Incidence of AIDS-Defining Opportunistic Infections and Mortality during Antiretroviral Therapy in a Cohort of Adult HIV-Infected Individuals in Hanoi, 2007-2014.
Incidence of AIDS-Defining Opportunistic Infections and Mortality during Antiretroviral Therapy in a Cohort of Adult HIV-Infected Individuals in Hanoi, 2007-2014.
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DOI：
10.1371/journal.pone.0150781
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Oka S
中科院分区：
文献类型：
--
作者：
Tanuma J;Lee KH;Haneuse S;Matsumoto S;Nguyen DT;Nguyen DT;Do CD;Pham TT;Nguyen KV;Oka S
虽然艾滋病毒感染者的预后在扩大抗逆转录病毒疗法(ART)后有所改善，但在资源有限的情况下，关于艾滋病定义机会性感染(ADI)的发病率和ART期间的死亡率的数据有限。从2007年10月到2013年12月，河内市区两家大型医院的艾滋病毒感染成年人被纳入预期队列。那些在入学前不到一年就开始抗逆转录病毒治疗的人被分配到生存分析中。艺术史和ADI的数据是在注册时回溯收集的，并进行了前瞻性跟踪，直到2014年4月。在2,070名队列参与者中，1,197人有资格接受分析，并提供了3,446人年(Pys)的抗逆转录病毒治疗。总体而言，在ART开始后的中位数3.20个月(范围0.03-75.8)，注意到161次ADIS发作，发生率为46.7/1,000 Pys(95%可信区间[CI]39.8-54.5)。最常见的ADI是肺结核，发病率为29.9/1000 Py。接受抗逆转录病毒治疗后的死亡率为8.68/1,000人/年，45%(19/45)的人死于艾滋病相关疾病。在控制了基线的CD4计数后，ART开始时年龄超过50岁与较短的生存期显著相关，但既无注射药物使用(IDU)史也没有ADI史与较差的生存期相关。对951名在ART前没有ADIs病史的患者进行的半竞争性风险分析显示，那些在开始ART后出现ADI的患者在前6个月的死亡风险高于6个月后。Adis并不少见，尽管他是一名有效的艺术工作者。年龄超过50岁，而不是吸毒史，与队列中较短的存活期相关。这项研究提供了越南ART患者在ART规模扩大的第一个十年期间的预后的深入数据。
Although the prognosis for HIV-infected individuals has improved after antiretroviral therapy (ART) scale-up, limited data exist on the incidence of AIDS-defining opportunistic infections (ADIs) and mortality during ART in resource-limited settings. HIV-infected adults in two large hospitals in urban Hanoi were enrolled to the prospective cohort, from October 2007 through December 2013. Those who started ART less than one year before enrollment were assigned to the survival analysis. Data on ART history and ADIs were collected retrospectively at enrollment and followed-up prospectively until April 2014. Of 2,070 cohort participants, 1,197 were eligible for analysis and provided 3,446 person-years (PYs) of being on ART. Overall, 161 ADIs episodes were noted at a median of 3.20 months after ART initiation (range 0.03–75.8) with an incidence 46.7/1,000 PYs (95% confidence interval [CI] 39.8–54.5). The most common ADI was tuberculosis with an incidence of 29.9/1,000 PYs. Mortality after ART initiation was 8.68/1,000 PYs and 45% (19/45) died of AIDS-related illnesses. Age over 50 years at ART initiation was significantly associated with shorter survival after controlling for baseline CD4 count, but neither having injection drug use (IDU) history nor previous ADIs were associated with poor survival. Semi-competing risks analysis in 951 patients without ADIs history prior to ART showed those who developed ADIs after starting ART were at higher risk of death in the first six months than after six months. ADIs were not rare in spite of being on effective ART. Age over 50 years, but not IDU history, was associated with shorter survival in the cohort. This study provides in-depth data on the prognosis of patients on ART in Vietnam during the first decade of ART scale-up.