Impact of Kaposi Sarcoma on Quality of Life Amongst HIV-infected Adults Initiating Antiretroviral Therapy in East Africa.
Impact of Kaposi Sarcoma on Quality of Life Amongst HIV-infected Adults Initiating Antiretroviral Therapy in East Africa.
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卡波西肉瘤对东非开始抗逆转录病毒治疗的艾滋病毒感染成人的生活质量的影响。
DOI：
10.1101/2023.07.21.23292658
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Martin,Jeffrey
中科院分区：
文献类型：
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作者：
Scott,Lu;Laker-Oketta,Miriam;Byakwaga,Helen;Glidden,David;Mwebesa,Bwana;Muzoora,Conrad;Maurer,Toby;Assenzio,Melissa;Hunt,Peter;Bangsberg,David;Haberer,Jessica;Martin,Jeffrey
背景技术背景：在撒哈拉以南非洲地区，与抗逆转录病毒治疗前相比，抗逆转录病毒治疗（ART）的增加改善了卡波西肉瘤（KS）诊断后的生存率，但KS患者的死亡率仍然大大高于没有KS的艾滋病毒感染者。此外，在那些最初接受ART治疗而没有辅助化疗的KS患者中，与那些没有KS的患者相比，他们的功能和感觉-生活质量（QOL）-知之甚少。方法：在乌干达的两项前瞻性研究中，我们对开始ART的HIV感染成人中出现KS的患者与没有KS的患者进行了比较。在ART开始前和之后的16、32和48周，使用医学结局调查-HIV工具测量QOL;分数越高，QOL越好。为了确定KS与非KS对生活质量的11个领域和两个总分的独立影响，我们建立了混合效应模型，调整了有向非循环图信息的混杂因素。结果：我们检查了224名KS患者和730名无KS患者，其中64%为女性，中位年龄为34岁。在ART开始之前，参与者的中位CD4 + T细胞计数为159个细胞/mm3，血浆HIV RNA为5.1 log10拷贝/ml。在ART开始前的校正分析中，与无KS的患者相比，KS患者在11个QOL领域中的8个领域以及身心健康总分的平均得分较低。ART治疗48周后，KS患者在4个领域和心理健康总分中的平均QOL评分高于无KS患者，仅在一个领域的评分较低。在6个领域和身体健康总分方面没有显著差异，结论：在东非HIV感染的成年人中，在ART开始时，与没有KS的人相比，KS患者的平均生活质量较差。在ART治疗的第一年，KS患者在大多数QOL领域与没有KS的患者相当或超过了他们。研究结果表明，一些KS患者可以单独接受ART治疗，并进一步强调需要预测那些单独接受ART治疗的患者与那些需要额外初始治疗的患者。
BACKGROUND: In sub-Saharan Africa, increased antiretroviral therapy (ART) availability has improved survival after diagnosis of Kaposi sarcoma (KS) compared to the pre-ART era, but mortality among patients with KS is still considerably higher than HIV-infected persons without KS. Furthermore, among those patients with KS who are treated initially with ART without adjunct chemotherapy and who do survive, little is known about how well they function and feel — quality of life (QOL) — compared to those without KS. METHODS: Among HIV-infected adults initiating ART in two prospective studies in Uganda, we compared those presenting with KS to those without KS. QOL was measured using the Medical Outcomes Survey-HIV instrument prior to ART initiation and at 16, 32, and 48 weeks thereafter; higher scores indicate better QOL. To ascertain the independent effect of KS versus non-KS on 11 domains of QOL and two summary scores, we created mixed effects models adjusted for directed acyclic graph-informed confounders. RESULTS: We examined 224 participants with KS and 730 without KS, among whom 64% were women and median age was 34 years. Prior to ART initiation, participants had a median CD4+ T count of 159 cells/mm3 and plasma HIV RNA of 5.1 log10 copies/ml. In adjusted analyses prior to ART initiation, those with KS had lower mean scores in 8 of 11 QOL domains and both physical and mental health summary scores compared to those without KS. After 48 weeks of ART, those with KS had higher mean QOL scores compared those without KS in 4 domains and the mental health summary score, and lower scores in only one domain. There was no significant difference in 6 domains and the physical health summary score, CONCLUSIONS: Amongst HIV-infected adults in East Africa, at time of ART initiation, those with KS had worse mean QOL compared to those without KS. Over the first year of ART, those with KS became comparable to or exceeded those without KS in most QOL domains. The findings indicate that some patients with KS can be treated with ART alone and further emphasize the need to predict those who will do well with ART alone versus those who need additional initial therapy.