Hawkins Claudia, Achenbach Chad, Fryda William, Ngare Duncan, Murphy Robert
Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA, and Department of Medicine, Saint Mary's Mission Hospital, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2007 Jul 1;45(3):304-10. doi: 10.1097/QAI.0b013e318050d66c.
Insufficient data exist on the durability and tolerability of first-line antiretroviral therapy (ART) regimens provided by HIV treatment programs implemented in developing countries.
Longitudinal observation of clinical, immunologic, and treatment parameters of all HIV-infected adult patients initiated on ART was performed at Saint Mary's Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.
A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration was 350 days (11.6 months). Significant improvements in clinical and immunologic status were noted after 12 months of therapy. ART switches occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12 months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis treatment interactions (28.1%) were the most frequent reasons for ART switch. Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]: 1.28 to 1.98; P<0.01) and a CD4 count<or=100 cells/mm3 (HR=1.20, CI: 1.01 to 1.43; P=0.04) were independent predictors of ART switch. ART-related clinical toxicity occurred in 341 (26.5%) patients. Peripheral neuropathy was reported most frequently (20.7%). A CD4 count<or=100 cells/mm3 was an independent predictor of clinical toxicity.
Excellent clinical and immunologic responses to ART were observed in this urban Kenyan population; however, frequent switches in ART among medication classes because of toxicity or drug interactions may limit the durability of these responses.
关于发展中国家实施的艾滋病治疗项目所提供的一线抗逆转录病毒治疗（ART）方案的耐用性和耐受性，现有数据不足。
2004年9月至2006年8月，在肯尼亚内罗毕的圣玛丽传教医院对所有开始接受ART治疗的成年HIV感染患者的临床、免疫和治疗参数进行了纵向观察。
共分析了1286例患者（59.1%为女性）。初始ART方案主要为司他夫定、拉米夫定和奈韦拉平（62.1%）。ART的中位持续时间为350天（11.6个月）。治疗12个月后，临床和免疫状态有显著改善。701例（54.5%）患者发生了ART方案更换。12个月时ART方案更换的累积发生率为78.4%。同时发生的ART相关毒性（40.6%）和结核病治疗相互作用（28.1%）是ART方案更换最常见的原因。基线艾滋病症状（风险率[HR]=1.59，95%置信区间[CI]：1.28至1.98；P<0.01）和CD4细胞计数≤100个/立方毫米（HR=1.20，CI：1.01至1.43；P=0.04）是ART方案更换的独立预测因素。341例（26.5%）患者发生了ART相关临床毒性。周围神经病变报告最为频繁（20.7%）。CD4细胞计数≤100个/立方毫米是临床毒性的独立预测因素。
在这个肯尼亚城市人群中观察到ART有良好的临床和免疫反应；然而，由于毒性或药物相互作用导致的ART药物类别频繁更换可能会限制这些反应的耐用性。
