Mortality and treatment response amongst HIV-infected patients 50 years and older accessing antiretroviral services in South Africa.
Mortality and treatment response amongst HIV-infected patients 50 years and older accessing antiretroviral services in South Africa.
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DOI：
10.1186/s12879-018-3083-z
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发表时间：
2018-04-10
影响因子：
3.7
通讯作者：
Naidoo K
中科院分区：
文献类型：
--
作者：
Dawood H;Hassan-Moosa R;Zuma NY;Naidoo K
在撒哈拉以南非洲，对接受抗逆转录病毒治疗的老年艾滋病毒感染人群的临床表现和结果知之甚少。我们比较了在南非夸祖鲁纳塔尔接受抗逆转录病毒治疗的50岁以下和≥50岁的HIV感染患者的死亡率。我们对2004年6月至2012年12月期间在CAPRISA艾滋病治疗项目（CAT）获得HIV服务的患者（N = 4003）的病历进行了回顾性分析。入组了14岁或以上的HIV感染患者。比较了< 50岁和≥50岁人群的全因死亡率和ART治疗反应。使用Kaplan-Meier曲线和对数秩检验比较两个年龄组之间的累积死亡概率，主要终点为死亡率。使用SAS（9.4版; SAS研究所有限公司卡里，北卡罗来纳州，美国）。在4003例受试者中，262例（6.5%）年龄≥ 50岁（老年组）。≥50岁和< 50岁的中位年龄分别为54.5岁和32.0岁。年轻组主要是女性（64.7%）。60个月时，老年组（6.9/100人-年（py），95%置信区间（CI）：4.7-9.6）和年轻组（5.3/100 py，95% CI：4.7-5.8）之间的死亡率无差异（p = 0.137）。在多变量模型中，老年患者的死亡风险显著高于年轻患者。< 50岁的患者中CD 4+细胞计数增加率较高（β = 0.34，95%CI：0.19-0.50，p < 0.001），病毒抑制无差异。老年组糖尿病和高血压患病率分别为6.3%和21.5%，P < 0.001。与年龄小于50岁的患者相比，年龄较大的艾滋病毒感染者开始接受抗逆转录病毒治疗的死亡率较高。ART免疫反应在老年人中不太强烈。老年患者中高血压和糖尿病的增加表明，需要调整初级和专门保健服务，并将其纳入抗逆转录病毒治疗服务。本文的在线版本（10.1186/s12879-018-3083-z）包含补充材料，可供授权用户使用。
Little is known about the clinical presentation and outcomes amongst older HIV infected populations accessing ART in sub-Saharan Africa. We compared mortality amongst HIV infected patients accessing ART that were < 50 years to those ≥50 years in Kwa-Zulu Natal, South Africa. We undertook a retrospective review of medical records of patients that accessed HIV services at the CAPRISA AIDS Treatment program (CAT) between June 2004 to December 2012 (N = 4003). HIV infected patients, 14 years or older were enrolled. All-cause mortality and treatment response to ART in those < 50 years to those ≥50 years were compared. A Kaplan-Meier curve and log-rank test were used to compare the cumulative probability of death between the two age groups with the primary endpoint being mortality. Statistical analysis was done using SAS (version 9.4.; SAS Institute Inc., Cary, NC, USA). Of 4003 individuals, 262 (6.5%) were ≥ 50 years (older group). The median age in those ≥50 years and < 50 year was 54.5 and 32.0 years, respectively. The younger group was mainly female (64.7%). There was no difference in mortality rate, between the older (6.9/100 person-years (py), 95% confidence interval (CI): 4.7–9.6) and younger group (5.3/100 py, 95% CI: 4.7–5.8) at 60 months (p = 0.137). In the multivariable model older patients had a significantly higher risk of death compared to younger patients. (hazard ratio (HR) 1.60, 95% CI: 1.08–2.39, p = 0.019).The rate of CD4+ cell count increase was higher in those < 50 years (β = 0.34, 95% CI: 0.19–0.50, p < 0.001) with no difference in viral suppression. The older group showed significantly higher prevalence of diabetes (6.3%) and hypertension (21.5%), p < 0.001. ART initiation in older HIV infected patients was associated with a higher mortality compared to those younger than 50 years. ART immunological response was less robust in older individuals. The increase in hypertension and diabetes among older patients suggests the need to restructure and integrate primary and specialized health care services into ART services. The online version of this article (10.1186/s12879-018-3083-z) contains supplementary material, which is available to authorized users.
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DOI：
10.1016/s0140-6736(08)61113-7
发表时间：
2008-07-26
期刊：
Lancet (London, England)
影响因子：
--
作者：
Antiretroviral Therapy Cohort Collaboration
通讯作者：
Antiretroviral Therapy Cohort Collaboration
影响因子：
11.8
作者：
Guaraldi, Giovanni;Orlando, Gabriella;Palella, Frank
通讯作者：
Palella, Frank
DOI：
10.1016/s1473-3099(15)00056-0
发表时间：
2015-07
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Smit M;Brinkman K;Geerlings S;Smit C;Thyagarajan K;Sighem Av;de Wolf F;Hallett TB;ATHENA observational cohort
通讯作者：
ATHENA observational cohort
DOI：
10.1126/science.1230413
发表时间：
2013-02-22
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Bor J;Herbst AJ;Newell ML;Bärnighausen T
通讯作者：
Bärnighausen T
DOI：
10.1093/cid/ciw125
发表时间：
2016-06-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Low A;Gavriilidis G;Larke N;B-Lajoie MR;Drouin O;Stover J;Muhe L;Easterbrook P
通讯作者：
Easterbrook P