Lessons learned from use of highly active antiretroviral therapy in Africa
Lessons learned from use of highly active antiretroviral therapy in Africa
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DOI：
10.1086/431482
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发表时间：
2005-08-01
影响因子：
11.8
通讯作者：
Mayer, KH
中科院分区：
文献类型：
--
作者：
Akileswaran, C;Lurie, MN;Mayer, KH
背景。由于抗逆转录病毒药物在发展中国家越来越容易获得，我们审查了记录在非洲使用高效抗逆转录病毒疗法（HAART）的研究结果，以确定吸取的经验教训。我们以世界卫生组织（世卫组织）的指导方针为参考框架，评估了在非洲实施此类方案的可行性。此外，对临床和实验室结果进行汇总，以确定HAART方案的有效性。我们检索了学术数据库和最近的会议摘要，并纳入了所有记录非洲患者接受HAART治疗的研究。特别地，除了对患者结果的评估外，我们还检查了诸如方案类型和监测频率等项目特征的研究。回顾了来自14个非洲国家的28篇文章和摘要。总体而言，6052例（96.4%）患者接受HAART治疗，主要包括2种核苷类逆转录酶抑制剂（NRTIs）和1种非核苷类逆转录酶抑制剂。所有研究都报告了CD4细胞计数的平均值和中位数的增加，并且在研究期结束时，中位数为73%的患者达到了无法检测到的病毒载量。每隔6个月监测CD4细胞计数和病毒载量。中位增重为5.0 kg，中位死亡率为7.4%（范围0% - 27%）。六项研究报告68% - 99%的患者服用了50% - 95%的药物。五项研究测量了耐药性；大多数耐药病例涉及nrtis。许多研究报告了积极的健康结果，包括与工业化国家相当的高水平治疗依从性。在所审查的所有研究中，都实施了基于世卫组织指南的方案和监测手段，有时甚至超出了标准。我们发现令人信服的证据表明，在资源有限的情况下，高效抗逆转录病毒疗法是可行的。
Background. Because antiretrovirals are becoming increasingly available in developing countries, we reviewed the findings of studies that have documented highly active antiretroviral therapy ( HAART) use in Africa to identify lessons learned. With the World Health Organization ( WHO) guidelines used as a frame of reference, we assessed the feasibility of implementing such programs in Africa. Moreover, clinical and laboratory outcomes were compiled to determine the effectiveness of HAART programs.Methods. We searched academic databases and recent conference abstracts for studies, and we included all studies that documented patients receiving HAART in Africa. In particular, we examined studies for such program features as type of regimen and frequency of monitoring, in addition to evaluations of patient outcomes.Results. Twenty- eight articles and abstracts involving studies from 14 African countries were reviewed. Overall, 6052 patients ( 96.4%) were receiving HAART, mainly consisting of 2 nucleoside reverse- transcriptase inhibitors ( NRTIs) and 1 nonnucleoside reverse- transcriptase inhibitor. All studies reported an increase in mean and median CD4 cell counts, and a median of 73% of patients achieved undetectable viral loads by the end of the study period. Monitoring of CD4 cell count and viral load at 6- month intervals was completed by all studies. The median weight gained was 5.0 kg, and the median mortality rate was 7.4% ( range, 0% - 27%). Six studies reported that 68% - 99% of patients took > 95% of medications. Five studies measured drug resistance; most cases of resistance involved NRTIs.Conclusions. Many studies reported positive health outcomes, including high levels of treatment adherence that were comparable to those of industrialized countries. Regimens and monitoring means based on WHO guidelines were implemented - and at times, exceeded - in all studies reviewed. We found compelling evidence that HAART can be feasibly administered in resource- limited settings.