Miiro George, Todd Jim, Mpendo Juliet, Watera Christine, Munderi Paula, Nakubulwa Susan, Kaddu Ismael, Rutebarika Diana, Grosskurth Heiner
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Trop Med Int Health. 2009 May;14(5):556-63. doi: 10.1111/j.1365-3156.2009.02259.x. Epub 2009 Mar 19.
To evaluate the effect of highly active anti-retroviral therapy (HAART) and cotrimoxazole prophylaxis on morbidity after HAART eligibility.
Between 1999 and 2006, we collected morbidity data from a community-based cohort of HAART-eligible patients, comparing patients initiating HAART and those non-HAART. Patients aged 15 years or older visited the clinic every 6 months and when ill. Baseline data on patients' characteristics, WHO stage, haemoglobin and CD4+ T-cell counts, along with follow-up data on morbidity (new, recurrent and drug-related), were collected for the first year after initiating HAART or becoming HAART-eligible. We estimated the overall effect of HAART on morbidity; adjusted for the effect of cotrimoxazole prophylaxis by Mantel-Haenszel methods. A negative binomial regression model was used to assess rate ratios (RR) after adjustment for other confounders, including cotrimoxazole.
A total of 219 HAART patients (median age 37 years; 73% women; 82% using cotrimoxazole prophylaxis, median haemoglobin 11.7 g/dl and median CD4+ 131 cells/microl) experienced 94 events in 127 person-years. 616 non-HAART patients (median age 33 years; 70% women; 26% using cotrimoxazole prophylaxis, median haemoglobin 11.2 g/dl and median CD4+ 130 cells/microl) experienced 862 events in 474 person-years. The overall morbidity during the first year of HAART was 80% lower than among non-HAART patients (adjusted RR = 0.20, 95% CI: 0.12-0.34). Cotrimoxazole prophylaxis also reduced morbidity (adjusted RR = 0.65, 95% CI: 0.45-0.94).
These results confirm the reduction in morbidity due to HAART, and the additional protection of cotrimoxazole prophylaxis.
评估高效抗逆转录病毒疗法（HAART）及复方新诺明预防用药对符合HAART治疗标准后的发病率的影响。
1999年至2006年期间，我们收集了一个以社区为基础的符合HAART治疗标准患者队列的发病数据，比较开始接受HAART治疗的患者和未接受HAART治疗的患者。15岁及以上的患者每6个月到诊所就诊一次，生病时也就诊。收集患者特征、世界卫生组织分期、血红蛋白和CD4 + T细胞计数的基线数据，以及开始HAART治疗或符合HAART治疗标准后第一年的发病（新发病、复发和药物相关）随访数据。我们估计了HAART对发病率的总体影响；通过Mantel-Haenszel方法对复方新诺明预防用药的效果进行校正。使用负二项回归模型评估在对包括复方新诺明在内的其他混杂因素进行校正后的率比（RR）。
共有219例接受HAART治疗的患者（中位年龄37岁；73%为女性；82%使用复方新诺明预防用药，中位血红蛋白11.7 g/dl，中位CD4 + 131细胞/微升）在127人年中发生了94起事件。616例未接受HAART治疗的患者（中位年龄33岁；70%为女性；26%使用复方新诺明预防用药，中位血红蛋白11.2 g/dl，中位CD4 + 130细胞/微升）在474人年中发生了862起事件。HAART治疗第一年的总体发病率比未接受HAART治疗的患者低80%（校正RR = 0.20，95%CI：0.12 - 0.34）。复方新诺明预防用药也降低了发病率（校正RR = 0.65，95%CI：0.45 - 0.94）。
这些结果证实了HAART可降低发病率，以及复方新诺明预防用药具有额外的保护作用。
