Coetzee David, Hildebrand Katherine, Boulle Andrew, Maartens Gary, Louis Francoise, Labatala Veliswa, Reuter Hermann, Ntwana Nonthutuzelo, Goemaere Eric
Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa.
AIDS. 2004 Apr 9;18(6):887-95. doi: 10.1097/00002030-200404090-00006.
A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service.
Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 x 10 cells/l. The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence.
Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 x 10 cells/l at initiation of treatment, and the mean log10 HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count > or =50 x 10 cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 x 10 cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone.
ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV.
2001年在南非一个城镇建立了一项基于社区的抗逆转录病毒疗法（ART）项目，以探讨在资源有限的环境中公共部门提供抗逆转录病毒疗法所涉及的操作问题，并证明这种服务的可行性。
对一组有症状的HIV疾病且CD4淋巴细胞计数<200×10⁶细胞/升的患者的数据进行了分析。该项目采用标准化方案（尽可能使用通用药物）、团队临床护理方法和以患者为中心的方法来促进依从性。
287名既往未接受过抗逆转录病毒治疗的成年人接受了中位时间为13.9个月的随访。治疗开始时CD4淋巴细胞计数的中位数为43×10⁶细胞/升，HIV RNA的平均log₁₀为5.18拷贝/毫升。在3、6、12、18和24个月时，分别有88.1%、89.2%、84.2%、75.0%和69.7%的患者HIV RNA水平低于检测下限（<400拷贝/毫升）。所有患者治疗24个月时的累积存活概率为86.3%，基线CD4淋巴细胞计数≥50×10⁶细胞/升的患者为91.4%，基线CD4淋巴细胞计数<50×10⁶细胞/升的患者为81.8%。到24个月时，因不良事件或禁忌证而更换单一抗逆转录病毒药物的累积概率为15.1%，仅因不良事件而更换的概率为8.4%。
在资源有限的环境中可以提供抗逆转录病毒疗法，并取得良好的患者留存率和临床结果。通过负责任的实施，抗逆转录病毒疗法是对受HIV影响最严重的社区的疫情做出全面应对的关键组成部分。
