Incidence, Long-Term Outcomes, and Healthcare Utilization of Patients With Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Disseminated Mycobacterium avium Complex From 1992-2015.
Incidence, Long-Term Outcomes, and Healthcare Utilization of Patients With Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Disseminated Mycobacterium avium Complex From 1992-2015.
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DOI：
10.1093/ofid/ofx120
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发表时间：
2017
影响因子：
4.2
通讯作者：
Stout JE
中科院分区：
文献类型：
--
作者：
Collins LF;Clement ME;Stout JE
尽管出现了联合抗逆转录病毒疗法 (cART)，但人类免疫缺陷病毒 (HIV) 患者仍继续出现晚期并发症，包括获得性免疫缺陷综合征 (AIDS)、播散性鸟分枝杆菌复合体 (DMAC) 和死亡。我们对 1992 年至 2015 年在杜克大学医疗系统中患 DMAC 的 HIV 感染成年人进行了一项观察性回顾性队列研究，以确定该人群不良结果高风险的发病率、长期结果和医疗保健利用情况。研究结果按“前 cART”时代（1996 年 1 月 1 日之前）和此后的“后 cART”进行分层。我们确定了 330 名新诊断为 DMAC 的成年 HIV 感染者，其中大多数 (75.2%) 是男性和非西班牙裔黑人 (69.1%)，中位年龄为 37 岁。 DMAC的发病率从1992年的65.3/1000人显着下降到2015年的2.0/1000人，并且后cART时代女性和非西班牙裔黑人的比例明显更高。在 DMAC 诊断后第 1-5 年，接受 cART 的 DMAC 患者的标准化死亡率分别为 69、58、27、5.9 和 6.8。对于 2000 年或之后诊断出 DMAC 的患者 (n = 135)，20% 的患者在出现 DMAC 之前的 3 个月内新诊断出感染 HIV。那些已确诊艾滋病毒的人从艾滋病毒诊断到 DMAC 诊断的中位时间为 7 年，并且更有可能是黑人，在 DMAC 诊断后 6 个月内再次住院，并在长期内死亡。在 cART 时代，播散性鸟分枝杆菌复合体仍然是一种致命的诊断，不成比例地影响少数群体，并反映出延迟进入护理和未能持续参与护理。
Despite the advent of combination antiretroviral therapy (cART), patients with human immunodeficiency virus (HIV) continue to develop late-stage complications including acquired immune deficiency syndrome (AIDS), disseminated Mycobacterium avium complex (DMAC), and death. We performed an observational retrospective cohort study of HIV-infected adults who developed DMAC in the Duke University Health System from 1992 to 2015 to determine the incidence, long-term outcomes, and healthcare utilization of this population at high risk for poor outcomes. Findings were stratified by the “pre-cART” era (before January 1, 1996) and “post-cART” thereafter. We identified 330 adult HIV-infected patients newly diagnosed with DMAC, the majority (75.2%) of whom were male and non-Hispanic black (69.1%), with median age of 37 years. Incidence of DMAC declined significantly from 65.3/1000 in 1992 to 2.0/1000 in 2015, and the proportion of females and non-Hispanic blacks was significantly higher in the post-cART era. The standardized mortality ratios for DMAC patients who received cART were 69, 58, 27, 5.9, and 6.8 at years 1–5, respectively, after DMAC diagnosis. For patients diagnosed with DMAC in 2000 or later (n = 135), 20% were newly diagnosed with HIV in the 3 months preceding presentation with DMAC. Those with established HIV had a median time from HIV diagnosis to DMAC diagnosis of 7 years and were more likely to be black, rehospitalized in the 6 months after DMAC diagnosis, and die in the long term. Disseminated Mycobacterium avium complex continues to be a lethal diagnosis in the cART era, disproportionately afflicts minority populations, and reflects both delayed entry into care and failure to consistently engage care.
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影响因子：
3.7
作者：
Hall HI;Tang T;Westfall AO;Mugavero MJ
通讯作者：
Mugavero MJ
DOI：
10.1093/cid/ciu261
发表时间：
2014-07-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Ingle SM;May MT;Gill MJ;Mugavero MJ;Lewden C;Abgrall S;Fätkenheuer G;Reiss P;Saag MS;Manzardo C;Grabar S;Bruyand M;Moore D;Mocroft A;Sterling TR;D'Arminio Monforte A;Hernando V;Teira R;Guest J;Cavassini M;Crane HM;Sterne JA;Antiretroviral Therapy Cohort Collaboration
通讯作者：
Antiretroviral Therapy Cohort Collaboration
DOI：
10.1097/qai.0b013e3180517407
发表时间：
2007-06-01
影响因子：
3.6
作者：
Hellinger, Fred J.
通讯作者：
Hellinger, Fred J.
影响因子：
39.2
作者：
Althoff KN;Buchacz K;Hall HI;Zhang J;Hanna DB;Rebeiro P;Gange SJ;Moore RD;Kitahata MM;Gebo KA;Martin J;Justice AC;Horberg MA;Hogg RS;Sterling TR;Cescon A;Klein MB;Thorne JE;Crane HM;Mugavero MJ;Napravnik S;Kirk GD;Jacobson LP;Brooks JT;North American AIDS Cohort Collaboration on Research and Design
通讯作者：
North American AIDS Cohort Collaboration on Research and Design
影响因子：
6.4
作者：
Djawe, Kpandja;Buchacz, Kate;Schwarcz, Sandra
通讯作者：
Schwarcz, Sandra