Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe
Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe
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DOI：
10.1093/cid/cis797
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发表时间：
2012-12-15
影响因子：
11.8
通讯作者：
Gibb, Diana M.
中科院分区：
文献类型：
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作者：
Walker, A. Sarah;Prendergast, Andrew J.;Gibb, Diana M.
背景。在接受抗逆转录病毒治疗（ART）的头3个月内，低收入国家的成人死亡率高于高收入国家，6个月后的死亡率更为相似。然而，很少在成人中调查变化的风险和死亡原因的具体模式，也很少与低收入国家的儿童进行比较。在津巴布韦和乌干达的两项试验中，我们使用灵活的参数风险模型来调查艾滋病毒感染的成人（18-73岁）和儿童（4个月至15岁）在抗逆转录病毒治疗的第一年死亡风险的变化。3316例成人死亡179例（5.4%），1199例儿童死亡39例（3.3%）；半数成人/儿童死亡发生在头3个月。第1年死亡率变化相似；在所有CD4计数/CD4%时，死亡风险在第30 ~ 50天最大，到第180天迅速下降，然后下降较慢。CD4细胞/ μ L为0-49、50-99或>= 100的成人开始ART治疗后1年死亡率分别为9.4%、4.5%和2.9%，4-15岁儿童1年死亡率分别为10.1%、4.4%和1.3%。同等CD4%年龄组4个月至3岁儿童开始抗逆转录病毒治疗的死亡率也相似（0%-4%:9.1%;5%-9%:4.5%;bb0 = 10%: 2.8%）。179例成人死亡中仅有10例（6%）和39例儿童死亡中仅有1例（3%）可能与药物有关。最常见的死亡原因是成人败血症/脑膜炎（20%，中位76天）和儿童（36%，中位79天）；肺炎也常导致儿童死亡（28%，平均41天）。在低收入国家，4岁儿童和CD4值较低的成人在开始抗逆转录病毒治疗后的头3个月内具有非常相似且较高的死亡风险，与未经治疗的人群相似。细菌感染是成人和儿童死亡的主要原因；有针对性的干预措施可能会带来重要的好处。
Background. Adult mortality in the first 3 months on antiretroviral therapy (ART) is higher in low-income than in high-income countries, with more similar mortality after 6 months. However, the specific patterns of changing risk and causes of death have rarely been investigated in adults, nor compared with children in low-income countries.Methods. We used flexible parametric hazard models to investigate how mortality risks varied over the first year on ART in human immunodeficiency virus-infected adults (aged 18-73 years) and children (aged 4 months to 15 years) in 2 trials in Zimbabwe and Uganda.Results. One hundred seventy-nine of 3316 (5.4%) adults and 39 of 1199 (3.3%) children died; half of adult/pediatric deaths occurred in the first 3 months. Mortality variation over year 1 was similar; at all CD4 counts/CD4%, mortality risk was greatest between days 30 and 50, declined rapidly to day 180, then declined more slowly. One-year mortality after initiating ART with 0-49, 50-99 or >= 100 CD4 cells/mu L was 9.4%, 4.5%, and 2.9%, respectively, in adults, and 10.1%, 4.4%, and 1.3%, respectively, in children aged 4-15 years. Mortality in children aged 4 months to 3 years initiating ART in equivalent CD4% strata was also similar (0%-4%: 9.1%; 5%-9%: 4.5%; >= 10%: 2.8%). Only 10 of 179 (6%) adult deaths and 1 of 39 (3%) child deaths were probably medication-related. The most common cause of death was septicemia/meningitis in adults (20%, median 76 days) and children (36%, median 79 days); pneumonia also commonly caused child deaths (28%, median 41 days).Conclusions. Children >= 4 years and adults with low CD4 values have remarkably similar, and high, mortality risks in the first 3 months after ART initiation in low-income countries, similar to cohorts of untreated individuals. Bacterial infections are a major cause of death in both adults and children; targeted interventions could have important benefits.