Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries
Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries
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DOI：
10.1016/s0140-6736(06)68337-2
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发表时间：
2006-03-11
期刊：
影响因子：
168.9
通讯作者：
Egger, M
中科院分区：
文献类型：
--
作者：
Braitstein, P;Brinkhof, MWG;Egger, M
高活性抗逆转录病毒疗法（HAART）正在发展中国家推广。我们比较了基线特征和结果在第一年的HAART HIV-1感染的患者在低收入和高收入settings.Methods 18 HAART方案在非洲，亚洲和南美洲（低收入设置）和12个艾滋病毒队列研究从欧洲和北美（高收入设置）提供的数据分别为4810和22 217，初治的成人患者开始HAART。所有来自高收入地区的患者和2725名（57%）来自低收入地区的患者均进行了积极随访，并纳入生存分析。结果与高收入国家相比，低收入地区开始HAART的患者CD 4细胞计数较低（中位数108个细胞/μ L vs 234个细胞/μ L），更可能是女性（51% vs 25%），更可能开始使用非核苷逆转录酶抑制剂（NNRTI）治疗（70% vs 23%）。在6个月时，获得的CD 4细胞中位数（106个细胞/μ L vs 103个细胞/μ L）和达到HIV-1 RNA水平低于500拷贝/mL的患者百分比（76% vs 77%）相似。低收入环境中的死亡率（2236人年随访期间有124人死亡）高于高收入环境（20532人年随访期间有414人死亡）。调整后的风险比（HR）从第一个月的4.3（95%CI 1.6-11.8）下降到第7-12个月的1.5（0.7-3.0）。在低收入环境中提供免费治疗与较低的死亡率相关（调整后的HR 0.23; 95%CI 0.08-0.61）。解释与发达国家相比，在资源贫乏环境中开始HAART治疗的患者在治疗的头几个月死亡率增加。及时诊断和评估治疗资格，加上免费提供高效抗逆转录病毒疗法，可能会降低这种过度死亡率。
Background Highly active antiretroviral therapy (HAART) is being scaled up in developing countries. We compared baseline characteristics and outcomes during the first year of HAART between HIV-1-infected patients in low-income and high-income settings.Methods 18 HAART programmes in Africa, Asia, and South America (low-income settings) and 12 HIV cohort studies from Europe and North America (high-income settings) provided data for 4810 and 22 217, respectively, treatment-naive adult patients starting HAART. All patients from high-income settings and 2725 (57%) patients from low-income settings were actively followed-up and included in survival analyses.Findings Compared with high-income countries, patients starting HAART in low-income settings had lower CD4 cell counts (median 108 cells per mu L vs 234 cells per mu L), were more likely to be female (51% vs 25%), and more likely to start treatment with a non-nucleoside reverse transcriptase inhibitor (NNRTI) (70% vs 23%). At 6 months, the median number of CD4 cells gained (106 cells per mu L vs 103 cells per mu L) and the percentage of patients reaching HIV-1 RNA levels lower than 500 copies/mL (76% vs 77%) were similar. Mortality was higher in low-income settings (124 deaths during 2236 person-years of follow-up) than in high-income settings (414 deaths during 20 532 person-years). The adjusted hazard ratio (HR) of mortality comparing tow-income with high-income settings fell from 4.3 (95% CI 1.6-11.8) during the first month to 1.5 (0.7-3.0) during months 7-12. The provision of treatment free of charge in low-income settings was associated with lower mortality (adjusted HR 0.23; 95% CI 0.08-0.61).Interpretation Patients starting HAART in resource-poor settings have increased mortality rates in the first months on therapy, compared with those in developed countries. Timely diagnosis and assessment of treatment eligibility, coupled with free provision of HAART, might reduce this excess mortality.