Doctors Without Borders USA, New York, New York, USA.
Int J Tuberc Lung Dis. 2010 Jul;14(7):903-8.
A prospective cohort study was conducted among human immunodeficiency virus (HIV) infected in-patients with tuberculosis (TB) or other opportunistic infections (OIs) in South Africa to estimate subsequent antiretroviral therapy (ART) uptake and survival.
Logistic regression modeling explored associations between baseline characteristics and starting ART, and ART exposure-adjusted incidence of death was estimated over 6 months of follow-up.
Among 49 participants enrolled, median CD4 cell count at hospital discharge was 42 cells/microl and the most common presenting OIs were TB (76%), Pneumocystis pneumonia (8%), chronic diarrhea (8%), cryptococcal meningitis (6%), and Toxoplasma gondii (4%). By 6 months, only 20 (45%) patients had initiated ART, and four (8%) were lost to follow-up. ART uptake was independently associated with previous use of traditional medicine (OR 7.2, 95%CI 1.4-55.1) and with less advanced HIV infection (baseline CD4 count per 50 cells/microl increase OR 1.4, 95%CI 0.9-2.2). A total of 14 (31%) patients died before initiating ART; the monthly incidence of death did not decrease over the 6-month interval.
The high mortality observed within the 6 months following hospitalization with TB or other acute OIs indicate that mechanisms are needed to expedite ART for patients after an acquired immune-deficiency syndrome defining illness.
本前瞻性队列研究纳入了南非因肺结核（TB）或其他机会性感染（OIs）住院的 HIV 感染者，旨在评估其随后接受抗逆转录病毒治疗（ART）的情况和生存结局。
采用逻辑回归模型分析了基线特征与开始 ART 治疗之间的关联，并在 6 个月的随访期间，估计了 ART 暴露调整后的死亡率。
在纳入的 49 名参与者中，住院时的 CD4 细胞计数中位数为 42 个/μL，最常见的首发 OIs 是结核病（76%）、卡氏肺孢子虫肺炎（8%）、慢性腹泻（8%）、隐球菌性脑膜炎（6%）和弓形体病（4%）。6 个月时，仅有 20 名（45%）患者开始接受 ART 治疗，4 名（8%）患者失访。ART 治疗的启动与既往使用传统药物（OR 7.2，95%CI 1.4-55.1）和 HIV 感染程度较轻（基线 CD4 计数每增加 50 个/μL，OR 1.4，95%CI 0.9-2.2）独立相关。在开始 ART 治疗前，共有 14 名（31%）患者死亡；在 6 个月的随访期间，死亡的月度发生率并未降低。
在因 TB 或其他急性 OIs 住院后的 6 个月内观察到的高死亡率表明，需要采取机制来加速 AIDS 定义性疾病后患者的 ART 治疗。
