Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya
Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya
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DOI：
10.1097/01.aids.0000196177.65551.ea
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发表时间：
2006-01-02
期刊：
影响因子：
3.8
通讯作者：
Tierney, WM
中科院分区：
文献类型：
--
作者：
Wools-Kaloustian, K;Kimaiyo, S;Tierney, WM
目的：确定接受抗逆转录病毒治疗的HIV感染患者队列的临床和免疫学结局。设计：回顾性研究，前瞻性收集肯尼亚西部8个HIV诊所连续登记的成人HIV感染患者的数据。CD 4细胞计数、体重、死亡率，收集了2059例HIV阳性非HIV感染者的失访和抗逆转录病毒治疗依从性。结果：抗逆转录病毒治疗后的中位随访时间为40周（95%置信区间，38-43）; 111例患者（5.4%）记录为死亡，505例（24.5%）失访。在1766例（86%）评估其抗逆转录病毒治疗依从性的患者中，78%的患者在每次访视时报告完全依从。尽管有和没有完全依从性的患者体重增加，但依从性低于完全依从性的患者比报告完全依从性的患者体重增加少1.04 kg（P= 0.059）。在治疗的前6周内，CD 4细胞计数平均增加109个细胞/μ l，此后增加更缓慢，导致在12、24和36个月时总体CD 4细胞计数分别增加160、225和297个细胞/μ l。在1年，平均增加170个细胞/亩的患者报告完美的遵守与123个细胞/亩之间的报告一些错过剂量（P < 0.001）。结论：抗逆转录病毒治疗的成年肯尼亚人在这个队列中导致显着和持久的临床和免疫学的好处。这些研究结果证明了在资源有限的情况下开展大规模艾滋病毒治疗举措的可行性和有效性。(C)2006年利平科特威廉姆斯&威尔金斯。
Objectives: To determine the clinical and immunological outcomes of a cohort of HIV-infected patients receiving antiretroviral therapy.Design: Retrospective study of prospectively collected data from consecutively enrolled adult HIV-infected patients in eight HIV clinics in western Kenya.Methods: CD4 cell counts, weight, mortality, loss to follow-up and adherence to antiretroviral therapy were collected for the 2059 HIV-positive non-pregnant adult patients treated with antiretroviral drugs between November 2001 and February 2005.Results: Median duration of follow-up after initiation of antiretroviral therapy was 40 weeks (95% confidence interval, 38-43); 111 patients (5.4%) were documented as deceased and 505 (24.5%) were lost to follow-up. Among 1766 (86%) evaluated for adherence to their antiretroviral regimen, 78% reported perfect adherence at every visit. Although patients with and without perfect adherence gained weight, patients with less than perfect adherence gained 1.04 kg less weight than those reporting perfect adherence (P= 0.059). CD4 cell counts increased by a mean of 109 cells/mu l during the first 6 weeks of therapy and increased more slowly thereafter, resulting in overall CD4 cell count increases of 160, 225 and 297 cells/mu l at 12, 24, and 36 months respectively. At 1 year, a mean increase of 170 cells/mu l was seen among patients reporting perfect adherence compared with 123 cells/mu l among those reporting some missed doses (P < 0.001).Conclusions: Antiretroviral treatment of adult Kenyans in this cohort resulted in significant and persistent clinical and immunological benefit. These findings document the viability and effectiveness of large-scale HIV treatment initiatives in resource-limited settings. (C) 2006 Lippincott Williams & Wilkins.