Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis.
Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis.
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DOI：
10.1097/qad.0b013e32835faa95
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发表时间：
2013-05-15
期刊：
影响因子：
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通讯作者：
Sterling TR
中科院分区：
文献类型：
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作者：
Antiretroviral Therapy Cohort Collaboration (ART-CC);Shepherd BE;Jenkins CA;Parrish DD;Glass TR;Cescon A;Masabeu A;Chene G;de Wolf F;Crane HM;Jarrin I;Gill J;del Amo J;Abgrall S;Khaykin P;Lehmann C;Ingle SM;May MT;Sterne JA;Sterling TR
在低收入国家，在联合抗逆转录病毒疗法（ART）的第一年，艾滋病定义事件（ADE）和死亡率很高。我们调查了在欧洲、美国和加拿大开始ART的外国出生（移民）和本土出生（非移民）患者之间的差异，并检查了ART第一年最常见的ADE和死亡率。我们研究了艾滋病毒阳性的成年人参加了抗逆转录病毒治疗队列协作（ART-CC）的12个队列之一。在48854例患者中，25.6%为移民：16.1%来自撒哈拉以南非洲，5.6%来自拉丁美洲，2.3%来自北非/中东，1.6%来自亚洲。抗逆转录病毒治疗第一年的ADE发生率为60.8/1000人-年：移民为69.9/1000人-年，非移民为57.7/1000人-年[粗风险比（HR）1.18; 95%置信区间（CI）1.08-1.29]，调整后HR（性别、年龄、CD 4、HIV-1 RNA、ART方案、既往ADE、可能的感染途径和开始治疗年份，按队列分层）1.21（95% CI 1.09-1.34）。移民的结核病发病率显著高于非移民（14.3 vs. 6.3;校正HR 1.94; 95% CI 1.53-2.46）。相比之下，非移民的死亡率高于移民（粗HR 0.71; 95% CI 0.61-0.84），尽管ART开始时的患者特征可部分解释死亡率过高（校正HR 0.91; 95% CI 0.76-1.09）。在抗逆转录病毒治疗的第一年，艾滋病毒阳性的移民比非移民有更高的ADE率。结核病是移民中最常见的ADE，强调了在该人群开始抗逆转录病毒治疗前进行结核病筛查的重要性。
In lower-income countries rates of AIDS-defining events (ADEs) and death are high during the first year of combination antiretroviral therapy (ART). We investigated differences between foreign-born (migrant) and native-born (nonmigrant) patients initiating ART in Europe, the US and Canada, and examined rates of the most common ADEs and mortality during the first year of ART. Observational cohort study. We studied HIV-positive adults participating in one of 12 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC). Of 48 854 patients, 25.6% were migrants: 16.1% from sub-Saharan Africa, 5.6% Latin America, 2.3% North Africa/Middle East, and 1.6% Asia. Incidence of ADEs during the first year of ART was 60.8 per 1000 person-years: 69.9 for migrants and 57.7 for nonmigrants [crude hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.08–1.29], adjusted HR (for sex, age, CD4, HIV-1 RNA, ART regimen, prior ADE, probable route of infection and year of initiation, and stratified by cohort) 1.21 (95% CI 1.09–1.34). Rates of tuberculosis were substantially higher in migrants than nonmigrants (14.3 vs. 6.3; adjusted HR 1.94; 95% CI 1.53–2.46). In contrast, mortality was higher among nonmigrants than migrants (crude HR 0.71; 95% CI 0.61–0.84), although excess mortality was partially explained by patient characteristics at start of ART (adjusted HR 0.91; 95% CI 0.76–1.09). During the first year of ART, HIV-positive migrants had higher rates of ADEs than nonmigrants. Tuberculosis was the most common ADE among migrants, highlighting the importance of screening for tuberculosis prior to ART initiation in this population.