Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa
Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa
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DOI：
10.1097/qad.0b013e3282f09876
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发表时间：
2007-11-30
期刊：
影响因子：
3.8
通讯作者：
Anglaret, Xavier
中科院分区：
文献类型：
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作者：
Moh, Raoul;Danel, Christine;Anglaret, Xavier
目的：评估西非成年人开始抗逆转录病毒治疗 (ART) 后头几个月内死亡率和严重发病率的发生率和危险因素。方法：在阿比让进行的一项队列研究，其中 792 名成年人开始 ART，中位 CD4 细胞计数为 252 个细胞/μl，并随访中位 8 个月。严重发病被定义为除口腔念珠菌病之外的所有世界卫生组织第 3 或 4 阶段定义的发病事件。结果：在 ART 前 CD4 细胞计数 < 200、200-350 和 > 350 个细胞/μl 的患者中，死亡率发生率为 5.0 [95% 置信区间 (CI)，2.6-8.7]、1.7（95% CI， 0.6-3.8) 和 0.0 (95% CI, 0.0-3.4)/100 人年，严重发病率为 13.3 (95% CI, 9.0-19.1)、9.5 (95% CI, 6.2-12.9) 和 7.9 (95% CI, 3.4-15.5)/100最常见的疾病分别是侵袭性细菌性疾病（32/65 次发病，49%）和结核病（25/65 次发病，38%）。随着时间的推移，这两种疾病的发病率均呈下降趋势。死亡、病毒学失败和免疫学失败的其他独立危险因素包括：基线时、高病毒载量、晚期临床分期、既往病史。结核病、低 BMI、低血红蛋白和低 CD4 细胞计数；随访期间：低 CD4 细胞计数和持续可检测到的病毒载量。结论：这些数据提供了新的论据，强化了这一假设：在该地区，应在 CD4 细胞计数降至 350 个细胞/μd 以下之前开始 ART。进一步的研究应评估低 BMI、低血红蛋白、高病毒载量或既往结核病史的患者是否应更早开始 ART。 2007 年 Wolters Kluwer Health 垂直条 Lippincott Williams & Wilkins。
Objective: To estimate the incidence and risk factors of mortality and severe morbidity during the first months following antiretroviral therapy (ART) initiation in West African adults.Methods: A cohort study in Abidjan in which 792 adults started ART with a median CD4 cell count of 252 cells/mu l and were followed for a median of 8 months. Severe morbidity was defined as all World Health Organization stage 3 or 4-defining morbidity events other than oral candidiasis.Results: In patients with pre-ART CD4 cell count < 200, at 200-350 and > 350cells/mu l, incidence of mortality was 5.0 [95% confidence interval (CI), 2.6-8.7], 1.7 (95% CI, 0.6-3.8) and 0.0 (95% CI, 0.0-3.4]/100 person-years, and incidence of severe morbidity was 13.3 (95% CI, 9.0-19.1), 9.5 (95% CI, 6.2-12.9) and 7.9 (95% CI, 3.4-15.5)/100 person-years, respectively. The most frequent diseases were invasive bacterial diseases (32/65 episodes, 49%) and tuberculosis (25/65 episodes, 38%). Both diseases followed the same curve of decreasing incidence over time. Patients who experienced severe morbidity had higher risks of mortality, virological failure and immunological failure. Other independent risk factors for mortality and/or severe morbidity were: at baseline, high viral load, advanced clinical stage, past history of tuberculosis, low BMI, low haemoglobin and low CD4 cell count; during follow-up: low CD4 cell count and persistently detectable viral load.Conclusion: These data give new arguments to reinforce the hypothesis that, in this region, ART should be started before the CD4 cell count drops below 350 cells/mu d. Further studies should assess whether patients with low BMI, low haemoglobin, high viral load or past history of tuberculosis should start ART earlier. (C) 2007 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.