Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa
Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa
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DOI：
10.1097/00002030-200404090-00006
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发表时间：
2004-04-09
期刊：
影响因子：
3.8
通讯作者：
Goemaere, E
中科院分区：
文献类型：
--
作者：
Coetzee, D;Hildebrand, K;Goemaere, E
背景：2001年在南非的一个乡镇建立了一个以社区为基础的抗逆转录病毒治疗（ART）方案，以探索在资源有限的情况下在公共部门提供抗逆转录病毒治疗所涉及的业务问题，并证明这种服务的可行性。方法：对CD4淋巴细胞计数< 200 × 10(6)细胞/l的有症状的HIV疾病患者队列进行数据分析。该方案采用标准化方案（尽可能使用仿制药），采用团队方法进行临床护理，并采用以患者为中心的方法促进依从性。结果：282名未接受过ART治疗的成年人被随访了13.9个月。治疗开始时，CD4淋巴细胞计数中位数为43 X 106细胞/l，平均对数（10）HIV RNA为5.18拷贝/ml。在3、6、12、18和24个月时，分别有88.1、89.2、84.2、75.0和69.7%的患者无法检测到HIV RNA水平（< 400拷贝/ml）。治疗24个月时，所有患者的累计存活概率为86.3%，基线CD4淋巴细胞计数大于或等于50 X 10(6)个细胞/升的患者存活概率为91.4%，基线CD4淋巴细胞计数< 50 X 10(6)个细胞/升的患者存活概率为81.8%。由于不良事件或禁忌症，24个月内更换单一抗逆转录病毒药物的累积概率为15.1%，仅由于不良事件的累积概率为8.4%。结论：在资源有限的情况下，抗逆转录病毒治疗具有良好的患者保留率和临床效果。在负责任的实施下，抗逆转录病毒疗法是在受艾滋病毒影响最严重的社区全面应对这一流行病的关键组成部分。(C) 2004利平科特·威廉姆斯·威尔金斯。
Background: A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service.Methods: Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 X 10(6) cells/l The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence.Results: Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 X 106 cells/l at initiation of treatment, and the mean log(10) HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count greater than or equal to 50 X 10(6) cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 X 10(6) cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone.Conclusions: ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV. (C) 2004 Lippincott Williams Wilkins.