Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design
Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design
复制标题
DOI：
10.1097/01.aids.0000194802.89540.e1
复制
发表时间：
2005-12-02
期刊：
影响因子：
3.8
通讯作者：
Wood, R
中科院分区：
文献类型：
--
作者：
Lawn, SD;Myer, L;Wood, R
目的：确定在开始治疗之前和之后接受基于社区的抗逆转录病毒治疗 (ART) 计划的患者的死亡率、危险因素和死亡原因。方法：在 2002 年 9 月至 2005 年 3 月期间，在南非开普敦参加前瞻性社区 ART 队列的初治患者中确定所有计划内死亡。结果：在 712 名患者中（中位 CD4 细胞计数，94 个细胞/μl）， 578 名 (81%) 患者在入组后中位数 29 天开始接受三重 ART。在 563 人年的观察期间，有 68 名患者（9.5%）死亡。在接受 ART 的患者中，治疗前高死亡率为 35.6 例死亡/100 人年 [95% 置信区间 (0), 23.0-55.1)，在 1 年时下降至 2.5 例/100 人年 (95% Cl, 0.9-6.6)。然而，在入组后的前 90 天内，44 例死亡中的 29 例 (66%) 发生在等待 ART 的患者中；这些不会通过治疗分析来识别。多变量分析表明，死亡风险（治疗前和治疗中）与基线 CD4 细胞计数和世界卫生组织 (WHO) 临床分期独立相关；第四阶段疾病是最强的危险因素。主要死亡原因是消耗综合征、结核病、急性细菌感染、恶性肿瘤和免疫重建疾病。结论：大多数早期计划内死亡发生在晚期免疫缺陷但尚未开始抗逆转录病毒治疗的患者中。使用治疗分析进行的项目评估大大低估了早期死亡率。通过最大限度地减少治疗启动中不必要的计划内延误以及在出现世界卫生组织第 4 期疾病之前开始抗逆转录病毒疗法，可以降低死亡率。 (c) 2005 年利平科特·威廉姆斯和威尔金斯。
Objectives: To determine rates, risk factors and causes of death among patients accessing a community-based antiretroviral treatment (ART) programme both prior to and following initiation of treatment.Methods: All in-programme deaths were ascertained between September 2002 and March 2005 among treatment-naive patients enrolled into a prospective community-based ART cohort in Cape Town, South Africa.Results: Of 712 patients (median CD4 cell count, 94 cells/mu l), 578 (81 %) started triple ART a median of 29 days after enrolment. 68 (9.5%) patients died during 563 person-years of observation. The high pretreatment mortality rate of 35.6 deaths/100 person-years [95% confidence interval (0), 23.0-55.1) decreased to 2.5/100 person-years (95% Cl, 0.9-6.6) at 1 year among those who received ART. However, within the first 90 days from enrolment, 29 of 44 (66%) deaths occurred among patients awaiting ART; these would not be identified by an on-treatment analysis. Multivariate analysis showed that risk of death (both pre-treatment and on-treatment) was independently associated with baseline CD4 cell count and World Health Organization (WHO) clinical stage; stage 4 disease was the strongest risk factor. Major attributed causes of death were wasting syndrome, tuberculosis, acute bacterial infections, malignancy and immune reconstitution disease.Conclusions: Most early in-programme deaths occurred among patients with advanced immunodeficiency but who had not yet started ART. Programme evaluation using ontreatment analyses greatly underestimated early mortality. This mortality would be reduced by minimizing unnecessary in-programme delays in treatment initiation and by starting ART before development of WHO stage 4 disease. (c) 2005 Lippincott Williams & Wilkins.