Rapid scaling-up of antiretroviral therapy in 10000 adults in Cote d'Ivoire: 2-year outcomes and determinants
Rapid scaling-up of antiretroviral therapy in 10000 adults in Cote d'Ivoire: 2-year outcomes and determinants
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DOI：
10.1097/qad.0b013e3282f768f8
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发表时间：
2008-04-23
期刊：
影响因子：
3.8
通讯作者：
Anglaret, Xavier
中科院分区：
文献类型：
--
作者：
Toure, Siaka;Kouadio, Bertin;Anglaret, Xavier
目的：为了评估死亡率和决定因素，损失的后续行动和免疫失败的非政府组织实施的方案，获得抗逆转录病毒治疗在Cote d 'Ivoire.Methods：在每个新的治疗中心，专业人员进行了培训，在艾滋病护理，并实施了计算机化的数据系统。通过多变量分析评估了个体患者和项目水平生存、失访和免疫失败的决定因素。结果：2004年5月至2007年2月，19个诊所的10211例患者开始接受抗逆转录病毒治疗（抗逆转录病毒治疗前的中位CD 4细胞计数，123个细胞/μ l;初始方案齐多夫定-拉米夫定-依法韦仑，20%;司他夫定-拉米夫定-依法韦仑，22%;司他夫定-拉米夫定-奈韦拉平，52%）。抗逆转录病毒治疗18个月时，CD 4细胞计数的中位增量为+202个细胞/μ l，死亡概率为0.15，失访概率为0.21。除了通常报告的受损结果的决定因素外，（低CD 4细胞计数、低BMI、低血红蛋白、晚期临床分期、年老和依从性差），两个因素也显示独立危及预后：男性（男性vs.女性：死亡风险比= 1.52，失访风险比= 1.27，免疫失败风险比= 1.31）;并参加最近开设的诊所（无经验与有经验的中心：死亡风险比= 1.40，失访风险比= 1.58）。这三个结果都与药物regiment.Discussion：在这个迅速扩大的计划，生存和免疫重建是好的，妇女和患者在中心随访更长的经验有更好的结果，结果是相似的齐多夫定/司他夫定为基础的方案和依法韦仑/奈韦拉平为基础的方案。降低失访率现在应该是抗逆转录病毒治疗推广工作的重中之重。(C)2008年威科健康垂直酒吧利平科特威廉姆斯&威尔金斯。
Objective: To assess the rates and determinants of mortality, loss to follow-up and immunological failure in a nongovernmental organization-implemented program of access to antiretroviral treatment in Cote d'Ivoire.Methods: In each new treatment center, professionals were trained in HIV care, and a computerized data system was implemented. Individual patient and program level determinants of survival, loss to follow-up and immunological failure were assessed by multivariate analysis.Results: Between May 2004 and February 2007, 10211 patients started antiretroviral treatment in 19 clinics(median preantiretroviral treatment CD4 cell count, 123 cells/mu l; initial regimen zidovudine-lamivudine-efavirenz, 20%; stavudine-lamivudine-efavirenz, 22%; stavudine-lamivudine-nevirapine, 52%). At 18 months on antiretroviral treatment, the median gain in CD4 cell count was +202 cells/mu l, the probability of death was 0.15 and the probability of being loss to follow-up was 0.21. in addition to the commonly reported determinants of impaired outcomes (low CD4 cell count, low BMI, low hemoglobin, advanced clinical stage, old age and poor adherence), two factors were also shown to independently jeopardize prognosis: male sex (men vs. women: hazard ratio = 1.52 for death, 1.27 for loss to follow-up, 1.31 for immunological failure); and attending a recently opened clinic (inexperienced vs. experienced centers: hazard ratio = 1.40 for death, 1.58 for loss to follow-up). None of the three outcomes was associated with the drug regimen.Discussion: In this rapidly scaling-up program, survival and immune reconstitution were good; women and patients followed up in centers with longer experience had better outcomes; outcomes were similar in zidovudine/stavudine-based regimens and in efavirenz/nevirapine-based regimens. Decreasing the rate of loss to follow-up should now be the top priority in antiretroviral treatment rollout. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.