Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: A five-year retrospective cohort study
Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: A five-year retrospective cohort study
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DOI：
10.1080/09540121.2011.630353
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Sondo, B.
中科院分区：
文献类型：
--
作者：
Kouanda, S.;Meda, I. B.;Sondo, B.
在这项研究中，我们调查了布基纳法索（一个资源有限的非洲国家）接受高效抗逆转录病毒治疗（HAART）的患者队列的死亡原因和死亡相关因素。这项回顾性队列研究纳入了14个卫生区2003年1月至2008年12月期间首次开始HAART治疗的15岁及以上患者。我们使用生存分析，包括Kaplan-Meier方法，来检查死亡的潜在预测因素，并使用两个考克斯比例风险模型来估计死亡的风险比，首先从基线协变量，然后从时间依赖性协变量。在此期间，共有6641例患者开始HAART治疗，其中5608例纳入分析。到研究期结束时，这些患者中有4310人仍在接受HAART治疗，690人死亡，207人转移，401人失访。中位随访时间为23.2个月[四分位距（IQR）：12.4-36.9]，总死亡率为6/100人-年。临床分期、CD 4计数、体重指数（BMI）、血红蛋白水平、HAART方案、性别、年龄、职业和开始治疗年份是与死亡相关的主要危险因素。在多因素分析中，BMI、临床分期、治疗方案和CD 4计数仍与死亡显著相关。最常见的死亡原因是消耗综合症、肺结核和贫血。这一结果突出了布基纳法索患者在开始HAART时已经处于免疫缺陷晚期。对患者进行艾滋病毒检测和尽早开始抗逆转录病毒治疗，对于进一步降低艾滋病毒感染者的死亡率是必要的。这项研究提供了一个坚实的证据基础，未来的评价HAART在布基纳法索可以进行比较。
In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan-Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4-36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared.