The causal effect of switching to second-line ART in programmes without access to routine viral load monitoring.
The causal effect of switching to second-line ART in programmes without access to routine viral load monitoring.
复制标题
在程序中切换到二线艺术的因果效应，而无需访问常规病毒载荷监测。
DOI：
10.1097/qad.0b013e32834e1b5f
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发表时间：
2012-01-02
期刊：
影响因子：
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通讯作者：
IeDEA Southern Africa
中科院分区：
文献类型：
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作者：
Gsponer T;Petersen M;Egger M;Phiri S;Maathuis MH;Boulle A;Musondad P;Tweya H;Peter K;Chi BH;Keiser O;IeDEA Southern Africa
我们研究了在撒哈拉以南非洲地区，在没有获得常规病毒载量监测的情况下，转换为二线抗逆转录病毒治疗（ART）对ART方案中免疫失败患者死亡率的影响。对赞比亚卢萨卡和马拉维利隆圭两个抗逆转录病毒疗法方案的合作分析。我们纳入了所有根据WHO标准发生免疫失败的成年患者。我们使用由转换的逆概率加权的考克斯比例风险模型来比较转换患者与未转换患者之间的死亡率;以及立即转换患者与稍后转换患者之间的死亡率。结果表示为风险比（HR）和95%可信区间（95% CI）。在3932人-年的随访中，在2,411例免疫失败患者中，324例（13.4%）转为二线ART。与未转换的患者相比，转换患者在ART开始和失败时的中位CD 4细胞计数较低：80 vs 155个细胞/μL（p<0.001）和77 vs 146个细胞/μL调整基线和时间依赖性混杂因素后，与仍在一线ART治疗失败的患者相比，转换治疗的患者死亡率较低：HR 0.25（95%CI 0.09-0.72）。在较短时间内接受一线ART治疗失败的患者中，死亡率也较低：暴露时间每缩短6个月，HR为0.70（95% CI 0.44-1.09）。在抗逆转录病毒治疗方案中，根据世卫组织免疫失败标准将患者转换为二线治疗方案似乎可以降低死亡率，在诊断出免疫失败后立即转换的患者获益最大。
We examined the effect of switching to second-line antiretroviral therapy (ART) on mortality in patients who experienced immunological failure in ART programmes without access to routine viral load monitoring in sub-Saharan Africa. Collaborative analysis of two ART programmes in Lusaka, Zambia and Lilongwe, Malawi. We included all adult patients experiencing immunological failure based on WHO criteria. We used Cox proportional hazards models weighted by the inverse probability of switching to compare mortality between patients who switched and patients who did not; and between patients who switched immediately and patients who switched later. Results are expressed as hazard ratios (HR) with 95% credible intervals (95% CI). Among 2,411 patients with immunological failure 324 patients (13.4%) switched to second-line ART during 3932person-years of follow-up. The median CD4 cell count at start of ART and failure was lower in patients who switched compared to patients who did not: 80 versus 155 cells/μL (p<0.001) and 77 versus 146 cells/μL (p<0.001), respectively.Adjusting for baseline and time-dependent confounders, mortality was lower among patients who switched compared to patients remaining on failing first-line ART: HR0.25 (95%CI 0.09-0.72). Mortality was also lower among patients who remained on failing first-line ART for shorter periods: HR 0.70 (95% CI 0.44-1.09) per 6 months shorter exposure. In ART programmes switching patients to second-line regimens based on WHO immunological failure criteria appears to reduce mortality, with the greatest benefit in patients switching immediately after immunological failure is diagnosed.