Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial.
Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial.
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DOI：
10.1093/cid/cix1142
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发表时间：
2018-03-04
期刊：
影响因子：
--
通讯作者：
REALITY Trial Team
中科院分区：
文献类型：
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作者：
Siika A;McCabe L;Bwakura-Dangarembizi M;Kityo C;Mallewa J;Berkley J;Maitland K;Griffiths A;Baleeta K;Mudzingwa S;Abach J;Nathoo K;Thomason MJ;Prendergast AJ;Walker AS;Gibb DM;REALITY Trial Team
严重免疫功能低下的人类免疫缺陷病毒（HIV）感染者在开始抗逆转录病毒治疗（ART）后不久死亡率很高。我们调查了早期死亡率和“晚期表现者”表型的预测因子。降低早期死亡率（REALITY）试验在乌干达、津巴布韦、马拉维和肯尼亚招募了未接受过ART治疗的成人和≥5岁的儿童，这些儿童的CD 4计数<100个细胞/微升，开始接受ART治疗。使用向后消除的考克斯回归分析确定48周内死亡率的基线预测因子（退出P > 0.1）。在纳入的1711名参与者中，203名（12%）死亡。死亡率独立地随着年龄的增长而升高; CD 4计数、白蛋白、血红蛋白和握力降低;存在世界卫生组织3/4级体重减轻、发热或呕吐;基线时存在活动或自我护理问题（均P <0.04）。接受加强的抗菌预防独立降低死亡率（P = 0.02）。在5种迟发表型中，第1组（n = 355）的死亡率最高（25%;中位CD 4计数，28个细胞/微升），症状负担高，体重减轻，活动性差，白蛋白和血红蛋白低。第2组（n = 394;死亡率11%; 43个细胞/µL）也出现体重减轻，白色细胞、血小板和中性粒细胞计数较高，提示存在潜在炎症/感染。第3组（n = 218;死亡率10%）的CD 4计数较低（27个细胞/µL），但症状负担较低，脂肪量维持不变。其余组的死亡率为4%-6%。临床和实验室特征确定了ART开始后死亡率最高的群体。筛查工具可以识别出CD 4计数低的患者，以优先考虑当天开始ART，加强预防和密集随访。ISRCTN43622374。
Severely immunocompromised human immunodeficiency virus (HIV)–infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and “late presenter” phenotypes. The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts <100 cells/µL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identified using Cox regression with backwards elimination (exit P > .1). Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%–6% mortality. Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. ISRCTN43622374.
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DOI：
10.1097/qad.0000000000001606
发表时间：
2017-10-23
期刊：
AIDS (London, England)
影响因子：
--
作者：
Bisson GP;Ramchandani R;Miyahara S;Mngqibisa R;Matoga M;Ngongondo M;Samaneka W;Koech L;Naidoo K;Rassool M;Kirui F;Banda P;Mave V;Kadam D;Leger P;Henestroza G;Manabe YC;Bao J;Kumwenda J;Gupta A;Hosseinipour MC;Adult AIDS Clinical Trials Group A5274 (REMEMBER) Study Team
通讯作者：
Adult AIDS Clinical Trials Group A5274 (REMEMBER) Study Team
DOI：
10.1097/qad.0b013e32833d45c5
发表时间：
2010-09-10
期刊：
AIDS (London, England)
影响因子：
--
作者：
Cornell M;Grimsrud A;Fairall L;Fox MP;van Cutsem G;Giddy J;Wood R;Prozesky H;Mohapi L;Graber C;Egger M;Boulle A;Myer L;International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
影响因子：
3.7
作者：
Gupta A;Nadkarni G;Yang WT;Chandrasekhar A;Gupte N;Bisson GP;Hosseinipour M;Gummadi N
通讯作者：
Gummadi N
影响因子：
158.5
作者：
Danel, Christine;Moh, Raoul;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
15.8
作者：
Kuller LH;Tracy R;Belloso W;De Wit S;Drummond F;Lane HC;Ledergerber B;Lundgren J;Neuhaus J;Nixon D;Paton NI;Neaton JD;INSIGHT SMART Study Group
通讯作者：
INSIGHT SMART Study Group