London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
BMC Public Health. 2011 Sep 14;11:700. doi: 10.1186/1471-2458-11-700.
Concerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women.
Prospective study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007. Patients were followed monthly for drug adherence (interview and pill count), and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events.
95 women, including 47 FSWs, were followed for a median of 32 months (interquartile range [IQR], 20-41). At HAART initiation, the median CD4 count was 147 cells/μl (IQR, 79-183) and 144 cells/μl (100-197), and the mean PVLs were 4.94 log10 copies/ml (95% confidence interval [CI], 4.70-5.18) and 5.15 log10 copies/ml (4.97-5.33), in FSWs and non-FSWs, respectively. Four FSWs died during follow-up (mortality rate: 1.7 per 100 person-years) and none among other women. At 36 months, the median CD4 count increase was 230 cells/μl (IQR, 90-400) in FSWs vs. 284 cells/μl (193-420) in non-FSWs; PVL was undetectable in 81.8% (95% CI, 59.7-94.8) of FSWs vs. 100% (83.9-100) of non-FSWs; and high adherence to HAART (> 95% pills taken) was reported by 83.3% (95% CI, 67.2-93.6), 92.1% (95% CI, 78.6-98.3), and 100% (95% CI, 54.1-100) of FSWs at 6, 12, and 36 months after HAART initiation, respectively, with no statistical difference compared to the pattern observed among non-FSWs.
Clinical and biological benefits of HAART can be maintained over the long-term among FSWs in Africa and could also lead to important public health benefits.
有人担心边缘化人群可能无法充分遵守抗逆转录病毒疗法。我们的目的是描述在布基纳法索为感染艾滋病毒的女性性工作者（FSW）提供高效抗逆转录病毒治疗（HAART）并辅以强化依从性支持的长期病毒学、免疫学和死亡率结果，并与常规感染艾滋病毒的女性队列的结果进行对比。
2004 年 8 月至 2007 年 10 月期间，对开始接受 HAART 的 FSW 和非 FSW 进行前瞻性研究。通过访谈和药丸计数每月监测一次药物依从性，每 6 个月监测一次 CD4 计数和 HIV-1 血浆病毒载量（PVL）以及临床事件。
95 名女性，包括 47 名 FSW，中位随访 32 个月（IQR，20-41）。在开始 HAART 时，FSW 和非 FSW 的中位 CD4 计数分别为 147 个细胞/μl（IQR，79-183）和 144 个细胞/μl（100-197），平均 PVL 分别为 4.94 log10 拷贝/ml（95%置信区间[CI]，4.70-5.18）和 5.15 log10 拷贝/ml（4.97-5.33）。在随访期间，有 4 名 FSW 死亡（死亡率：每 100 人年 1.7 人），而其他女性没有死亡。在 36 个月时，FSW 的中位 CD4 计数增加了 230 个细胞/μl（IQR，90-400），而非 FSW 则增加了 284 个细胞/μl（IQR，193-420）；FSW 的病毒载量不可检测率为 81.8%（95%CI，59.7-94.8），而非 FSW 为 100%（83.9-100）；83.3%（95%CI，67.2-93.6）、92.1%（95%CI，78.6-98.3）和 100%（95%CI，54.1-100）的 FSW 在 HAART 开始后 6、12 和 36 个月分别报告了对 HAART 的高度依从性（>95%的药物服用），与非 FSW 的模式相比，没有统计学差异。
在非洲，FSW 可以长期保持 HAART 的临床和生物学益处，这也可能带来重要的公共卫生益处。
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