Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries.
Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries.
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DOI：
10.1097/qai.0b013e3182a39979
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发表时间：
2014-01-01
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影响因子：
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通讯作者：
Egger M
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作者：
IeDEA and ART Cohort Collaborations;Avila D;Althoff KN;Mugglin C;Wools-Kaloustian K;Koller M;Dabis F;Nash D;Gsponer T;Sungkanuparph S;McGowan C;May M;Cooper D;Chimbetete C;Wolff M;Collier A;McManus H;Davies MA;Costagliola D;Crabtree-Ramirez B;Chaiwarith R;Cescon A;Cornell M;Diero L;Phanuphak P;Sawadogo A;Ehmer J;Eholie SP;Li PC;Fox MP;Gandhi NR;González E;Lee CK;Hoffmann CJ;Kambugu A;Keiser O;Ditangco R;Prozesky H;Lampe F;Kumarasamy N;Kitahata M;Lugina E;Lyamuya R;Vonthanak S;Fink V;d'Arminio Monforte A;Luz PM;Chen YM;Minga A;Casabona J;Mwango A;Choi JY;Newell ML;Bukusi EA;Ngonyani K;Merati TP;Otieno J;Bosco MB;Phiri S;Ng OT;Anastos K;Rockstroh J;Santos I;Oka S;Somi G;Stephan C;Teira R;Wabwire D;Wandeler G;Boulle A;Reiss P;Wood R;Chi BH;Williams C;Sterne JA;Egger M
描述低收入 (LIC)、中低收入 (LMIC)、中高收入 (UMIC) 和高收入 (HIC) 国家联合抗逆转录病毒治疗 (cART) 开始时的 CD4 细胞计数。参与跨越六大洲的多队列合作（评估艾滋病的国际流行病学数据库和 ART 队列协作）的诊所中开始 cART 的年龄≥16 岁的患者符合资格。多级线性回归模型针对年龄、性别和历年进行了调整；对缺失的 CD4 计数进行估算。来自 9 个 LIC、4 个 LMIC、4 个 UMIC 和 6 个 HIC 的 379,865 名患者被纳入其中。在 LIC 中，从 2002 年到 2009 年，开始 cART 时 CD4 细胞计数中位数增加了 83%，从 80 个细胞/μl 增加到 145 个细胞/μl。LMIC、UMIC 和 HIC 的相应增加分别为从 87 个细胞/μl 增加到 155 个细胞/μl（增加 76%）、从 88 个细胞/μl 增加到 135 个细胞/μl（增加 53%）以及从 209 个细胞/μl 增加到 274 个细胞/μl（31%）。 2009年，与LIC相比，LMIC中的中值计数低13个细胞/μl（95% CI -56至+30），UMIC中低22个细胞/μl（-62至+18），HIC中中值计数高112个/μl（+75至+149）。女性比男性高 23 个细胞/μl (95% CI +18 至 +28)。与覆盖率 <40% 的国家相比，估计国家 cART 覆盖率 >80% 的国家中位数计数高出 88 个细胞/μl（95% CI +35 至 +141）。 cART 开始时的中位 CD4 细胞计数在 2000-2009 年有所增加，但在 LIC 和 MIC 中仍低于 200 个细胞/μl，在 HIC 中仍低于 300 个细胞/μl。 cART 的早期启动需要全球范围内的大量努力和资源。
To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC) and high-income (HIC) countries. Patients aged ≥16 years starting cART in a clinic participating in a multi-cohort collaboration spanning six continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multi-level linear regression models were adjusted for age, gender and calendar year; missing CD4 counts were imputed. 379,865 patients from nine LIC, four LMIC, four UMIC and six HIC were included. In LIC the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μl between 2002 and 2009. Corresponding increases in LMIC, UMIC and HIC were from 87 to 155 cells/μl (76% increase), 88 to 135 cells/μl (53%) and 209 to 274 cells/μl (31%). In 2009, compared to LIC, median counts were 13 cells/μl (95% CI -56 to +30) lower in LMIC, 22 cells/μl (-62 to +18) lower in UMIC and 112 /μl (+75 to +149) higher in HIC. They were 23 cells/μl (95% CI +18 to +28) higher in women than men. Median counts were 88 cells/μl (95% CI +35 to +141) higher in countries with an estimated national cART coverage >80%, compared to countries with <40% coverage. Median CD4 cell counts at start of cART increased 2000-2009 but remained below 200 cells/μl in LIC and MIC and below 300 cells/μl in HIC. Earlier start of cART will require substantial efforts and resources globally.