Advanced HIV disease during the 'Treat All' era in Botswana.
Advanced HIV disease during the 'Treat All' era in Botswana.
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DOI：
10.1097/qad.0000000000002701
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发表时间：
2020-12-01
期刊：
影响因子：
--
通讯作者：
Hachaambwa L
中科院分区：
文献类型：
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作者：
Vinikoor MJ;Hachaambwa L
HIV-1感染是一种可通过早期诊断、参与慢性护理模式和持续使用抗逆转录病毒疗法（ART）进行管理的慢性疾病。在艾滋病毒流行率最高的撒哈拉以南非洲（SSA），已经建立了有效的ART护理模式，艾滋病毒检测已成为卫生机构、社区甚至家庭中无处不在的干预措施。过去15年来，与艾滋病毒有关的死亡率和艾滋病毒发病率大幅下降。近年来，大多数国家都采用了“治疗所有人”，这有望加速控制艾滋病毒的流行。不幸的是，晚期艾滋病毒疾病，感染阶段的特点是严重的免疫缺陷和高发病率的危及生命的机会性感染，似乎是一个持久的问题，在撒哈拉以南非洲。Lebelonyane等人[1]分析了博茨瓦纳艾滋病晚期的流行率、预测因素和结果，博茨瓦纳是采用循证艾滋病治疗和预防干预措施（包括“治疗所有人”）最雄心勃勃的国家之一，也是撒哈拉以南非洲第一个宣布实现90- 90 - 90目标的国家[2]。[1]对博茨瓦纳综合预防项目进行了二次分析，该项目是2013年10月至2018年3月在15个社区的成年人（16- 64岁）中实施的干预措施。一揽子干预措施包括艾滋病毒检测运动、扩大医疗男性包皮环切术、普及抗逆转录病毒疗法而不论CD 4+细胞计数，以及加强艾滋病毒护理的联系和保留。艾滋病毒感染者（PLHIV）被确定为没有接受抗逆转录病毒治疗，因为他们要么是新诊断的，要么是以前诊断的，但目前没有接受治疗，他们与该设施的临床护理有关。在那些与护理有关的人中，研究人员描述了晚期HIV疾病的比例，定义为CD 4+计数200个细胞/μl或更少，确定了人口统计学和治疗相关的风险因素，并描述了随后的ART结果，与CD 4+计数较高的人相比。儿童和青少年的数据没有报告。
HIV-1 infection is a potentially manageable chronic disease through early diagnosis, engagement in a model of chronic care, and sustained use of antiretroviral therapy (ART). In sub-Saharan Africa (SSA), where HIV prevalence is the highest, effective models of care have been established for ART delivery and HIV testing has become a ubiquitous intervention at health facilities, in the community, and even at home. HIV-related mortality and HIV incidence have been cut drastically over the past 15 years. In recent years, most countries have adopted ‘Treat all’, which is expected to accelerate control of the HIV epidemic. Unfortunately, advanced HIV disease, the phase of infection that is characterized by severe immunodeficiency and high incidence of life-threatening opportunistic infections, appears to be an enduring problem in SSA. Lebelonyane et al.[1] analyzed the prevalence, predictors, and outcomes advanced HIV disease in Botswana, which has been among the most ambitious in adopting evidence-based HIV treatment and prevention interventions, including ‘Treat all’, and was the first country in SSA to announce that it had achieved the 90--90--90 targets [2].Lebelonyane et al.[1] performed a secondary analysis of the Botswana Combination Prevention Project, an intervention that was implemented from October 2013 to March 2018, among adults (16--64-year-olds) across 15 communities. The intervention package included HIV testing campaigns, scale-up of medical male circumcision, universal ART regardless of CD4+ count, and enhanced linkage and retention in HIV care. People living with HIV (PLHIV), who were identified as not taking ART as they were either newly diagnosed or previously diagnosed but not currently on therapy, were linked to clinical care at the facility. Among those who linked to care, investigators described the proportion with advanced HIV disease, defined as CD4+ count 200 cells/μl or less, identified demographic and treatment-related risk factors, and described subsequent ART outcomes, in comparison to those with higher CD4+ counts. Data from children and younger adolescents were unfortunately not reported.