National adult antiretroviral therapy guidelines in resource-limited countries: concordance with 2003 WHO guidelines?
National adult antiretroviral therapy guidelines in resource-limited countries: concordance with 2003 WHO guidelines?
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DOI：
10.1097/01.aids.0000237365.18747.13
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发表时间：
2006-07-13
期刊：
影响因子：
3.8
通讯作者：
Souteyrand, Yves
中科院分区：
文献类型：
--
作者：
Beck, Eduard J.;Vitoria, Marco;Souteyrand, Yves
目的：调查存在的国家成人抗逆转录病毒治疗（ART）的指南，在43个世界卫生组织（WHO）的“3乘5”重点国家，并比较其内容与2003年WHO ART guidelines. Methods：包括启动ART，选择第一线或二线ART，监测治疗反应和毒性和传播的国家指南。加权一致性分数创建和国家分数相关的国家指标和WHO recommendations.Results：三十九（91%）国家返回问卷，其中三个国家没有国家ART指南。根据WHO临床分期标准和CD4细胞计数或T淋巴细胞计数，建议开始抗逆转录病毒治疗16例（44%），根据WHO临床分期标准和CD4细胞计数，建议开始抗逆转录病毒治疗12例（33%），仅根据CD4细胞计数，建议开始抗逆转录病毒治疗4例（11%）。35例（97%）推荐标准一线方案，24例（67%）首选司他夫定+拉米夫定+奈韦拉平; 33例（92%）推荐二线方案，24例（60%）首选阿巴卡韦+去羟肌苷+洛匹那韦/利托那韦。31名（94%）建议使用CD 4细胞计数（可能与其他指标结合）来监测ART。人均卫生支出较低（P = 0.009）和人均GDP较低（P <0.03）的国家的一致性评分较高。中位一致性得分开始ART是100 [四分位数范围（IQR），67至100];一线治疗，70（IQR，60至80）;二线方案，45（IQR，27至55）和实验室调查，80（IQR，80至100）。结论：大多数国家制定了国家ART指南作为一个全面的国家艾滋病毒规划的一部分。在开始一线抗逆转录病毒疗法和常规监测方面，与世卫组织建议的一致性很强，但二线建议的一致性较低。(c)2006年利平科特威廉姆斯&威尔金斯。
Aims: To investigate the existence of national adult antiretroviral therapy (ART) guidelines in 43 World Health Organization (WHO) '3 by 5' focus countries and compare their content with the 2003 WHO ART guidelines.Methods: Questionnaires covered initiation of ART, selection of first or second-line ART, monitoring treatment response and toxicity and dissemination of national guidelines. Weighted concordance scores were created and country scores correlated with national indicators and WHO recommendations.Results: Thirty-nine (91%) countries returned questionnaires, three of which had no national ART guidelines. Of the 36, 16 (44%) recommended to start ART based on WHO clinical staging criteria and CD4 cell count or T-lymphocyte count, 12 (33%) WHO clinical staging criteria and CD4 cell count, four (11%) only CD4 cell counts. 35 (97%) recommended a standard first-line regimen and 24 (67%) preferred stavudine + lamivudine + nevirapine; 33 (92%) recommended second-line regimens, and 24 (60%) preferred abacavir + didanosine + lopinavir/ritonavir. Thirty-one (94%) recommended CD4 cell count, possibly combined with other indicators, to monitor ART. Concordance scores were higher in countries with lower health expenditure per capita (P = 0.009) and lower GDP per capita (P < 0.03). Median concordance scores for starting ART was 100 [interquartile range (IQR), 67 to 100]; first line therapy, 70 (IQR, 60 to 80); second-line regimens, 45 (IQR, 27 to 55) and for laboratory investigations, 80 (IQR, 80 to 100).Conclusions: Most countries had developed national ART guidelines as part of a comprehensive national HIV program. Concordance with WHO recommendations was strong on starting first-line ART regimens and routine monitoring but lower for second-line recommendations. (c) 2006 Lippincott Williams & Wilkins.