A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?
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DOI：
10.1186/s12879-019-3724-x
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发表时间：
2019-01-21
影响因子：
3.7
通讯作者：
Castelnuovo, Barbara
中科院分区：
文献类型：
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作者：
Kiragga, Agnes N.;Mubiru, Frank;Castelnuovo, Barbara
在撒哈拉以南非洲推广抗逆转录病毒疗法（ART）导致死亡率下降。很少有研究记录了撒哈拉以南非洲接受长期抗逆转录病毒治疗的患者的死亡原因。我们的目标是描述撒哈拉以南非洲长期抗逆转录病毒治疗患者的死亡原因。我们使用的数据来自乌干达坎帕拉传染病研究所接受护理和治疗的抗逆转录病毒治疗（ART）患者的前瞻性队列。患者随访10年。所有死亡都被记录下来，并通过尸检确定可能的死因。死亡分为艾滋病毒相关死亡（抗逆转录病毒药物毒性、任何机会性感染和艾滋病毒相关恶性肿瘤）和非艾滋病毒相关死亡，有些死亡仍然未知。我们使用Kaplan Meier生存法估计所有死因的累积发病率和死亡率。在559名患者中，（386,69%）为女性，中位年龄36岁（IQR: 21-44）， 89%为WHO临床3期和4期，抗逆转录病毒治疗开始时的中位CD4计数为98个细胞/ μ L （IQR: 21-163）。10年内共发生127例（22.7%）死亡。与艾滋病毒有关的死亡原因（n = 70）包括：结核病17例（24.3%），隐球菌性脑膜炎10例（15.7%），卡波西氏肉瘤7例（10%），HIV相关毒性6例（8.6%），HIV相关贫血5例（7.1%），卡氏肺囊虫肺炎5例（7.1%），HIV相关慢性腹泻4例（5.7%），非霍奇金淋巴瘤3例（4.3%），带状疱疹2例（2.8%），其他10例（14.3%）。与艾滋病毒无关的死亡原因（n = 20）包括非传染性疾病（糖尿病、高血压、中风）6例（30%）、疟疾3例（15%）、妊娠相关死亡2例（10%）、宫颈癌2例（10%）、创伤1例（5%）和其他6例（30%）。尽管在开始抗逆转录病毒治疗的早期，oi的死亡率较高，但我们观察到出现了与艾滋病毒无关的发病和死亡原因。建议资源有限环境中的艾滋病毒方案开始规划非传染性疾病的筛查和治疗。
The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa.We used data from a prospective cohort of ART na < ve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda. Patients were followed up for 10 years. All deaths were recorded and possible causes established using verbal autopsy. Deaths were grouped as HIV-related (ART toxicities, any opportunistic infections (OIs) and HIV-related malignancies) and non-HIV related deaths while some remained unknown. We used Kaplan Meier survival methods to estimate cumulative incidence and rates of mortality for all causes of death.Of the 559, (386, 69%) were female, median age 36 years (IQR: 21-44), 89% had WHO clinical stages 3 and 4, and median CD4 count at ART initiation was 98 cells/mu L (IQR: 21-163). A total of 127 (22.7%) deaths occurred in 10 years. The HIV related causes of death (n = 70) included the following; Tuberculosis 17 (24.3%), Cryptococcal meningitis 10 (15.7%), Kaposi's Sarcoma 7(10%), HIV related toxicity 6 (8.6%), HIV related anemia 5(7.1%), Pneumocystis carinii Pneumonia (PCP) 5 (7.1%), HIV related chronic diarrhea 4 (5.7%), Non-Hodgkin Lymphoma 3 (4.3%), Herpes Zoster 2 (2.8%), other 10 (14.3%). The non-HIV related causes of death (n = 20) included non-communicable diseases (diabetes, hypertension, stroke) 6 (30%), malaria 3 (15%), pregnancy-related death 2 (10%), cervical cancer 2 (10%), trauma 1(5%) and others 6 (30%).Despite the higher rates of deaths from OIs in the early years of ART initiation, we observed an emergence of non-HIV related causes of morbidity and mortality. It is recommended that HIV programs in resource-limited settings start planning for screening and treatment of non-communicable diseases.