Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating Antiretroviral therapy in resource-limited settings
Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating Antiretroviral therapy in resource-limited settings
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DOI：
10.1089/aid.2007.0217
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发表时间：
2008-04-01
影响因子：
1.5
通讯作者：
Palombi, Leonardo
中科院分区：
文献类型：
--
作者：
Marazzi, Maria Cristina;Liotta, Giuseppe;Palombi, Leonardo
在一组非洲患者中开始使用联合抗逆转录病毒药物(ARV)后，对治疗的反应和早期死亡的危险因素进行了回顾性队列设计的描述。在莫桑比克、坦桑尼亚和马拉维的12个临床中心，对启动抗逆转录病毒药物患者的病史、实验室参数和死亡率数据进行了回顾。在接受抗逆转录病毒药物治疗6个月以上的3456名HIV-1感染者中，72%的患者处于WHO临床3/4期，7%的患者病毒载量为400拷贝/毫升，38%的患者CD_4细胞计数为200个/亩L。一年后，78%的患者无法检测到病毒载量，79%的患者CD_4细胞计数为200细胞/毫米(3)。在HAART的第一年，发生了260例死亡(每1000人/年97例)，死亡率在前3个月达到峰值。观察到低体重指数、低血红蛋白水平和CD4值为200个细胞/亩的患者死亡率最高。在资源有限地区的患者中，尤其是在治疗开始后的前90天，启动HAART后的死亡率更高。在较高的CD4细胞计数水平上启动HAART，特别是在营养不良和/或贫血患者中，将对公共卫生产生重大影响。
The response to treatment and risk factors for early mortality following initiation of combination antiretrovirals ( ARVs) in a cohort of African patients are described in a retrospective cohort design. Medical history, laboratory parameters, and mortality data were reviewed for patients initiating ARVs in 12 clinical centers in Mozambique, Tanzania, and Malawi. Among 3456 HIV-1- infected patients who received ARVs for more than 6 months, at baseline 72% had WHO clinical stages 3/4, 7% had a viral load < 400 copies/ml, and 38% had a CD4 cell count > 200/mu l. One year later, 78% had undetectable virus loads and 79% had CD4 cell counts > 200 cells/ mm(3). In the first year of HAART 260 deaths occurred ( 97 per 1000 person/years) with mortality peaking in the first 3 months. The highest mortality was observed in patients with low BMI, low hemoglobin levels, and CD4 values > 200 cells/mu l at baseline. Mortality rates following initiation of HAART are higher in patients in resource-limited areas, particularly in the first 90 days following treatment initiation. HAART initiated at higher CD4 cell count levels, especially among malnourished and/or anemic patients, will carry significant public health impact.