国家的报告相似，这表明抗逆转录病毒疗法可以在发展中国家成功使用。相关的变量坚持，知识和对ART的看法是与缺乏响应ART。这些研究结果有重要意义的发展中国家正在考虑增加获得ART。
Objective: Brazil provides antiretroviral therapy (ART) to HIV-infected persons free of charge. The objective of this study was to investigate factors associated with ART failure in patients receiving free ART in public clinics in Brazil.Methods: This is a cross-sectional study of adults taking ART for 6 to 24 months in 5 public clinics in Rio de Janeiro. Patients were interviewed and their charts were reviewed. The following definitions of response to therapy at 6 months were used: virologic responders (VR), greater than or equal to 1 log reduction in plasma viral load (VL); immunologic responders (IR), increase of greater than or equal to50 CD4(+) cells/mL; complete responders (CR), both VR and IR; and nonresponders (NR), neither VR nor IR.Results: Of 211 patients enrolled, 173 (82%) were VR, IR, or CR and 38 (18%) were NR. Of the responders, 28 (13%) were IR, 32 (15%) were VR, and 113 (53%) were CR. In multivariate analysis, factors associated with NR were less than 80% adherence (OR = 8.6; 95% CI, 2.9-25.7), baseline CD4(+) count (OR = 0.5 per 50 cells/mL; 95% CI, 0.2-1.1), interval between starting ART and first VL/CD4(+) testing (OR = 1.4 for each month; 95% CI, 1.1-1.8), opportunistic disease after starting ART (OR = 6.8; 95% CI, 1.4-34.0), inability to read prescription (OR = 3.9; 95% CI, 1.4-10.9), not believing physician is knowledgeable about HIV (OR = 4.0; 95% CI, 1.1-15.0), not having a friend with HIV (OR = 6.1; 95% CI, 1.7-21.8), believing ART will make him/her ill (OR = 5.6; 95% CI, 1.7-18.8), and believing ART will delay HIV progression (OR = 0.001; 95% CI, 0.0-0.2).Conclusion: The proportion of patients responding to ART in Brazil was similar to reports from developed countries, suggesting that ART can be used successfully in developing countries. Variables related to adherence, knowledge, and perceptions about ART were as sociated with a lack of response to ART. These findings have important implications for developing nations that are considering increased access to ART.