Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.
Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.
复制标题
DOI：
10.1093/cid/ciw125
复制
发表时间：
2016-06-15
期刊：
影响因子：
--
通讯作者：
Easterbrook P
中科院分区：
文献类型：
--
作者：
Low A;Gavriilidis G;Larke N;B-Lajoie MR;Drouin O;Stover J;Muhe L;Easterbrook P
这项荟萃分析提供了强有力的证据，证明抗逆转录病毒治疗（ART）导致中低收入国家关键机会性感染（OIs）的发生率大幅降低。据估计，2013年抗逆转录病毒治疗避免了大约100万例oi病例。背景。为了了解区域负担并为卫生服务的提供提供信息，我们进行了一项系统回顾和荟萃分析，以评估抗逆转录病毒治疗（ART）对中低收入国家（LMICs）人类免疫缺陷病毒（HIV）感染成人中关键机会性感染（oi）发生率的影响。方法。使用多个数据库确定1990年至2013年11月描述oi累积发病率和ART比例的合格研究。使用随机效应荟萃分析计算了ART初始期、ART治疗期间和第一年之后的总事件风险。ART亚组的总估计值采用meta回归进行比较。根据联合国艾滋病毒/艾滋病联合规划署（UNAIDS）的国家估计和全球平均每例成骨不全症治疗费用，在CD4细胞计数≥200细胞/µL时开始抗逆转录病毒治疗，估计成骨不全症病例的数量和避免的相关费用。结果。我们确定了7965篇引用，并纳入了126篇描述491 608名hiv感染者的研究。在初次接受抗逆转录病毒治疗的患者中，口腔念珠菌病、结核病、带状疱疹和细菌性肺炎的总风险最高（bb0.5 %）。在抗逆转录病毒治疗的前12个月，除结核病外，所有oi的发病率下降幅度最大（范围，57%-91%），口腔念珠菌病、肺囊虫肺炎和弓形虫病的发病率下降幅度最大。据估计，2013年早期抗逆转录病毒治疗避免了857 828例病例（95%置信区间[CI]， 828 032-874 853），节省了4670万美元（95%置信区间，4380 - 4940万美元）。结论。在低收入和中等收入国家中，大多数接受抗逆转录病毒治疗的oi的风险显著降低，在治疗的第一年效果最大。ART避免了oi，从而节省了大量成本。
This meta-analysis provides strong evidence that antiretroviral therapy (ART) has led to a major reduction in the incidence of key opportunistic infections (OIs) in low- and middle-income countries. ART was estimated to have averted about a million cases of OIs in 2013. Background. To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)–infected adults in low- and middle-income countries (LMICs). Methods. Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count ≥200 cells/µL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. Results. We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%–91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032–874 853), with cost savings of $46.7 million (95% CI, $43.8–$49.4 million). Conclusions. There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.