在资源有限的环境中，营养不良和社会决定因素对开始抗逆转录病毒治疗的 HIV 感染成年人的生存的影响。

Impact of malnutrition and social determinants on survival of HIV-infected adults starting antiretroviral therapy in resource-limited settings.

机构信息

Department of Infectious Diseases, Nouvel Hopital Civil, Strasbourg, France.

出版信息

AIDS. 2012 Jun 1;26(9):1161-6. doi: 10.1097/QAD.0b013e328353f363.

DOI:10.1097/QAD.0b013e328353f363

PMID:22472856

Abstract

OBJECTIVES

Determining the impact of malnutrition, anaemia and social determinants on survival once starting antiretroviral therapy (ART) in a cohort of HIV-infected adults in a rural HIV care centre in Sihanoukville, Cambodia.

METHODS

Retrospective and descriptive cohort study of adults starting ART between December 2004 and July 2009. We used the Kaplan-Meier and Cox regression survival analyses to identify predictors of death.

RESULTS

Out of 1002 patients, 49.7% were men; median age was 40; median time of follow-up was 2.4 years and 10.4% died during the follow-up. At baseline, median CD4 cell count was 83 cells/μl, 79.9% were at WHO stage III or IV. In multivariate analysis, malnutrition appeared to be a strong and independent risk factor of death; 11.2% had a BMI less than 16 kg/m and hazard ratio was 6.97 [95% confidence interval (CI), 3.51-13.89], 21.5% had a BMI between 16 and 18 kg/m and hazard ratio was 2.88 (95% CI, 1.42-5.82), 30.8% had a BMI between 18 and 20 kg/m and hazard ratio was 2.18 (95% CI, 1.09-4.36). Severe anaemia (haemoglobin≤8.4 g/dl) and CD4 cell count below 100 cells/μl also predicted mortality, hazard ratio were 2.25 (95% CI, 1.02-4.34) and 2.29 (95% CI, 1.01-2.97), respectively. Social determinants were not significantly associated with death in univariate analysis.

CONCLUSION

Malnutrition and anaemia are strong and independent prognostic factors at the time of starting ART. Nutritional cares are essential for the clinical success of HIV programs started in developing countries.

摘要

目的

在柬埔寨西哈努克城的一个农村艾滋病毒护理中心，对一组感染艾滋病毒的成年人开始抗逆转录病毒治疗（ART）后，确定营养不良、贫血和社会决定因素对生存的影响。

方法

这是一项回顾性和描述性队列研究，纳入了 2004 年 12 月至 2009 年 7 月期间开始接受 ART 的成年人。我们使用 Kaplan-Meier 和 Cox 回归生存分析来确定死亡的预测因素。

结果

在 1002 名患者中，49.7%为男性；中位年龄为 40 岁；中位随访时间为 2.4 年，10.4%在随访期间死亡。基线时，中位 CD4 细胞计数为 83 个/μl，79.9%处于世界卫生组织（WHO）III 或 IV 期。多变量分析显示，营养不良似乎是死亡的一个强烈且独立的危险因素；11.2%的患者 BMI 小于 16 kg/m2，风险比为 6.97（95%置信区间[CI]，3.51-13.89），21.5%的患者 BMI 在 16 至 18 kg/m2 之间，风险比为 2.88（95%CI，1.42-5.82），30.8%的患者 BMI 在 18 至 20 kg/m2 之间，风险比为 2.18（95%CI，1.09-4.36）。严重贫血（血红蛋白≤8.4 g/dl）和 CD4 细胞计数低于 100 个/μl 也预测死亡率，风险比分别为 2.25（95%CI，1.02-4.34）和 2.29（95%CI，1.01-2.97）。在单变量分析中，社会决定因素与死亡无显著相关性。