Tamí-Maury Irene, Coulibaly Yaya Ibrahim, Cissoko Souare Salimata, Dao Sounkalo, Kristensen Sibylle
University of Alabama at Birmingham, Department of Epidemiology, Birmingham, United States.
Pan Afr Med J. 2012;11:18. Epub 2012 Jan 31.
In 2004, the sudden availability of free antiretroviral therapy (ART in Mali, within the context of an already overburdened health care system created gaps in individual patient quality of care. The objective of this study was to determine the prevalence of HIV-related oral manifestations (OM) during the first month of ART therapy in a Malian health facility.
Medical records of adult patients who initiated ART regimens at the Gabriel Touré Hospital, Mali (2001 to 2008) were randomly identified. Multiple logistic regression models were used to evaluate the relationship between the presence of OM during the first month of ART and selected variables, including CD4 counts and WHO clinical staging at ART initiation.
Out of 205 patients on ART (mean age 39 ± 10 years), 71.0% were females and 36.1% had no formal education. 40.6% were in WHO clinical stage III. OM prevalence during the first month of HIV care was 31.4%, being oral candidiasis the commonest lesion. 73.2% and 82.5% of the patients with OM had CD4 count < 200 cells/mm3 and were classified as WHO clinical stage III or IV. WHO clinical stage III and VI patients had 5.4-fold increased odds of having any OM (both p< 0.01) when controlling for age, ethnicity, gender, marital status, and CD4 counts.
OM detected in people with low CD4 count and WHO clinical stage III and IV at ART initiation suggested that they were very immune-compromised when initiating HIV care. Early identification of OM could improve the quality of care and guarantee the benefits of ART.
2004年，在马里，免费抗逆转录病毒疗法（ART）突然普及，而当时的医疗保健系统本已不堪重负，这导致个体患者的医疗质量出现差距。本研究的目的是确定在马里一家医疗机构接受抗逆转录病毒治疗的第一个月内，与艾滋病毒相关的口腔表现（OM）的患病率。
随机抽取了在马里加布里埃尔·图雷医院（2001年至2008年）开始接受抗逆转录病毒治疗方案的成年患者的病历。使用多元逻辑回归模型来评估抗逆转录病毒治疗第一个月内口腔表现的存在与选定变量之间的关系，这些变量包括开始抗逆转录病毒治疗时的CD4细胞计数和世界卫生组织临床分期。
在205名接受抗逆转录病毒治疗的患者中（平均年龄39±10岁），71.0%为女性，36.1%没有接受过正规教育。40.6%处于世界卫生组织临床III期。艾滋病毒护理第一个月内口腔表现的患病率为31.4%，口腔念珠菌病是最常见的病变。有口腔表现的患者中，73.2%和82.5%的CD4细胞计数<200个细胞/mm3，并被归类为世界卫生组织临床III期或IV期。在控制年龄、种族、性别、婚姻状况和CD4细胞计数后，世界卫生组织临床III期和VI期患者出现任何口腔表现的几率增加了5.4倍（p均<0.01）。
在开始抗逆转录病毒治疗时，CD4细胞计数低以及处于世界卫生组织临床III期和IV期的患者中检测到口腔表现，这表明他们在开始艾滋病毒护理时免疫功能非常低下。早期识别口腔表现可以提高护理质量并确保抗逆转录病毒治疗的益处。
