Early mortality and cause of deaths in patients using HAART in Brazil and the United States
Early mortality and cause of deaths in patients using HAART in Brazil and the United States
复制标题
DOI：
10.1097/qad.0b013e32832ec494
复制
发表时间：
2009-10-23
期刊：
影响因子：
3.8
通讯作者：
Moore, Richard D.
中科院分区：
文献类型：
--
作者：
Grinsztejn, Beatriz;Veloso, Valdilea G.;Moore, Richard D.
目的：比较巴西和美国开始HAART的患者的早期死亡模式和死亡原因。方法：我们分析了美国巴尔的摩的约翰霍普金斯艾滋病服务中心和巴西里约热内卢的Evandro Chagas临床研究所艾滋病诊所的两个临床队列的联合数据。参与者包括那些在1999年至2007年期间进入这两个队列的人，他们都是抗逆转录病毒天真的人。HAART开始后随访1年。结果：来自巴尔的摩和里约热内卢的受试者分别为859人和915人。在里约热内卢，64.7%的死亡发生在HAART启动后90天内；在巴尔的摩，48.9%发生在180至365天之间。在里约热内卢和巴尔的摩，艾滋病定义的疾病(61.8%)和非艾滋病定义的疾病(55.6%)分别是主要的死亡原因。在调整了CD4(+)T细胞计数、年龄、性别、HIV风险组、既往艾滋病定义疾病、肺炎和禽分枝杆菌预防后，两个城市的死亡风险相似(风险比1.04；P值=0.95)。CD+T细胞数小于或等于50个/亩的个体死亡的可能性较大。L(风险比4.36；P=0.001)或年龄较大的个体(风险比1.0 3；P=0.0 3)更有可能死亡。结论：尽管艾滋病晚期诊断在发达国家和发展中国家都是一个问题，但死亡时间和死亡原因的差异清楚地表明，除了艾滋病毒早期诊断的干预措施外，每个国家需要制定不同的策略来遏制早期死亡。(C)2009年Wolters Kluwer Health|Lippincott Williams&Wilkins
Objective: To compare the early mortality pattern and causes of death among patients starting HAART in Brazil and the United States.Methods: We analyzed the combined data from two clinical cohorts followed at the Johns Hopkins AIDS Service in Baltimore, United States, and the Evandro Chagas Clinical Research Institute AIDS Clinic in Rio de Janeiro, Brazil. Participants included those who entered either cohort between 1999 and 2007 and were antiretroviral naive. Follow-up was at 1 year since HAART initiation. Cox proportional hazards regression analysis was used to assess the role of the city on the risk of death.Results: A total of 859 and 915 participants from Baltimore and Rio de Janeiro, respectively, were included. In Rio de Janeiro, 64.7% of deaths occurred within 90 days of HAART initiation; in Baltimore, 48.9% occurred between 180 and 365 days. AIDS-defining illness (61.8%) and non-AIDS-defining illness (55.6%) predominated as causes of death in Rio de Janeiro and Baltimore, respectively. Risk of death was similar in both cities (hazard ratio 1.04; P value=0.95) after adjusting for CD4(+) T cell count, age, sex, HIV risk group, prior AIDS-defining illness, and Pneumocystis jirovecii pneumonia and Mycobacterium avium prophylaxis. Individuals with CD4+ T cell count less than or equal to 50cells/mu l (hazard ratio 4.36; P=0.001) or older (hazard ratio, 1.03; P=0.03) were more likely to die.Conclusion: Although late HIV diagnosis is a problem both in developed and developing countries, differences in the timing and causes of deaths clearly indicate that, besides interventions for early HIV diagnosis, different strategies to curb early mortality need to be tailored in each country. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins