Adults Receiving HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa: Patient Outcomes and Associated Risk Factors
Adults Receiving HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa: Patient Outcomes and Associated Risk Factors
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DOI：
10.1097/qai.0b013e3182a61e8d
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发表时间：
2013-12-15
影响因子：
3.6
通讯作者：
Pujades-Rodriguez, Mar
中科院分区：
文献类型：
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作者：
Bastard, Mathieu;Nicolay, Nathalie;Pujades-Rodriguez, Mar
工作背景：需要了解抗逆转录病毒治疗（ART）之前的时期，以改善治疗结果并减少艾滋病毒传播。本研究描述了级联的艾滋病毒护理，前ART后续，死亡率和失访（LTFU）ART initiation.Methods的预测因素的登记：我们进行了一项队列研究，艾滋病毒感染的成年患者尚未开始在4艾滋病毒撒哈拉以南非洲地区的ART计划。患者随访从入组时开始，并在死亡、转出、ART启动、末次访视日期或治疗后60个月（以最早者为准）结束。在0-6和6-60个月期间调查死亡和LTFU.Results的危险因素：共55，789例患者（65.4%的女性）包括如下：44.2%的患者处于临床3期或4期，中位CD 4为261个细胞/微升[四分位距（IQR）：125-447]。患者护理在HIV诊断后中位数3天（IQR：0-11）开始，55，789例患者中有31，104例（55.8%）在入组后1个月内进行了CD 4计数。在入组时已知ART合格状态的47，283例患者中，36，969例（78.2%）患者需要ART，36，969例患者中的27，798例（75.7%）患者开始治疗。中位随访时间为2.5个月（IQR：0.9-13.1）。死亡率和LTFU率分别为3.9/100人-年[95%置信区间（CI）：3.7 - 4.1]和28.3/100人-年（95% CI：27.8 - 28.8）。无论期间，增加死亡率和LTFU与男性，较低的体重指数，先进的临床阶段，和较低的CD 4细胞count.Conclusions：在我们的艾滋病毒项目中观察到艾滋病毒检测和护理登记之间的短暂延迟，但延迟确定ART资格很长。需要采取干预措施，特别是针对男性的早期启动抗逆转录病毒治疗，以改善非洲患者的保留情况。
Background: Gaining understanding of the period before antiretroviral therapy (ART) is needed to improve treatment outcomes and to reduce HIV transmission. This study describes the cascade of enrollment in HIV care, pre-ART follow-up, and predictors of mortality and lost to follow-up (LTFU) before ART initiation.Methods: We conducted a cohort study among HIV-infected adult patients not yet started on ART in 4 HIV Sub-Saharan African programs. Patient follow-up began at enrollment and ended at the earliest of death, transfer-out, ART initiation, last visit date, or 60 months postenrollment. Risk factors for death and LTFU were investigated during the periods 0-6 and 6-60 months.Results: A total of 55,789 patients (65.4% women) were included as follows: 44.2% in clinical stage 3 or 4, with median CD4 of 261 cells per microliter [interquartile range (IQR): 125-447]. Patient care started with a median of 3 days (IQR: 0-11) after HIV diagnosis, and 31,104 of 55,789 (55.8%) patients had CD4 counts performed within 1 month of enrollment. Of 47,283 patients with known ART eligibility status at enrollment, 36,969 (78.2%) patients required ART and 27,798 of 36,969 (75.7%) patients initiated therapy. Median follow-up was 2.5 months (IQR: 0.9-13.1). Mortality and LTFU rates were 3.9 per 100 person-years [95% confidence interval (CI): 3.7 to 4.1] and 28.3 per 100 person-years (95% CI: 27.8 to 28.8), respectively. Regardless of period, increased mortality and LTFU were associated with male, lower body mass index, advanced clinical stage, and lower CD4 cell count.Conclusions: Short delays between HIV testing and care enrollment were observed in our HIV programs, but delays to determine ART eligibility were long. Interventions to initiate ART earlier, specifically targeted to men, are needed to improve patient retention in Africa.