Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
PLoS One. 2012;7(12):e52019. doi: 10.1371/journal.pone.0052019. Epub 2012 Dec 20.
To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS).
DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010.
SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41).
Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations.
The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4). The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4). During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years) and children aged 5-14 years (25.76) and oral candidiasis was the most common in children <5 years (25.79). Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001). Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia.
The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly after ART initiation. Access to appropriate disease prevention tools prior to ART, and early initiation of ART, are important for their prevention.
在资源有限的环境下(RLS),确定在早期抗逆转录病毒治疗(ART)期间出现世界卫生组织(WHO)临床 3 期和 4 期疾病的发生率。
设计/设置:对 2002 年至 2010 年间 8 个国家的 25 个无国界医生组织支持的艾滋病毒治疗项目中前瞻性收集的常规项目数据进行描述性分析。
受试者/参与者:35349 名研究参与者,ART 中位随访时间为 1.33 年(IQR 0.51-2.41)。
在 ART 启动后 5 个时期内,每 100 人年中出现 WHO 3 或 4 期疾病的发生率。根据 WHO 标准诊断疾病,并依靠临床评估,辅以基本实验室检查。
在 3 年内,任何 WHO 临床 3 或 4 期疾病的发生率为 40.02/100 人年(31.77 期为 3 期,8.25 期为 4 期)。在第 0-3 个月和第 25-36 个月之间,3 期和 4 期疾病的发生率下降了 97%以上(3 期为 77.81 至 2.40,4 期为 28.70 至 0.64)。在第 0-3 个月期间,肺结核是成年人(发病率为 22.24/100 人年)和 5-14 岁儿童(发病率为 25.76)中最常见的疾病诊断,而 5 岁以下儿童中最常见的疾病是口腔念珠菌病(发病率为 25.79)。与亚洲相比,非洲的总发病率更高(3 期为 43.98,4 期为 8.98)。肺结核、体重减轻、口腔和食管念珠菌病、慢性腹泻、艾滋病消耗综合征和严重细菌感染在非洲更为常见。在亚洲,肺外结核、非结核分枝杆菌感染、隐球菌病、青霉素病和弓形体病更为常见。
在 RLS 中,ART 早期出现 WHO 3 期和 4 期疾病的发生率较高,但随着时间的推移大大降低。这可能是由于 ART 的益处以及在 ART 开始后不久最病重的患者死亡。在开始 ART 之前获得适当的疾病预防工具,并尽早开始 ART,对于预防这些疾病非常重要。