Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda.
Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda.
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DOI：
10.1097/qad.0000000000000520
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发表时间：
2015-01-02
期刊：
影响因子：
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通讯作者：
IeDEA Central Africa Collaboration
中科院分区：
文献类型：
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作者：
Mutimura E;Addison D;Anastos K;Hoover D;Dusingize JC;Karenzie B;Izimukwiye I;Mutesa L;Nsanzimana S;Nash D;IeDEA Central Africa Collaboration
在艾滋病毒感染的晚期阶段启动抗逆转录病毒疗法仍然是撒哈拉以南非洲的一项重大挑战。这项研究是为了更好地了解卢旺达及时开展抗逆转录病毒治疗的障碍和推动因素，卢旺达抗逆转录病毒治疗覆盖率很高，2007-2008年首次扩大了国家抗逆转录病毒治疗资格指南。利用卢旺达五家诊所6 326名患者(≥15年)的数据，我们评估了开始抗逆转录病毒治疗时CD+细胞计数的趋势和相关性，以及开始接受抗逆转录病毒治疗时与晚期艾滋病毒疾病(CD 4+200细胞/微克L或世卫组织IV期)的比例。在6,326名患者中，4,486名参加艾滋病毒护理的患者启动了抗逆转录病毒治疗，CD_4+细胞计数的中位数为211个/微米L[四分位数范围：131-300]。抗逆转录病毒治疗启动时的CD+细胞计数中值从2007年的183个/微升至2011年至2012年的293个/微微L，晚期HIV疾病患者的比例从66.2%降至29.4%。在抗逆转录病毒治疗开始时，与晚期艾滋病毒疾病的高风险相关的因素是男性[调整后的优势比(AOR)=1.7；95%可信区间(CI)：1.3-2.1]和年龄较大(AOR46-55+vs.<；25=2.3；95%CI：1.2-4.3)。在那些在注册CARE后1年以上开始接受ART的人中，那些在ART开始前有12个月或更长时间护理间隔的人患晚期艾滋病毒疾病的几率更高(AOR=5.2；95%CI：1.2-21.1)。在卢旺达扩大抗逆转录病毒治疗的资格标准后，观察到启动抗逆转录病毒治疗时的CD4+细胞计数中值和启动抗逆转录病毒治疗晚期艾滋病毒疾病的比例有了显着改善。然而，延迟治疗启动方面的性别差异在2011-2012年间持续存在，而且似乎是由男性中较晚的诊断和/或延迟与护理的联系所驱动的。
Initiation of antiretroviral therapy (ART) in the advanced stages of HIV infection remains a major challenge in sub-Saharan Africa. This study was conducted to better understand barriers and enablers to timely ART initiation in Rwanda where ART coverage is high and national ART eligibility guidelines first expanded in 2007–2008. Using data on 6326 patients (≥15 years) at five Rwandan clinics, we assessed trends and correlates of CD4+ cell count at ART initiation and the proportion initiating ART with advanced HIV disease (CD4+ <200 cells/µl or WHO stage IV). Out of 6326 patients, 4486 enrolling in HIV care initiated ART with median CD4+ cell count of 211 cells/µl [interquartile range: 131–300]. Median CD4+ cell counts at ART initiation increased from 183 cells/µl in 2007 to 293 cells/µl in 2011–2012, and the proportion with advanced HIV disease decreased from 66.2 to 29.4%. Factors associated with a higher odds of advanced HIV disease at ART initiation were male sex [adjusted odds ratios (AOR) = 1.7; 95% confidence interval (CI): 1.3–2.1] and older age (AOR46–55+ vs. <25 = 2.3; 95% CI: 1.2–4.3). Among those initiating ART more than 1 year after enrollment in care, those who had a gap in care of 12 or more months prior to ART initiation had higher odds of advanced HIV disease (AOR = 5.2; 95% CI: 1.2–21.1). Marked improvements in the median CD4+ cell count at ART initiation and proportion initiating ART with advanced HIV disease were observed following the expansion of ART eligibility criteria in Rwanda. However, sex disparities in late treatment initiation persisted through 2011–2012, and appeared to be driven by later diagnosis and/or delayed linkage to care among men.