CD4 decline and incidence of opportunistic infections in Cape Town, South Africa: Implications for prophylaxis and treatment
CD4 decline and incidence of opportunistic infections in Cape Town, South Africa: Implications for prophylaxis and treatment
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DOI：
10.1097/01.qai.0000225729.79610.b7
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发表时间：
2006-08-01
影响因子：
3.6
通讯作者：
Losina, Elena
中科院分区：
文献类型：
--
作者：
Holmes, Charles B.;Wood, Robin;Losina, Elena
目的：为了确定抗逆转录病毒治疗初治的南非HIV感染者的CD4下降率和机会性感染（OI）的发病率，并告知OI prophylaxy.Methods的时间：我们使用混合效应模型来估计CD4细胞下降的CD4细胞计数分层HIV感染者在开普敦艾滋病队列1984年至2000年。每100人-年的观察层特异性OI发病率确定使用发病率密度analysis.Results：974例患者2个或更多的CD4细胞计数。CD4计数在500个/μ L以上的层中每年下降47.1个/μ L，在351 - 500个/μ L的层中每年下降30.6个/μ L，在201 - 350个/μ L的层中每年下降20.5个/μ L。结核病和口腔念珠菌病是CD4细胞数超过200/RL的人群中唯一经常发生的OIs。慢性腹泻，消耗综合征，肺结核，口腔和食管念珠菌病的发病率增加，在分层小于200个细胞/亩L，和所有的OI率最高的分层与50个细胞/亩L.Conclusions：CD4细胞计数下降依赖于CD4层，可以告知在南非的诊所就诊和治疗开始的时间。OI的发病率表明，有针对性的OI预防可以防止大量的艾滋病毒相关的发病率在南非。
Objectives: To determine the rate of CD4 decline and the incidence of opportunistic infections (OIs) among antiretroviral therapy-naive South African HIV-infected patients and inform timing of OI prophylaxis.Methods: We used mixed-effect models to estimate CD4 cell decline by CD4 cell count strata in HIV-infected patients in the Cape Town AIDS Cohort between 1984 and 2000. Stratum-specific OI incidence per 100 person-years of observation was determined using incidence density analysis.Results: Nine hundred seventy-four patients with 2 or more CD4 cell counts were included. CD4 counts declined by 47.1 cells/mu L per year in the stratum with more than 500 cells/mu L, 30.6 cells/mu L per year in the stratum with 351 to 500 cells/mu L, and 20.5 cells/mu L per year in the stratum with 201 to 350 cells/mu L. Tuberculosis and oral candidiasis were the only OIs that occurred frequently in the stratum with more than 200 CD4 cells/RL. Rates of chronic diarrhea, wasting syndrome, tuberculosis, and oral and esophageal candidiasis increased in the stratum with less than 200 cells/mu L, and rates of all OIs were highest in the stratum with 50 cells/mu L or less.Conclusions: CD4 cell count declines were dependent on CD4 strata and can inform timing of clinic visits and treatment initiation in South Africa. Incidence rates of OIs suggest that targeted OI prophylaxis could prevent substantial HIV-related morbidity in South Africa.