Antiretroviral therapy in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America
Antiretroviral therapy in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America
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DOI：
10.1111/j.1365-3156.2008.02078.x
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发表时间：
2008-07-01
影响因子：
3.3
通讯作者：
Egger, Matthias
中科院分区：
文献类型：
--
作者：
Keiser, Olivia;Anastos, Kathryn;Egger, Matthias
为了描述时间趋势的基线临床特征，初始治疗方案和监测患者开始抗逆转录病毒治疗（ART）在资源有限的setting.METHODS我们分析了数据，从17个ART方案在撒哈拉以南非洲，南美洲和亚洲的12个国家。纳入了16岁或16岁以上的患者，记录了高活性ART（HAART）的开始日期。通过按区域和时间段计算中位数、四分位距（IQR）和百分比对数据进行分析。不是所有的中心提供的数据为2006年和2005年和2006年，因此combined.RESULTS共36 715例患者开始ART 1996-2006年被纳入分析。2005-2006年，撒哈拉以南非洲和亚洲的患者人数大幅增加，初始治疗方案的数量分别减少到4个和5个。在南美洲，2005-2006年采用了20种制度。56%的非洲患者和42%的亚洲患者使用3 TC/D4 T/NVP联合治疗; 33%的南美患者使用AZT/3 TC/EFV。中位基线CD 4计数近年来增加至122个细胞/μ l（IQR 53-194），2005-2006年在非洲，134个细胞/μ l（IQR 72-191）在亚洲，197个细胞/μ l（IQR 61-277），但在2005-2006年，分别有77%、78%和51%的人开始时细胞数< 200个/μ l。在所有地区，女性的基线CD 4细胞计数均高于男性：非洲的差异为22个细胞/μ l，亚洲为65个细胞/μ l，南美洲为10个细胞/μ l。2005-2006年，21%的非洲患者、8%的亚洲患者和73%的南美洲患者在6个月时可获得病毒载量。6个月CD 4细胞计数的相应数字分别为74%、77%和81%.CONCLUSION由世界卫生组织提出的提供ART的公共卫生方法已在撒哈拉以南非洲和亚洲实施。尽管近年来ART开始时的CD 4细胞计数有所增加，但大多数患者开始时的计数仍远低于推荐的阈值。应特别注意在感染艾滋病毒的男子中更及时地开始抗逆转录病毒疗法。
OBJECTIVES To describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings.METHODS We analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined.RESULTS A total of 36 715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/mu l (IQR 53-194) in 2005-2006 in Africa, 134 cells/mu l (IQR 72-191) in Asia, and 197 cells/mu l (IQR 61-277) in South America, but 77%, 78% and 51%, respectively, started with < 200 cells/mu l in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/mu l in Africa, 65 cells/mu l in Asia and 10 cells/mu l in South America. In 2005-2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74%, 77% and 81%.CONCLUSIONS The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.