Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial.
Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial.
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DOI：
10.1093/cid/cix1141
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发表时间：
2018-03-04
期刊：
影响因子：
--
通讯作者：
Reduction of EArly mortaLITY in HIV-infected adults and children starting antiretroviral therapy (REALITY) Trial Team
中科院分区：
文献类型：
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作者：
Post FA;Szubert AJ;Prendergast AJ;Johnston V;Lyall H;Fitzgerald F;Musiime V;Musoro G;Chepkorir P;Agutu C;Mallewa J;Rajapakse C;Wilkes H;Hakim J;Mugyenyi P;Walker AS;Gibb DM;Pett SL;Reduction of EArly mortaLITY in HIV-infected adults and children starting antiretroviral therapy (REALITY) Trial Team
在撒哈拉以南非洲地区，20%-25%开始抗逆转录病毒治疗（ART）的人有严重的免疫抑制;大约10%在3个月内死亡。在降低早期死亡率（REALITY）随机试验中，广泛增强的抗感染预防捆绑治疗与复方新诺明相比降低了死亡率。我们调查的贡献和时间的不同原因的死亡率/发病率。参与者开始ART时CD 4计数<100个细胞/微升;加强预防包括复方新诺明加12周异烟肼+氟康唑，单剂量阿苯达唑和5天阿奇霉素。设盲委员会将事件和死亡原因裁定为（非互斥）结核病、隐球菌病、重度细菌感染（SBI）、其他潜在阿奇霉素反应性感染、其他事件和未知。ART前CD 4计数中位数为37个细胞/微升。在1805名参与者中，225名（12.7%）在第48周死亡。致死性/非致死性事件发生较早（中位数4周）;然后发生率呈指数下降。154例死亡为单一原因，71例为多种原因，包括4.5%参与者的结核病，1.1%的隐球菌病，1.9%的SBI，1.3%的其他潜在阿奇霉素反应性感染，3.6%的其他事件和5.0%的未知事件。加强预防可减少隐球菌病和不明原因的死亡（P <0.05），但不能减少结核病、SBI、潜在阿奇霉素敏感感染或其他原因的死亡（P > 0.3）;减少非致命/致命结核病和隐球菌病（P <0.05），但不能减少SBI、其他潜在阿奇霉素敏感感染或其他事件（P > 0.2）。加强预防可降低隐球菌病和不明原因以及非致命性结核病和隐球菌病的死亡率。早期致死性/非致死性事件的高发生率强调了在晚期疾病中开始加强ART预防的必要性。ISRCTN43622374。
In sub-Saharan Africa, 20%–25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity. Participants started ART with a CD4 count <100 cells/µL; enhanced prophylaxis comprised cotrimoxazole plus 12 weeks of isoniazid + fluconazole, single-dose albendazole, and 5 days of azithromycin. A blinded committee adjudicated events and causes of death as (non–mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infection (SBI), other potentially azithromycin-responsive infections, other events, and unknown. Median pre-ART CD4 count was 37 cells/µL. Among 1805 participants, 225 (12.7%) died by week 48. Fatal/nonfatal events occurred early (median 4 weeks); rates then declined exponentially. One hundred fifty-four deaths had single and 71 had multiple causes, including tuberculosis in 4.5% participants, cryptococcosis in 1.1%, SBI in 1.9%, other potentially azithromycin-responsive infections in 1.3%, other events in 3.6%, and unknown in 5.0%. Enhanced prophylaxis reduced deaths from cryptococcosis and unknown causes (P < .05) but not tuberculosis, SBI, potentially azithromycin-responsive infections, or other causes (P > .3); and reduced nonfatal/fatal tuberculosis and cryptococcosis (P < .05), but not SBI, other potentially azithromycin-responsive infections, or other events (P > .2). Enhanced prophylaxis reduced mortality from cryptococcosis and unknown causes and nonfatal tuberculosis and cryptococcosis. High early incidence of fatal/nonfatal events highlights the need for starting enhanced-prophylaxis with ART in advanced disease. ISRCTN43622374.
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DOI：
10.1097/qad.0b013e32833d45c5
发表时间：
2010-09-10
期刊：
AIDS (London, England)
影响因子：
--
作者：
Cornell M;Grimsrud A;Fairall L;Fox MP;van Cutsem G;Giddy J;Wood R;Prozesky H;Mohapi L;Graber C;Egger M;Boulle A;Myer L;International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
影响因子：
3.7
作者：
Gupta A;Nadkarni G;Yang WT;Chandrasekhar A;Gupte N;Bisson GP;Hosseinipour M;Gummadi N
通讯作者：
Gummadi N
影响因子：
56.3
作者：
Mueller, Monika;Wandel, Simon;Colebunders, Robert;Attia, Suzanna;Furrer, Hansjakob;Egger, Matthias
通讯作者：
Egger, Matthias
影响因子：
15.8
作者：
Kuller LH;Tracy R;Belloso W;De Wit S;Drummond F;Lane HC;Ledergerber B;Lundgren J;Neuhaus J;Nixon D;Paton NI;Neaton JD;INSIGHT SMART Study Group
通讯作者：
INSIGHT SMART Study Group
影响因子：
11.8
作者：
Walker, A. Sarah;Prendergast, Andrew J.;Gibb, Diana M.
通讯作者：
Gibb, Diana M.