Advanced Human Immunodeficiency Virus Disease at Diagnosis in Mozambique and Swaziland.
Advanced Human Immunodeficiency Virus Disease at Diagnosis in Mozambique and Swaziland.
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莫桑比克和斯威士兰的晚期人类免疫缺陷病毒病诊断。
DOI：
10.1093/ofid/ofx156
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发表时间：
2017
影响因子：
4.2
通讯作者：
Elul B
中科院分区：
文献类型：
--
作者：
Kujawski SA;Lamb MR;Lahuerta M;McNairy ML;Ahoua L;Abacassamo F;Nuwagaba-Biribonwoha H;Gachuhi A;El-Sadr WM;Elul B
人类免疫缺陷病毒（HIV）的早期诊断是使抗逆转录病毒治疗的个人和社会效益最大化的先决条件。在莫桑比克和斯威士兰的10个卫生机构检测艾滋病毒呈阳性的≥18岁的成年人在诊断后立即接受护理点CD4+细胞计数检测。我们检测了诊断时中位CD4+细胞计数、诊断为晚期HIV疾病（CD4+细胞计数≤350细胞/μL）和严重免疫抑制（CD4+细胞计数≤100细胞/μL）的比例，以及后两项措施的决定因素。在2333名参与者中，诊断时CD4+细胞计数中位数为313个细胞/μL（四分位数范围为164-484），超过一半（56.5%）的CD4+≤350个细胞/μL， 13.9%的CD4+≤100个细胞/μL。诊断时晚期HIV疾病和严重免疫抑制的校正相对危险度（aRR）男性高于女性（晚期疾病aRR = 1.31； 95%可信区间[CI] = 1.16-1.48；严重免疫抑制aRR = 1.54, 95% CI = 1.17-2.02）和因感觉不健康而寻求HIV检测的患者（晚期疾病aRR = 1.30, 95% CI = 1.08-1.55；严重免疫抑制aRR = 2.10, 95% CI = 1.35-2.26）。18-24岁与25-39岁相比，两种结果的风险都较低（晚期疾病aRR = 0.70, 95% CI = 0.59-0.84；严重免疫抑制aRR = 0.62, 95% CI = 0.41-0.95）。在全球扩大艾滋病毒综合服务10多年后，在两个高流行国家的卫生机构中，大多数被诊断患有艾滋病毒的成年人出现了晚期疾病，七分之一的人出现了严重的免疫抑制。迫切需要创新的策略来早期识别艾滋病毒阳性个体。
Early diagnosis of human immunodeficiency virus (HIV) is a prerequisite to maximizing individual and societal benefits of antiretroviral therapy. Adults ≥18 years of age testing HIV positive at 10 health facilities in Mozambique and Swaziland received point-of-care CD4+ cell count testing immediately after diagnosis. We examined median CD4+ cell count at diagnosis, the proportion diagnosed with advanced HIV disease (CD4+ cell count ≤350 cells/μL) and severe immunosuppression (CD4+ cell count ≤100 cells/μL), and determinants of the latter 2 measures. Among 2333 participants, the median CD4+ cell count at diagnosis was 313 cells/μL (interquartile range, 164–484), more than half (56.5%) had CD4+ ≤350 cells/μL, and 13.9% had CD4+ ≤100 cells/μL. The adjusted relative risk (aRR) of both advanced HIV disease and severe immunosuppression at diagnosis was higher in men versus women (advanced disease aRR = 1.31; 95% confidence interval [CI] = 1.16–1.48; severe immunosuppression aRR = 1.54, 95% CI = 1.17–2.02) and among those who sought HIV testing because they felt ill (advanced disease aRR = 1.30, 95% CI = 1.08–1.55; severe immunosuppression aRR = 2.10, 95% CI = 1.35–2.26). Age 18–24 versus 25–39 was associated with a lower risk of both outcomes (advanced disease aRR = 0.70, 95% CI = 0.59–0.84; severe immunosuppression aRR = 0.62, 95% CI = 0.41–0.95). More than 10 years into the global scale up of comprehensive HIV services, the majority of adults diagnosed with HIV at health facilities in 2 high-prevalence countries presented with advanced disease and 1 in 7 had severe immunosuppression. Innovative strategies for early identification of HIV-positive individuals are urgently needed.
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影响因子：
1.4
作者：
Lahuerta M;Ue F;Hoffman S;Elul B;Kulkarni SG;Wu Y;Nuwagaba-Biribonwoha H;Remien RH;El Sadr W;Nash D
通讯作者：
Nash D
影响因子：
1.9
作者：
Forbi, Joseph C.;Forbi, Thanda D.;Agwale, Simon M.
通讯作者：
Agwale, Simon M.
影响因子：
3
作者：
Krentz, HB;Auld, MC;Gill, MJ
通讯作者：
Gill, MJ
DOI：
10.1097/qai.0000000000000102
发表时间：
2014-05-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Ng'ang'a A;Waruiru W;Ngare C;Ssempijja V;Gachuki T;Njoroge I;Oluoch P;Kimanga DO;Maina WK;Mpazanje R;Kim AA;KAIS Study Group
通讯作者：
KAIS Study Group
影响因子：
11.8
作者：
Siedner, Mark J.;Ng, Courtney K.;Tsai, Alexander C.
通讯作者：
Tsai, Alexander C.