One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients
One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients
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DOI：
10.1111/j.1365-2796.2006.01762.x
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发表时间：
2007-03-01
影响因子：
11.1
通讯作者：
Choe, K. W.
中科院分区：
文献类型：
--
作者：
Park, W. B.;Choe, P. G.;Choe, K. W.
目标。目的：确定在开始接受高效抗逆转录病毒治疗(HAART)后早期坚持就诊是否能预测长期临床结果。观察性队列研究。三级转诊医院。在1998年1月至2004年12月期间，共有387名成年HIV患者在HAART开始后进行了至少1年的随访。主要结果测量。用Kaplan-Meier生存估计法评估坚持就诊1年对新的艾滋病定义疾病或死亡的影响，并用Cox比例风险回归模型估计危险比。多因素分析显示，临床分期较高、HAART新药较少、HAART后1年未就诊总时间较长均是导致新的艾滋病定义疾病或死亡的显著危险因素。与无漏诊比较，HAART按临床分期和新药数量调整的风险比分别为1次、2次和3次以上，风险比分别为2.87(95%可信区间，1.34~6.16，P=0.007)、4.37(95%可信区间：1.74~10.98，P=0.002)和8.19(95%可信区间：2.95~22.78，P<；0.001)。在HAART开始后早期坚持就诊是HIV患者长期临床进展的独立预测因素。
Objective. To determine whether adherence to clinic visits early after initiation of highly active antiretroviral therapy (HAART) is predictive of long-term clinical outcome.Design. Observational cohort study.Setting. A tertiary referral hospital.Subjects. A total of 387 adult HIV patients who were followed for at least 1 year after initiation of HAART between January 1998 and December 2004.Main outcome measurements. The effect of 1-year adherence to clinic visits on the occurrence of new AIDS-defining illness or death was assessed using Kaplan-Meier survival estimates, and hazard ratios were estimated using Cox proportional hazards regression model.Results. Multivariate analysis revealed that advanced clinical stage, fewer new drugs in HAART, and longer total elapsed time without clinical visits for 1 year after HAART were all significant risk factors for the occurrence of new AIDS-defining illnesses or death. Compared with no missed visits, the hazard ratio adjusted by clinical stage and number of new drugs in HAART was 2.87 (95% confidence interval [CI], 1.34-6.16, P = 0.007) for one missed appointment, 4.37 (95% CI: 1.74-10.98, P = 0.002) for two, and 8.19 (95% CI: 2.95-22.78, P < 0.001) for three or more.Conclusion. Adherence to clinic visits early after initiation of HAART is an independent predictor for long-term clinical progression in HIV patients.