Long-TermOutcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality
Long-TermOutcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality
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DOI：
10.1155/2011/434375
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发表时间：
2011-01-01
影响因子：
1.7
通讯作者：
Hoepelman, Andy I. M.
中科院分区：
文献类型：
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作者：
Barth, Roos E.;Tempelman, Hugo A.;Hoepelman, Andy I. M.
Objective.确定南非农村抗逆转录病毒治疗（ART）项目的长期（2-4年）临床和病毒学结局。方法.我们进行了一项回顾性观察性队列研究，包括735例开始ART的患者。进行了半年一次的监测，包括HIV-RNA检测。主要终点是患者保留;病毒学抑制（HIV-RNA < 50拷贝/mL）和失败（HIV-RNA > 1000拷贝/mL）是次要终点。此外，还分析了治疗失败的可能预测因素。结果63%的患者（466/735）在治疗开始后的中位3年内完全抑制了HIV-RNA。早期死亡率高：14%在治疗开始后3个月内死亡。16%的患者经历了病毒学失败，但只有4%的患者转为二线ART治疗。男性和低绩效评分与治疗失败相关;免疫学失败是病毒学失败的不良预测因素。结论.在南非农村的抗逆转录病毒治疗项目中观察到一种“全有或全无”的现象：早期流失率高，但仍在接受治疗的患者病毒学控制良好。需要继续努力，尽早招募患者。此外，观察到的病毒免疫解离强调了需要更广泛地提供HIV-RNA检测。
Objective. To define the long-term (2-4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa. Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed. Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure. Conclusions. An "all or nothing" phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.