Disease Progression Among Untreated HIV-Infected Patients in South Ethiopia: Implications for Patient Care.
Disease Progression Among Untreated HIV-Infected Patients in South Ethiopia: Implications for Patient Care.
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DOI：
10.1186/1758-2652-7-3-66
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发表时间：
2005-08-30
影响因子：
6
通讯作者：
Lindtjorn, Bernt
中科院分区：
文献类型：
--
作者：
Jerene, Degu;Lindtjorn, Bernt
背景：资源贫乏的患者人群中HIV疾病进展的自然过程还没有明确的定义。目的：描述在埃塞俄比亚农村资源有限的门诊中看到的HIV疾病进展的预测因素。设计：这项前瞻性队列研究包括2003年1月30日至2004年4月1日期间在埃塞俄比亚南部Arba Minch医院门诊就诊的所有成年HIV患者。临床和血液学测量在基线时进行，此后每12周进行一次，直到患者被转移、接受抗逆转录病毒治疗、失去随访或死亡。社区工作人员每月报告患者情况。设置：一家拥有基本设施的地区医院，用于艾滋病毒检测和患者监测。主要观察指标：死亡、结核病诊断和疾病分期变化。结果：我们对207名患者进行了中位时间19周(范围0-60周)的跟踪调查。总死亡率为46/百人年(PYO)。病死率随病程进展而增加。腹泻、口腔鹅口疮和淋巴细胞总数低是死亡率的重要标志。结核病发病率为9.9/10万。易疲劳和发烧的基线病史与随后的结核病发展密切相关。结论：我们队列中的结核病死亡率和发病率是撒哈拉以南非洲地区报道的最高水平之一。我们发现口腔鹅口疮、腹泻和淋巴细胞总数是死亡率的预测因子，易疲劳和发热是结核病的预测因子。这些发现对资源有限的患者护理具有实际意义。内容：资源贫乏的患者群体中HIV疾病进展的自然过程尚未明确定义。目的：描述在埃塞俄比亚农村资源有限的门诊中看到的HIV疾病进展的预测因素。设计：这项前瞻性队列研究包括2003年1月30日至2004年4月1日期间在埃塞俄比亚南部Arba Minch医院门诊就诊的所有成年HIV患者。临床和血液学测量在基线时进行，此后每12周进行一次，直到患者被转移、接受抗逆转录病毒治疗、失去随访或死亡。社区工作人员每月报告患者情况。设置：一家拥有基本设施的地区医院，用于艾滋病毒检测和患者监测。主要观察指标：死亡、结核病诊断和疾病分期变化。结果：我们对207名患者进行了中位时间19周(范围0-60周)的跟踪调查。总死亡率为46/百人年(PYO)。病死率随病程进展而增加。腹泻、口腔鹅口疮和淋巴细胞总数低是死亡率的重要标志。结核病发病率为9.9/10万。易疲劳和发烧的基线病史与随后的结核病发展密切相关。结论：我们队列中的结核病死亡率和发病率是撒哈拉以南非洲地区报道的最高水平之一。我们发现口腔鹅口疮、腹泻和淋巴细胞总数是死亡率的预测因子，易疲劳和发热是结核病的预测因子。这一发现对在资源有限的情况下进行患者护理具有实际意义。
CONTEXT: The natural course of HIV disease progression among resource-poor patient populations has not been clearly defined.OBJECTIVE: To describe predictors of HIV disease progression as seen at an outpatient clinic in a resource-limited setting in rural Ethiopia.DESIGN: This prospective cohort study included all adult HIV patients who visited an outpatient clinic at Arba Minch hospital in South Ethiopia between January 30, 2003 and April 1, 2004. Clinical and hematologic measurements were done at baseline and every 12 weeks thereafter until the patient was transferred, put on antiretroviral therapy, was lost to follow-up, or died. Community agents reported patient status every month.SETTING: A district hospital with basic facilities for HIV testing and patient monitoring.MAIN OUTCOME MEASURES: Death, diagnosis of tuberculosis, and change in disease stage.RESULTS: We followed 207 patients for a median duration of 19 weeks (range, 0-60 weeks). A total of 132 (64%) of them were in WHO stage III. The overall mortality rate was 46 per 100 person-years of observation (PYO). Mortality increased with advancing disease stage. Diarrhea, oral thrush, and low total lymphocyte count were significant markers of mortality. The incidence of tuberculosis was 9.9 per 100 PYO. Baseline history of easy fatigability and fever were strongly associated with subsequent development of tuberculosis.CONCLUSIONS: The mortality rate and the incidence of tuberculosis in our cohort are among the highest ever reported in sub-Saharan Africa. We identified oral thrush, diarrhea, and total lymphocyte count as predictors of mortality, and easy fatigability and fever as predictors of tuberculosis. The findings have practical implications for patient care in resource-limited settings.CONTEXT: The natural course of HIV disease progression among resource-poor patient populations has not been clearly defined.OBJECTIVE: To describe predictors of HIV disease progression as seen at an outpatient clinic in a resource-limited setting in rural Ethiopia.DESIGN: This prospective cohort study included all adult HIV patients who visited an outpatient clinic at Arba Minch hospital in South Ethiopia between January 30, 2003 and April 1, 2004. Clinical and hematologic measurements were done at baseline and every 12 weeks thereafter until the patient was transferred, put on antiretroviral therapy, was lost to follow-up, or died. Community agents reported patient status every month.SETTING: A district hospital with basic facilities for HIV testing and patient monitoring.MAIN OUTCOME MEASURES: Death, diagnosis of tuberculosis, and change in disease stage.RESULTS: We followed 207 patients for a median duration of 19 weeks (range, 0-60 weeks). A total of 132 (64%) of them were in WHO stage III. The overall mortality rate was 46 per 100 person-years of observation (PYO). Mortality increased with advancing disease stage. Diarrhea, oral thrush, and low total lymphocyte count were significant markers of mortality. The incidence of tuberculosis was 9.9 per 100 PYO. Baseline history of easy fatigability and fever were strongly associated with subsequent development of tuberculosis.CONCLUSION: The mortality rate and the incidence of tuberculosis in our cohort are among the highest ever reported in sub-Saharan Africa. We identified oral thrush, diarrhea, and total lymphocyte count as predictors of mortality, and easy fatigability and fever as predictors of tuberculosis. The findings have practical implications for patient care in resource-limited settings.