Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal:: a 7-year cohort study
Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal:: a 7-year cohort study
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DOI：
10.1097/01.aids.0000226959.87471.01
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发表时间：
2006-05-12
期刊：
影响因子：
3.8
通讯作者：
Delaporte, E
中科院分区：
文献类型：
--
作者：
Etard, JF;Ndiaye, I;Delaporte, E
目的：评估塞内加尔接受HAART治疗的HIV-1成人感染者的生存率并调查其死亡原因。设计：观察性前瞻性队列研究。方法：对1998年8月至2002年4月在塞内加尔抗逆转录病毒药物获取倡议中登记的第一批患者的死亡率进行评估。一线方案联合两种核苷类逆转录酶抑制剂和非核苷类逆转录酶抑制剂或蛋白酶抑制剂。最可能的死因是通过医疗记录或死后面谈（口头解剖）确定的。结果：共有404例患者（54.7%为女性）参加了这项研究，在HAART治疗开始后，中位随访时间为46个月（四分位数范围：32-57个月）。基线时，5%接受抗逆转录病毒治疗（ART）， 39%和55%分别处于CDC B期和C期，中位年龄、CD4细胞计数和病毒载量分别为37岁、128个细胞/ μ l和5.2 log cp/ml。随访期间死亡93例，总死亡率为6.3/100人-年[95%可信区间（CI）， 5.2-7.7]。在HAART开始治疗后的第一年，47名患者死亡，7名患者失去随访，死亡概率为11.7% （95% CI, 8.9-15.3%）。死亡率在HAART开始后的第一年最高，随着时间的推移而下降，2年和5年的累积死亡概率分别为17.4% （95% CI, 13.9-21.5%）和24.6% （95% CI, 20.4-29.4%）。在76例死亡中确定了死亡原因。分枝杆菌感染、嗜神经性感染和败血症是最常见的可能死亡原因。结论：这项研究强调了HAART开始后的早期死亡模式，并强调了分枝杆菌感染在死亡原因中的主要作用。
Objectives: To evaluate survival and investigate causes of death among HIV-1 infected adults receiving HAART in Senegal.Design: An observational prospective cohort.Methods: Mortality was assessed in the first patients enrolled between August 1998 and April 2002 in the Senegalese antiretroviral drug access initiative. First-line regimen combined two nucleoside reverse transcriptase inhibitors and either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. The most likely causes of death were ascertained through medical records or post-mortem interviews (verbal autopsy).Results: Four hundred and four patients (54.7% women) were enrolled in the study and were followed for a median of 46 months (interquartile range: 32-57 months) after HAART initiation. At baseline, 5% were antiretroviral therapy (ART) non-naive, 39 and 55% were respectively at CDC stage B and C, median age, CD4 cell count and viral load were 37 years, 128 cells/mu l and 5.2 log cp/ml, respectively. Ninety-three patients died during follow-up and the overall incidence rate of death was 6.3/100 person-years [95% confidence interval (CI), 5.2-7.7]. During the first year after HAART initiation, 47 patients died and seven were lost to follow-up, yielding to a probability of dying of 11.7% (95% CI, 8.9-15.3%). The death rate, which was highest during the first year after HAART initiation, decreased with time yielding a cumulative probability of dying of 17.4% (95% Cl, 13.9-21.5%) and 24.6% (95% CI, 20.4-29.4%) at 2 and 5 years. Causes of death were ascertained in 76 deaths. Mycobacterial infections, neurotropic infections and septicaemia were the most frequent likely causes of death.Conclusions: This study underlines the early mortality pattern after HAART initiation and highlights the leading role of mycobacterial infections in the causes of death.