Wouters E, Van Loon F, Van Rensburg D, Meulemans H
Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium.
AIDS Care. 2009 Nov;21(11):1401-11. doi: 10.1080/09540120902884034.
The South African public-sector antiretroviral treatment (ART) program has yielded promising early results. To extend and reinforce these preliminary findings, we undertook a detailed assessment of the clinical efficacy and outcomes over two years of ART. The primary objective was to assess the clinical outcomes and adverse effects of two years of ART, while identifying the possible effects of baseline health and patient characteristics. A secondary objective was to address the interplay between positive and negative outcomes (clinical benefits versus adverse effects) in terms of the patients' physical and emotional quality of life (QoL). Clinical outcome, baseline characteristics, health status, and physical and emotional QoL scores were determined from clinical files and interviews with 268 patients enrolled in the Free State ART program at three time points (6, 12, and 24 months of ART). Age, sex, education, and baseline health (CD4 cell count and viral load) were all independently associated with the ART outcome in the early stages of treatment, but their impact diminished as the treatment progressed. The number of patients classified as treatment successes increased over the first two years of ART, whereas the proportion of patients experiencing adverse effects diminished. Importantly, our findings show that ART had strong and stable positive effects on physical and emotional QoL. These favorable results demonstrate that a well-managed public-sector ART program can be very successful within a high-HIV-prevalence resource-limited setting. This finding emphasizes the need to adopt treatment scale-up as a key policy priority, while at the same time ensuring that the highest standards of healthcare provision are maintained. Healthcare services should also target vulnerable groups (males, less-educated patients, those with low baseline CD4 cell counts, and high baseline viral loads) who are most likely to experience treatment failure.
南非公共部门的抗逆转录病毒治疗（ART）项目已取得了令人鼓舞的初步成果。为了扩展和强化这些初步发现，我们对ART两年的临床疗效和结果进行了详细评估。主要目标是评估ART两年的临床结果和不良反应，同时确定基线健康状况和患者特征可能产生的影响。次要目标是从患者的身体和情感生活质量（QoL）方面探讨积极和消极结果（临床益处与不良反应）之间的相互作用。通过查阅临床档案并对自由邦ART项目登记的268名患者在三个时间点（ART治疗6个月、12个月和24个月）进行访谈，确定了临床结果、基线特征、健康状况以及身体和情感QoL评分。年龄、性别、教育程度和基线健康状况（CD4细胞计数和病毒载量）在治疗早期均与ART结果独立相关，但随着治疗的推进，它们的影响逐渐减弱。在ART治疗的头两年，被归类为治疗成功的患者数量增加，而出现不良反应的患者比例下降。重要的是，我们的研究结果表明，ART对身体和情感QoL有强烈且稳定的积极影响。这些良好结果表明，在艾滋病毒高流行的资源有限环境中，管理良好的公共部门ART项目可以非常成功。这一发现强调了将扩大治疗规模作为关键政策优先事项的必要性，同时确保维持最高的医疗服务标准。医疗服务还应针对最有可能治疗失败的弱势群体（男性、受教育程度较低的患者、基线CD4细胞计数低和基线病毒载量高的患者）。
