Efficacy of antiretroviral therapy programs in resource-poor settings: A meta-analysis of the published literature
Efficacy of antiretroviral therapy programs in resource-poor settings: A meta-analysis of the published literature
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DOI：
10.1086/431199
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发表时间：
2005-07-15
影响因子：
11.8
通讯作者：
Doucette, K
中科院分区：
文献类型：
--
作者：
Ivers, LC;Kendrick, D;Doucette, K
背景资料。尽管出现了有效的联合抗逆转录病毒药物疗法(ART)来治疗人类免疫缺陷病毒(HIV)感染，但许多人怀疑ART治疗计划在资源匮乏的环境中的可行性。我们对发展中国家ART项目的效果进行了荟萃分析。我们在Medline数据库中搜索了“HIV”、“抗逆转录病毒治疗”、“CD4计数”、“病毒载量”、“经验”和“结果”等关键词。共对201篇摘要进行了综述，并选择了25篇文章进行详细综述。分析中最终纳入了10项关于患者结局的观察性研究。三位读者独立地从这些文章中提取了数据。记录的细节包括患者的人口学特征、基线CD4细胞计数、基线HIV RNA病毒载量、抗逆转录病毒治疗病史、结果以及结果测量的时间。无法检测到艾滋病毒病毒载量的受试者比例提供了治疗效果的衡量标准。随机效应模型加权了ART期间不同时间点未检测到病毒载量的患者的比例。术后6个月为0.697(95%CI，0.582~0.812)，12个月为0.573(95%CI，0.432~0.715)。与要求患者支付部分或全部治疗费用相比，向患者免费提供药物与6个月和12个月时病毒载量检测不到的概率高出29%-31%。在资源匮乏的环境中，抗逆转录病毒治疗方案的有效率与发达国家的报告相似。向患者免费提供药物与ART治疗6个月和12个月时病毒学抑制的可能性显著增加有关。
Background. Despite the advent of effective combination antiretroviral drug therapy (ART) for the treatment of human immunodeficiency virus (HIV) infection, many doubt the feasibility of ART treatment programs in resource-poor settings. We performed a meta-analysis of the efficacy of ART programs in the developing world. We searched the Medline database with the index terms "HIV," "antiretroviral therapy," "CD4 count," "viral load," "experience," and "outcomes." A total of 201 abstracts were reviewed, and 25 articles were selected for detailed review. Ten observational studies with details on patient outcomes were ultimately included in the analysis.Methods. Three readers independently extracted data from the articles. The details recorded included patient demographic characteristics, baseline CD4 cell counts, baseline HIV RNA viral loads, ART histories, outcomes, and timing of the outcome measure.Results. The proportion of subjects with an undetectable HIV viral load provided the measure of treatment efficacy. A random-effects model weighted the proportion of patients with undetectable viral load at various time points during ART. The proportion was 0.697 (95% CI, 0.582 - 0.812) at month 6 and 0.573 (95% CI, 0.432 - 0.715) at month 12 of ART. The provision of medications free of charge to the patient was associated with a 29% - 31% higher probability of having an undetectable viral load at months 6 and 12 than was the requirement that patients pay part or all of the cost of therapy.Conclusions. ART treatment programs in resource-poor settings have efficacy rates similar to those reported for developed countries. The provision of medications free of charge to the patient is associated with a significantly increased probability of virologic suppression at months 6 and 12 of ART.