Cotrimoxazole prophylaxis and antiretroviral therapy: an observational cohort study in China.
Cotrimoxazole prophylaxis and antiretroviral therapy: an observational cohort study in China.
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DOI：
10.2471/blt.14.142745
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发表时间：
2015-03-01
影响因子：
11.1
通讯作者：
Zhang F
中科院分区：
文献类型：
--
作者：
Cheng W;Wu Y;Wen Y;Ma Y;Zhao D;Dou Z;Zhang W;Bulterys M;Zhang F
评估在抗逆转录病毒治疗(ART)期间早期应用复方新诺明是否能降低感染人类免疫缺陷病毒(HIV)的中国成年人的死亡率。我们利用中国国家免费抗逆转录病毒数据库中的数据进行了一项回溯性观察性队列研究。对在2010年1月1日至2012年12月31日期间开始抗逆转录病毒治疗，且基线CD_4+T淋巴细胞(CD_4+细胞)计数低于200M细胞/微克L的14岁以上患者进行随访，直至死亡、失访或2013年12月31日。使用多变量分析计算了几个变量的危险比(HR)。这项分析涉及23名 816名艾滋病毒感染者，其中2,706人在随访期间死亡。在抗逆转录病毒治疗的前6个月中，服用和未服用复方新诺明的患者的死亡率分别为每100人年5.3和7.0人。复方新诺明的死亡率降低了37%(危险比，HR：0.63；95%可信区间，CI：0.56-0.70)。在持续6个月(HR：0.65；95%CI：0.59-0.73)、12个月(HR：0.58；95%CI：0.49-0.70)、18个月(HR：0.49；95%CI：0.38-0.63)和24个月(HR：0.66；95%CI：0.48-0.90)的随访中，复方新诺明联合ART显著降低死亡率。当基线CD_4+细胞数低于50个/微细胞/微米L(HR：0.60；95%可信区间：0.54-0.67)、50-99微细胞/微米L(人力资源：0.66；95%可信区间：0.56-0.78)和100-199微细胞/微米L(人力资源：0.78；95%可信区间：0.62-0.98)时，死亡率下降明显。复方新诺明预防在抗逆转录病毒治疗期间及早开始，可降低死亡率，应提供给低收入和中等收入国家的艾滋病毒感染患者。
To assess if cotrimoxazole prophylaxis administered early during antiretroviral therapy (ART) reduces mortality in Chinese adults who are infected with human immunodeficiency virus (HIV). We did a retrospective observational cohort study using data from the Chinese national free antiretroviral database. Patients older than 14 years who started ART between 1 January 2010 and 31 December 2012 and had baseline CD4+ T-lymphocyte (CD4+ cell) count less than 200 cells/µL were followed until death, loss to follow-up or 31 December 2013. Hazard ratios (HRs) for several variables were calculated using multivariate analyses. The analysis involved 23 816 HIV-infected patients, 2706 of whom died during the follow-up. Mortality in patients who did and did not start cotrimoxazole during the first 6 months of ART was 5.3 and 7.0 per 100 person–years, respectively. Cotrimoxazole was associated with a 37% reduction in mortality (hazard ratio, HR: 0.63; 95% confidence interval, CI: 0.56–0.70). Cotrimoxazole in addition to ART reduced mortality significantly over follow-up lasting 6 months (HR: 0.65; 95% CI: 0.59–0.73), 12 months (HR: 0.58; 95% CI: 0.49–0.70), 18 months (HR: 0.49; 95% CI: 0.38–0.63) and 24 months (HR: 0.66; 95% CI: 0.48–0.90). The mortality reduction was evident in patients with baseline CD4+ cell counts less than 50 cells/µL (HR: 0.60; 95% CI: 0.54–0.67), 50–99 cells/µL (HR: 0.66; 95% CI: 0.56–0.78) and 100–199 cells/µL (HR: 0.78; 95% CI: 0.62–0.98). Cotrimoxazole prophylaxis started early during ART reduced mortality and should be offered to HIV-infected patients in low- and middle-income countries.