St. Francis Designated District Hospital, Ifakara, United Republic of Tanzania.
BMC Infect Dis. 2011 Apr 19;11:98. doi: 10.1186/1471-2334-11-98.
Data on combination antiretroviral therapy (cART) in remote rural African regions is increasing.
We assessed prospectively initial cART in HIV-infected adults treated from 2005 to 2008 at St. Francis Designated District Hospital, Ifakara, Tanzania. Adherence was assisted by personal adherence supporters. We estimated risk factors of death or loss to follow-up by Cox regression during the first 12 months of cART.
Overall, 1,463 individuals initiated cART, which was nevirapine-based in 84.6%. The median age was 40 years (IQR 34-47), 35.4% were males, 7.6% had proven tuberculosis. Median CD4 cell count was 131 cells/μl and 24.8% had WHO stage 4. Median CD4 cell count increased by 61 and 130 cells/μl after 6 and 12 months, respectively. 215 (14.7%) patients modified their treatment, mostly due to toxicity (56%), in particular polyneuropathy and anemia. Overall, 129 patients died (8.8%) and 189 (12.9%) were lost to follow-up. In a multivariate analysis, low CD4 cells at starting cART were associated with poorer survival and loss to follow-up (HR 1.77, 95% CI 1.15-2.75, p=0.009; for CD4<50 compared to >100 cells/μl). Higher weight was strongly associated with better survival (HR 0.63, 95% CI 0.51-0.76, p<0.001 per 10 kg increase).
cART initiation at higher CD4 cell counts and better general health condition reduces HIV related mortality in a rural African setting. Efforts must be made to promote earlier HIV diagnosis to start cART timely. More research is needed to evaluate effective strategies to follow cART at a peripheral level with limited technical possibilities.
在偏远的非洲农村地区，有关联合抗逆转录病毒疗法（cART）的数据正在增加。
我们前瞻性地评估了 2005 年至 2008 年在坦桑尼亚伊法卡拉圣弗朗西斯指定区医院接受治疗的感染艾滋病毒的成年患者的初始 cART。通过个人依从性支持者来帮助患者保持依从性。我们通过 Cox 回归在 cART 治疗的前 12 个月内估计了死亡或失访的风险因素。
总体而言，有 1463 人开始接受 cART，其中 84.6%采用了奈韦拉平为基础的方案。中位年龄为 40 岁（IQR 34-47），35.4%为男性，7.6%有确诊的结核病。中位 CD4 细胞计数为 131 个/μl，24.8%为世卫组织第 4 期。分别在第 6 个月和第 12 个月时，CD4 细胞计数分别增加了 61 和 130 个/μl。215 名（14.7%）患者修改了治疗方案，主要原因是毒性（56%），特别是多发性神经病和贫血。总共有 129 名患者死亡（8.8%），189 名（12.9%）失访。在多变量分析中，开始 cART 时的低 CD4 细胞计数与生存率和失访率较差相关（HR 1.77，95%CI 1.15-2.75，p=0.009；与 CD4<50 相比，CD4>100 个/μl）。体重增加与生存状况显著相关（HR 0.63，95%CI 0.51-0.76，每增加 10 公斤 p<0.001）。
在农村非洲环境中，在较高的 CD4 细胞计数和更好的一般健康状况下开始 cART 可降低与 HIV 相关的死亡率。必须努力促进早期 HIV 诊断，以及时开始 cART。需要进一步研究，以评估在技术条件有限的情况下，在基层有效实施 cART 随访的策略。
