Early mortality in adults initiating antiretroviral therapy (ART) in low- and middle-income countries (LMIC): a systematic review and meta-analysis.
Early mortality in adults initiating antiretroviral therapy (ART) in low- and middle-income countries (LMIC): a systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0028691
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Gummadi N
中科院分区：
文献类型：
--
作者：
Gupta A;Nadkarni G;Yang WT;Chandrasekhar A;Gupte N;Bisson GP;Hosseinipour M;Gummadi N
我们系统地回顾了世界银行定义的亚洲、非洲和中南美洲低收入和中等收入国家（LMIC）抗逆转录病毒治疗（ART）后早期死亡率的观察性研究，以总结已知情况。在Medline和EMBASE中检索了1996年1月至2010年12月期间以英文发表的研究。三位独立的评审员检查了ART后一年内死亡率的研究。如果研究在LMIC中进行，参与者在非临床试验环境中开始ART并且年龄≥15岁，则纳入一篇文章。纳入了50项研究; 38项（76%）来自撒哈拉以南非洲（SSA），5项（10%）来自亚洲，2项（4%）来自美洲，5项（10%）为多地区研究。中位随访时间和ART前CD 4细胞计数范围分别为3-55个月和11-192个细胞/mm 3。40项（80%）研究报告的失访率范围为0.3%-27%。总体而言，SSA的汇总12个月死亡率概率最高，为0.17（95% CI 0.11-0.24），亚洲为0.11（95% CI 0.10-0.13），美洲为0.07（95% CI 0.007-0.20）。在14项（28%）报告死因特异性死亡率的研究中，结核（TB）（5%-44%）、消瘦（5%-53%）、晚期HIV（20%-37%）和慢性腹泻（10%-25%）最常见。在30项（60%）研究中，与早期死亡率相关的独立因素包括：基线CD 4细胞计数低、男性、世界卫生组织临床分期高、体重指数低、贫血、年龄大于40岁和ART前定量HIV RNA。已发表的评估LMIC患者开始ART治疗后第一年死亡率的研究结果和报告结果的方法存在显著异质性。撒哈拉以南非洲的早期死亡率最高，肺结核和消耗综合征等机会性疾病是最常见的死亡原因。迫切需要制定解决与过早死亡相关的可改变风险因素的策略。
We systematically reviewed observational studies of early mortality post-antiretroviral therapy (ART) initiation in low- and middle-income countries (LMIC) in Asia, Africa, and Central and South America, as defined by the World Bank, to summarize what is known. Studies published in English between January 1996 and December 2010 were searched in Medline and EMBASE. Three independent reviewers examined studies of mortality within one year post-ART. An article was included if the study was conducted in a LMIC, participants were initiating ART in a non-clinical trial setting and were ≥15 years. Fifty studies were included; 38 (76%) from sub-Saharan Africa (SSA), 5 (10%) from Asia, 2 (4%) from the Americas, and 5 (10%) were multi-regional. Median follow-up time and pre-ART CD4 cell count ranged from 3–55 months and 11–192 cells/mm3, respectively. Loss-to-follow-up, reported in 40 (80%) studies, ranged from 0.3%–27%. Overall, SSA had the highest pooled 12-month mortality probability of 0.17 (95% CI 0.11–0.24) versus 0.11 (95% CI 0.10–0.13) for Asia, and 0.07 (95% CI 0.007–0.20) for the Americas. Of 14 (28%) studies reporting cause-specific mortality, tuberculosis (TB) (5%–44%), wasting (5%–53%), advanced HIV (20%–37%), and chronic diarrhea (10%–25%) were most common. Independent factors associated with early mortality in 30 (60%) studies included: low baseline CD4 cell count, male sex, advanced World Health Organization clinical stage, low body mass index, anemia, age greater than 40 years, and pre-ART quantitative HIV RNA. Significant heterogeneity in outcomes and in methods of reporting outcomes exist among published studies evaluating mortality in the first year after ART initiation in LMIC. Early mortality rates are highest in SSA, and opportunistic illnesses such as TB and wasting syndrome are the most common reported causes of death. Strategies addressing modifiable risk factors associated with early death are urgently needed.