Strategies to reduce early morbidity and mortality in adults receiving antiretroviral therapy in resource-limited settings
Strategies to reduce early morbidity and mortality in adults receiving antiretroviral therapy in resource-limited settings
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DOI：
10.1097/coh.0b013e328333850f
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发表时间：
2010-01-01
影响因子：
4.1
通讯作者：
Wood, Robin
中科院分区：
文献类型：
--
作者：
Lawn, Stephen D.;Harries, Anthony D.;Wood, Robin
综述的目的我们回顾了最近发表的关于资源有限的患者在抗逆转录病毒治疗(ART)期间的早期发病率和死亡率的文献。最近的发现在撒哈拉以南非洲，抗逆转录病毒治疗第一年的死亡率非常高(8-26%)，大多数死亡发生在最初的几个月。相比之下，拉丁美洲和加勒比地区的课程比例为3%-13%，东南亚地区的比例为11%-13%。危险因素通常表现为晚期症状性疾病。发病率和死亡率的主要原因包括结核病、急性败血症、隐球菌性脑膜炎、恶性肿瘤和消瘦综合征/慢性腹泻。目前的文献表明，基本的需要是更早地进行艾滋病毒诊断和启动抗逆转录病毒疗法。此外，进一步的研究提供了关于筛查和预防机会性疾病(特别是结核病、细菌性败血症和隐球菌病)的作用以及对特定机会性疾病和抗逆转录病毒疗法并发症的管理的数据。有效和可持续地提供这些干预措施需要加强方案。概要应对这一疾病负担的战略应包括更早的艾滋病毒诊断和抗逆转录病毒治疗、机会性感染的筛查和预防、对特定疾病和治疗并发症的优化管理以及加强方案。
Purpose of reviewWe review recently published literature concerning early morbidity and mortality during antiretroviral therapy (ART) among patients in resource-limited settings. We focus on articles providing insights into this burden of disease and strategies to address it.Recent findingsIn sub-Saharan Africa, mortality rates during the first year of ART are very high (8-26%), with most deaths occurring in the first few months. This figure compares with 3-13% in programmes in Latin America and the Caribbean and 11-13% in south-east Asia. Risk factors generally reflect late presentation with advanced symptomatic disease. Key causes of morbidity and mortality include tuberculosis (TB), acute sepsis, cryptococcal meningitis, malignancy and wasting syndrome/chronic diarrhoea. Current literature shows that the fundamental need is for much earlier HIV diagnosis and initiation of ART. In addition, further studies provide data on the role of screening and prophylaxis against opportunistic diseases (particularly TB, bacterial sepsis and cryptococcal disease) and the management of specific opportunistic diseases and complications of ART. Effective and sustainable delivery of these interventions requires strengthening of programmes.SummaryStrategies to address this disease burden should include earlier HIV diagnosis and ART initiation, screening and prophylaxis for opportunistic infections, optimized management of specific diseases and treatment complications, and programme strengthening.