Hermanides Hillegonda, Holman Rebecca, Gras Luuk, Winkel Carel, Gerstenbluth Izzy, de Wolf Frank, Duits Ashley
1 Red Cross Blood Bank Foundation , Willemstad, Curaçao.
AIDS Res Hum Retroviruses. 2013 Oct;29(10):1300-5. doi: 10.1089/AID.2012.0362. Epub 2013 Aug 31.
We estimated the impact of loss to follow-up (LTFU) on the mortality rate among HIV-1-infected patients in Curaçao. A total of 214 therapy-naive HIV-1-infected patients aged 15 years or older upon entering into HIV care between January 2005 and July 2009 were included. Persons who discontinued follow-up for more than 365 days were defined as LTFU and traced with the aim of registering their vital status. If no personal contact could be made, data were matched with the Curaçao National Death Registry. Mortality rates were estimated before and after starting combination antiretroviral therapy (cART). We used log-rank tests to compare survival rates among patients LTFU and patients who experienced continuous follow-up. Pre-cART mortality in patients LTFU was similar to pre-cART mortality in those with continuous follow-up (p=0.79). All pre-cART deaths occurred within 6 months after entry. Low CD4 cell count was predictive of a shorter time to death after entry. Adjusting for those who were LTFU, the mortality rate after starting cART increased from 4.3 to 5.5 per 100 person years of observation (p=0.06). Mortality after starting cART was highest in the first 2 months after starting cART, especially for those who had late disease stage. Mortality rates were lower in patients with continuous follow-up compared to LTFUs (p<0.001). Mortality rates in HIV-1-infected patients who have started cART in Curaçao are underestimated as a result of inefficient patient administration combined with people starting cART at a very late disease stage. Monitoring HIV treatment could help in reducing the risk of LTFU and may improve the effect of treatment.
我们评估了失访对库拉索岛HIV-1感染患者死亡率的影响。纳入了2005年1月至2009年7月期间开始接受HIV治疗时年龄在15岁及以上的214例初治HIV-1感染患者。随访中断超过365天的患者被定义为失访，并进行追踪以登记其生命状态。如果无法进行个人联系，则将数据与库拉索岛国家死亡登记处进行匹配。在开始联合抗逆转录病毒治疗（cART）之前和之后估计死亡率。我们使用对数秩检验比较失访患者和持续随访患者的生存率。失访患者的cART前死亡率与持续随访患者的cART前死亡率相似（p=0.79）。所有cART前死亡均发生在入组后6个月内。低CD4细胞计数可预测入组后较短的死亡时间。在调整了失访患者后，开始cART后的死亡率从每100人年观察期4.3例增加到5.5例（p=0.06）。开始cART后的死亡率在开始cART后的前2个月最高，尤其是疾病晚期患者。持续随访患者的死亡率低于失访患者（p<0.001）。由于患者管理效率低下以及患者在疾病晚期才开始接受cART，库拉索岛开始接受cART的HIV-1感染患者的死亡率被低估。监测HIV治疗有助于降低失访风险，并可能提高治疗效果。
