Five-year outcomes of initial patients treated in Botswana's National Antiretroviral Treatment Program.
Five-year outcomes of initial patients treated in Botswana's National Antiretroviral Treatment Program.
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DOI：
10.1097/qad.0b013e3283129db0
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发表时间：
2008-11-12
期刊：
影响因子：
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通讯作者：
Marlink RG
中科院分区：
文献类型：
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作者：
Bussmann H;Wester CW;Ndwapi N;Grundmann N;Gaolathe T;Puvimanasinghe J;Avalos A;Mine M;Seipone K;Essex M;Degruttola V;Marlink RG
许多撒哈拉以南非洲国家现已制定了抗逆转录病毒治疗举措，并显示出早期效益。迄今为止，很少有结果是关于这些治疗方案的长期临床结果。在2002年博茨瓦纳抗逆转录病毒疗法方案登记的第一批HIV-1C感染成年人中描述了对抗逆转录病毒疗法的反应。对截至2007年4月1日的可用纵向数据进行数据分析。633例中位CD 4+细胞计数为67个细胞/mm 3的严重免疫缺陷患者开始接受基于NNRTI的联合ART治疗，中位随访时间为41.9个月。第1年、第3年和第5年的中位CD 4+增加分别为169个细胞/mm 3、302个细胞/mm 3和337个细胞/mm 3。1年、3年和5年时病毒载量低于400拷贝/mL的患者百分比分别为91.3%、90.1%和98.3%。75%的患者每年没有错过一次或仅错过一次每月的ART领取，平均领取率为92.5%。1年、3年和5年时的Kaplan-Meier生存率估计值（95% CI）分别为82.7%（81.2%，84.3%）、79.3%（77.6%，81.0%）和79.0%（77.3%，80.7%）。6个月时，贫血治疗调整的风险为6.94%（5.9%，8.0%），皮肤超敏反应为1.3%（0.8%，1.7%），肝毒性为1.1%（0.7%，1.6%）。博茨瓦纳接受ART治疗的最初一组成年人在长达5年的随访中具有良好的持续免疫学、病毒学和临床结局，存活至抗逆转录病毒治疗第二年的患者死亡率较低。
Antiretroviral treatment (ART) initiatives have now been established in many sub-Saharan African countries showing early benefits. To date, few results are available concerning long-term clinical outcomes in these treatment programs. Response to ART is described in the first HIV–1C infected adults enrolled in the Botswana ART program in 2002. Data analysis was conducted on available longitudinal data up to April 1st, 2007. 633 severely immunodeficient patients with a median CD4+ cell count of 67 cells/mm3 were initiated on NNRTI-based combination ART and followed for a median of 41.9 months. The median CD4+ increases were 169 cells/mm3, 302 cells/mm3, and 337 cells/mm3 at 1, 3, and 5 years, respectively. The percentages of patients with a viral load of less than 400 copies/mL at 1, 3, and 5 years were 91.3%, 90.1%, and 98.3%, respectively. 75% of patients did not miss a single, or missed only one, monthly ART pick-up per year with a mean pick-up rate of 92.5%. The Kaplan-Meier survival estimates (95% CI) at 1, 3, and 5 years were 82.7% (81.2%, 84.3%), 79.3% (77.6%, 81.0%), and 79.0% (77.3%, 80.7%), respectively. At six months, the risk of treatment modification for anemia was 6.94% (5.9%, 8.0%) for cutaneous hypersensitivity reactions, 1.3% (0.8%, 1.7%), and 1.1% (0.7%, 1.6%) for hepatotoxicity. This initial group of adults on ART in Botswana had excellent sustained immunologic, virologic, and clinical outcomes for up to five years of follow-up with low mortality among those surviving into the second year of antiretroviral treatment.