Antiretroviral therapy refusal among newly diagnosed HIV-infected adults.
Antiretroviral therapy refusal among newly diagnosed HIV-infected adults.
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新诊断的HIV感染的成年人拒绝抗逆转录病毒疗法。
DOI：
10.1097/qad.0b013e32834b6464
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发表时间：
2011-11-13
期刊：
影响因子：
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通讯作者：
De Bruyn G
中科院分区：
文献类型：
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作者：
Katz IT;Essien T;Marinda ET;Gray GE;Bangsberg DR;Martinson NA;De Bruyn G
确定南非索韦托新发现的HIV感染者拒绝治疗的比率和预测因素。我们分析了在围产期艾滋病毒研究中心Zazi检测中心接受自愿咨询和检测（VCT）的成年客户（> 18岁）的数据，以确定符合治疗条件的艾滋病毒感染者（CD 4 + <200个细胞/mm 3或WHO第4阶段）拒绝抗逆转录病毒治疗（ART）的比例。多元Logistic回归模型被用来调查与拒绝相关的因素。2008年12月至2009年12月，7 287名成年人在咨询后接受了艾滋病毒检测。2562例（35%）HIV感染者，其中743例（29%）有资格立即接受抗逆转录病毒治疗。148例（20%）拒绝转诊开始抗逆转录病毒治疗，其中大多数（92%）在咨询2个月后继续拒绝。拒绝抗逆转录病毒治疗的主要原因是“感觉健康”（37%），尽管接受治疗者的中位CD 4+细胞计数为110个细胞/mm 3，活动性结核病的发病率是未拒绝者的三倍。在调整后的模型中，单身客户（AOR= 1.80，95%CI：1.06-3.06）和活动性结核病患者（AOR = 3.50，95%CI：1.55-6.61）更有可能拒绝ART。在索韦托，近五分之一符合治疗条件的HIV感染者在VCT后拒绝开始ART，使他们面临更高的早期死亡风险。“感觉健康”是拒绝ART的最常见原因，尽管CD 4+计数和合并症（如结核病）受到抑制。这些发现强调了迫切需要研究为针对抗逆转录病毒疗法拒绝者的干预措施提供信息。
To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa Cross-sectional Study. We analyzed data from adult clients (> 18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4+ <200 cells/mm3 or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal. From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. 2562 (35%) were HIV-infected, of whom 743 (29%) were eligible for immediate ART. One-hundred and forty-eight (20%) refused referral to initiate ART, most of whom (92%) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as “feeling healthy” (37%), despite clients having a median CD4+ cell count of 110 cells/mm3 and triple the rate of active tuberculosis as seen in non-refusers. In adjusted models, single clients (AOR= 1.80, 95% CI: 1.06–3.06) and those with active tuberculosis (AOR = 3.50, 95% CI: 1.55–6.61) were more likely to refuse ART. Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. “Feeling healthy” was given as the most common reason to refuse ART, despite a suppressed CD4+ count and co-morbidities, such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.