Association of isoniazid preventive therapy with lower early mortality in individuals on antiretroviral therapy in a workplace programme.
Association of isoniazid preventive therapy with lower early mortality in individuals on antiretroviral therapy in a workplace programme.
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DOI：
10.1097/01.aids.0000391010.02774.6f
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发表时间：
2010-11
期刊：
影响因子：
--
通讯作者：
Churchyard GJ
中科院分区：
文献类型：
--
作者：
Charalambous S;Grant AD;Innes C;Hoffmann CJ;Dowdeswell R;Pienaar J;Fielding KL;Churchyard GJ
描述结核病发病率非常高的南非工作场所项目中开始抗逆转录病毒治疗（ART）的个人中异烟肼预防性治疗（IPT）与死亡率之间的关系。对2004年1月至2007年12月开始抗逆转录病毒治疗的初治患者进行了长达12个月的随访。根据诊所和人力资源数据确定死亡。采用考克斯回归分析评估IPT与死亡率之间的相关性。纳入了3，270名受试者（中位年龄45岁; 93%为男性;中位基线CD 4 155个细胞/mm 3（IQR：87-221）; 45%为WHO 3/4期）。922人（28%）开始IPT之前，或在三个月内，开始ART。开始IPT的个人往往有较低的先进艾滋病毒疾病在ART启动。观察到259例（7.9%）死亡，总死亡率为8.9/100人年[pyrs]（95%CI：7.9-10.6）。接受IPT的患者与未接受IPT的患者相比，未校正的死亡率较低（分别为3.7/100 pyrs与11.1/100 pyrs，风险比（HR）0.34 [95%CI：0.24-0.49]）;在校正年龄、基线CD 4、基线WHO分期、ART开始年份和个体公司后，这种相关性仍然存在（HR 0.51，95%CI 0.32-0.80）。在仅限于既往无TB病史（n=3036）或ART开始时无TB症状（n=2251）的患者的敏感性分析中，IPT仍与死亡率降低相关（校正HR分别为0.51（95%CI：0.32 - 0.81）和0.48（95%CI：0.24-0.96））。在ART开始或之前接受IPT的个体死亡率较低。这些结果支持IPT与ART联合常规使用。
To describe the association between isoniazid preventive therapy (IPT) and mortality among individuals starting antiretroviral therapy (ART) in a workplace programme in South Africa where tuberculosis incidence is very high. ART-naïve individuals starting ART from January 2004 to December 2007 were followed for up to 12 months. Deaths were ascertained from clinic and human resources data. The association between IPT and mortality was assessed using Cox regression. 3,270 individuals were included (median age 45; 93% male; median baseline CD4 155 cells/mm3 (IQR:87–221); 45% WHO stage 3/4). 922(28%) individuals started IPT either prior to, or within three months of, starting ART. Individuals who started IPT tended to have less advanced HIV disease at ART initiation. 259 (7.9%) deaths were observed, overall mortality rate 8.9/100 person years [pyrs] (95%CI:7.9–10.6). The unadjusted mortality rate was lower among those who received IPT vs. not (3.7/100 pyrs versus 11.1/100 pyrs respectively, hazard ratio (HR) 0.34 [95%CI:0.24–0.49]); this association remained after adjustment for age, baseline CD4, baseline WHO stage, year of ART start and individual company (HR 0.51, 95%CI 0.32–0.80). In sensitivity analyses restricted to those with no previous history of TB (n=3036) or with no TB symptoms at ART initiation (n=2251), IPT remained associated with reduced mortality (adjusted HRs 0.51 (95%CI: 0.32 – 0.81) and 0.48 (95%CI: 0.24–0.96) respectively). Mortality was lower among individuals receiving IPT with or prior to ART start. These results support routine use of IPT in conjunction with ART.
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影响因子：
120.7
作者：
Grant, AD;Charalambous, S;Churchyard, GJ
通讯作者：
Churchyard, GJ
影响因子：
4.1
作者：
Lawn SD;Churchyard G
通讯作者：
Churchyard G
影响因子：
11.8
作者：
Corbett, EL;Churchyard, GJ;De Cock, KM
通讯作者：
De Cock, KM
影响因子：
3.8
作者：
LUCAS, SB;HOUNNOU, A;DECOCK, KM
通讯作者：
DECOCK, KM
影响因子：
168.9
作者：
Braitstein, P;Brinkhof, MWG;Egger, M
通讯作者：
Egger, M