Seyler Catherine, Anglaret Xavier, Dakoury-Dogbo Nicole, Messou Eugène, Touré Siaka, Danel Christine, Diakité Nafissa, Daudié Alain, Inwoley André, Maurice Chantal, Tonwe-Gold Besigin, Rouet François, N'Dri-Yoman Thérèse, Salamon Roger
Programme PAC-CI, Abidjan, Côte d'Ivoire.
Antivir Ther. 2003 Oct;8(5):385-93.
To evaluate survival, morbidity, and CD4 and viral load (VL) evolution in HIV-infected adults receiving antiretroviral therapy (ART) in Côte d'Ivoire.
Since 1996, 723 HIV-infected adults have been followed up in the ANRS 1203 cohort study in Abidjan. For those patients who received ART, we describe data between ART initiation and August 2002.
One-hundred-and-one adults (61% women) were followed up under ART for a median of 17 months. At ART initiation, median age, CD4 count and VL were 36 years, 135/mm3 and 5.3 log10 copies/ml, respectively. Initial ART regimens were two nucleoside reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor in 74 patients, two NRTIs plus one non-nucleoside reverse transcriptase inhibitor in 16, and two NRTIs in 11. No patient was lost to follow-up. The most frequent causes of severe morbidity were bacterial infections [11.6/100 person-years (PY), 95% CI: 7.2-18.7], drug-related events (6.5/100 PY, 3.5-12.0), tuberculosis (3.1/100 PY, 1.3-7.4) and malaria (3.1/100 PY, 1.3-7.4). The incidence of death was 3.0/100 PY (1.1-8.0) in patients with baseline CD4 > or = 50/mm3 and 16.1/100 PY (7.2-35.9) in patients with CD4 < 50/mm3. Fifty percent of causes of death were active infections pre-existing ART initiation, mainly atypical mycobacteriosis. After 1 year, 51% of patients had undetectable VL, 28% had detectable VL reduced by more than 0.5 log10 copies/ml since ART initiation, and the median gain in CD4 was +115/mm3.
Medium-term survival under ART may be as good in Africa as in industrialized countries, provided that patients benefit from access to care for opportunistic infections, including bacterial diseases, tuberculosis and malaria.
评估在科特迪瓦接受抗逆转录病毒治疗（ART）的HIV感染成人的生存率、发病率以及CD4和病毒载量（VL）的变化情况。
自1996年以来，723名HIV感染成人在阿比让的ANRS 1203队列研究中接受随访。对于那些接受ART的患者，我们描述了ART开始至2002年8月期间的数据。
101名成人（61%为女性）在ART治疗下接受了中位时间为17个月的随访。开始ART治疗时，中位年龄、CD4细胞计数和VL分别为36岁、135/立方毫米和5.3 log10拷贝/毫升。初始ART治疗方案为74例患者使用两种核苷类逆转录酶抑制剂（NRTIs）加一种蛋白酶抑制剂，16例患者使用两种NRTIs加一种非核苷类逆转录酶抑制剂，11例患者使用两种NRTIs。无患者失访。严重发病的最常见原因是细菌感染[11.6/100人年（PY），95%可信区间：7.2 - 18.7]、药物相关事件（6.5/100 PY，3.5 - 12.0）、结核病（3.1/100 PY，1.3 - 7.4）和疟疾（3.1/100 PY，1.3 - 7.4）。基线CD4≥50/立方毫米的患者死亡率为3.0/100 PY（1.1 - 8.0），CD4＜50/立方毫米的患者死亡率为16.1/100 PY（7.2 - 35.9）。50%的死亡原因是ART开始前就存在的活动性感染，主要是非典型分枝杆菌病。1年后，51%的患者病毒载量检测不到，28%的患者病毒载量自ART开始后下降超过0.5 log10拷贝/毫升，CD4的中位增加值为+115/立方毫米。
在非洲，只要患者能获得针对机会性感染（包括细菌性疾病、结核病和疟疾）的治疗，ART治疗下的中期生存率可能与工业化国家一样好。
