Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study
Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study
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DOI：
10.1016/s0140-6736(08)60345-1
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发表时间：
2008-03-01
期刊：
影响因子：
168.9
通讯作者：
Bunnell, Rebecca
中科院分区：
文献类型：
--
作者：
Mermin, Jonathan;Were, Willy;Bunnell, Rebecca
背景 抗逆转录病毒疗法（ART）在非洲越来越普及，但医生和临床服务却很少。因此，我们评估了乌干达家庭 ART 计划对 HIV-1 感染者及其家庭成员的死亡率、住院率和孤儿身份的影响。 方法 2001 年，我们在一项前瞻性队列研究中招募并随访了 466 名 HIV 感染者和 1481 名未感染 HIV 的家庭成员。 5 个月后，我们每天为 HIV 感染者提供复方新诺明（160 毫克甲氧苄啶和 800 毫克磺胺甲恶唑）预防。 2003 年 5 月至 2005 年 12 月期间，我们在一项 ART（主要是司他夫定、拉米夫定和奈韦拉平）研究中对 138 名符合条件的感染成年人和 907 名新感染 HIV 的参与者及其 HIV 阴性家庭成员进行了随访。每周都会有非专业服务人员拜访各户家庭，注册后不会安排任何就餐拜访。我们比较了不同研究期间的死亡率、住院率和孤儿率，并计算了为防止出现结果而需要治疗的人数。结果显示，1373 名 HIV 感染者中有 233 名（17%）人死亡，4601 名未感染 HIV 的家庭成员中有 40 名（1%）人死亡。在接受 ART 联合复方新诺明治疗的前 16 周内，HIV 感染者的死亡率比单独使用复方新诺明治疗期间降低了 55%（每 100 人年分别有 14 例死亡和 16 例死亡；调整后的风险比 0 . 45，95% CI 0 . 27-0.74，p=0.0018），16 周后死亡率降低了 92%（每 100 人年死亡 14 例，95% CI 0 . 27-0.74，p=0.0018），16 周后死亡率降低了 92%（每 100 人年死亡 14 例，95% CI 0 . 27-0.74，p=0.0018）。每 100 人年 16 人死亡；08, 0.06-0.13, p
Background Antiretroviral therapy (ART) is increasingly available in Africa, but physicians and clinical services are few. We therefore assessed the effect of a home-based ART programme in Uganda on mortality, hospital admissions, and orphanhood in people with HIV-1 and their household members.Methods In 2001, we enrolled and followed up 466 HIV-infected adults and 1481 HIV-uninfected household members in a prospective cohort study. After 5 months, we provided daily co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole) prophylaxis to HIV-infected participants. Between May, 2003, and December, 2005, we followed up 138 infected adults who were eligible and 907 new HIV-infected participants and their HIV-negative household members in a study of ART (mainly stavudine, lamivudine, and nevirapine). Households were visited every week by lay providers, and no dinic visits were scheduled after enrolment. We compared rates of death, hospitalisation, and orphanhood during diffierent study periods and calculated the number needed to treat to prevent an outcome.Findings 233 (17%) of 1373 participants with HIV and 40 (1%) of 4601 HIV-uninfected household members died. During the first 16 weeks of ART and co-trimoxazole, mortality in HIV-infected participants was 55% lower than that during co-trimoxazole alone (14 vs 16 deaths per 100 person-years; adjusted hazard ratio 0 . 45, 95% CI 0 . 27-0.74, p=0.0018), and after 16 weeks, was reduced by 92% (3 vs 16 deaths per 100 person-years; 0 . 08, 0.06-0.13, p