Highly active antiretroviral therapy outcomes in a primary care clinic
Highly active antiretroviral therapy outcomes in a primary care clinic
复制标题
DOI：
10.1080/0954012031000068371
复制
发表时间：
2003-04-01
影响因子：
1.7
通讯作者：
Jasinski, DR
中科院分区：
文献类型：
--
作者：
Rastegar, DA;Fingerhood, MI;Jasinski, DR
本文比较了初级保健诊所患者的抗逆转录病毒治疗结果与先前在艾滋病毒专科诊所报告的结果，并检查了治疗失败的危险因素。进行了回顾性医疗记录审查。在马里兰州巴尔的摩市的学术初级保健实践。123名患者之前没有接受过HAART治疗，他们开始的治疗方案包括蛋白酶抑制剂或非核苷逆转录酶抑制剂和至少一种其他新的抗逆转录病毒药物。分析了HIV RNA水平、CD4淋巴细胞计数、错过预约率、HAART方案、人口统计学变量以及它们与7-14个月时病毒RNA达到或低于500的相关性。47%的患者在HAART开始后7-14个月的HIV RNA水平为500或更低，与治疗失败相关的因素包括错过预约率、注射药物使用和以前接触过抗逆转录病毒药物。在多变量分析中，只有漏诊率和较低的基线CD4淋巴细胞计数与治疗失败独立相关。在初级保健实践中，由经验丰富的卫生保健提供者开始HAART治疗的患者的抗逆转录病毒治疗结果与在专科诊所报告的结果相当。与之前的报道一样，大多数患者没有维持病毒抑制。失约率是导致治疗失败最重要的危险因素。
This paper compares antiretroviral outcomes of patients at a primary care clinic with those previously reported at HIV specialty clinics and examines risk factors for treatment failure. A retrospective medical record review was undertaken at an. academic primary care practice in Baltimore, Maryland. One hundred and twenty-three patients were included who had not previously received HAART and who were started on a regimen that included a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor and at least one other new antiretroviral medication. HIV RNA levels, CD4 lymphocyte counts, missed appointment rate, HAART regimen, demographic variables, and,their association with the achievement of a viral RNA of 500 or less at 7-14 months were analyzed. Forty-seven per cent of the patients had an HIV RNA level of 500 or less at 7-14 months after initiation of HAART Factors associated with treatment failure included missed appointment rate, injection drug use and previous exposure to antiretroviral medication. On multivariate analysis, only missed appointment rate and lower baseline CD4 lymphocyte count were independently associated with treatment failure. The antiretroviral outcomes of patients started on HAART by experienced health care providers in this primary care practice were comparable to those reported in specialty clinics. As with previous reports, most patients did not maintain viral suppression. Missed appointment rate was the most important risk factor for treatment failure.