城市公立诊所中符合抗逆转录病毒治疗条件的患者的死亡率。
Mortality among antiretroviral-eligible patients in an urban public clinic.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
J Acquir Immune Defic Syndr. 2011 Aug 1;57(4):297-300. doi: 10.1097/QAI.0b013e31822233aa.
BACKGROUND
Advances in antiretroviral therapy (ART) over the last decade have improved clinical outcomes for people living with human immunodeficiency virus (HIV), but whether these improvements are experienced by disadvantaged urban populations is less clear.
METHODS
We evaluated mortality among a clinical cohort in a public safety-net HIV specialty clinic in San Francisco, California.
RESULTS
Among 1651 ART-eligible patients attending an urban US HIV clinic, 4-year mortality was 10.0% in 2000-2004 and 11.0% in 2005-2009. Despite universal ART availability, only 72 (42%) of 172 patients who died, compared with 69% of survivors, ever achieved an HIV viral load, 400 copies per cubic millimeter. The leading causes of death were acquired immunodeficiency syndrome (56%), violence/overdose (16%), and pulmonary disease (6%).
CONCLUSIONS
Disadvantaged subpopulations in the developed world can experience high mortality rates despite accessing specialty HIV clinical services with full ART availability. New strategies are needed to improve the outcomes in these populations.
背景
过去十年中，抗逆转录病毒疗法（ART）的进步改善了人类免疫缺陷病毒（HIV）感染者的临床预后，但这些改善是否能惠及处于不利地位的城市人群尚不清楚。
方法
我们评估了加利福尼亚州旧金山一家公立医疗保障 HIV 专科诊所临床队列的死亡率。
结果
在参加美国城市 HIV 诊所的 1651 名符合 ART 条件的患者中，2000-2004 年的 4 年死亡率为 10.0%，2005-2009 年为 11.0%。尽管普遍提供 ART，但在 172 名死亡患者中，仅有 72 名（42%）患者达到了 HIV 病毒载量<400 拷贝/毫升的目标，而幸存者中达到这一目标的比例为 69%。死亡的主要原因是获得性免疫缺陷综合征（56%）、暴力/过量用药（16%）和肺部疾病（6%）。
结论
尽管发达国家的弱势亚群可以获得提供充分 ART 的 HIV 专科临床服务，但仍可能经历高死亡率。需要采取新策略来改善这些人群的预后。
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