Bhatta Laxmi, Klouman Elise, Deuba Keshab, Shrestha Rachana, Karki Deepak Kumar, Ekstrom Anna Mia, Ahmed Luai Awad
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
BMC Infect Dis. 2013 Dec 26;13:604. doi: 10.1186/1471-2334-13-604.
Though financial and policy level efforts are made to expand antiretroviral treatment (ART) service free of cost, survival outcome of ART program has not been systematically evaluated in Nepal. This study assesses the mortality rates and determinants among adult HIV-infected patients on ART in Far-western region of Nepal.
This retrospective cohort study included 1024 (51.2% men) HIV-infected patients aged ≥15 years, who started ART between May 15th 2006 and May 15th 2011 in five ART sites in the Far-western region, Nepal. Follow-up time was calculated from the date of ART initiation to date of death or censoring (loss to follow-up, transferred out, or 15 November 2011). Mortality rates (per 100 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore determinants of mortality.
The median follow-up time was 19.1 months. The crude mortality rate was 6.3 (95% confidence interval (CI) 5.3-7.6) but more than three-times higher in first 3 months after ART initiation (21.9 (95% CI 16.6- 28.8)). About 12% (83% men) of those newly initiated on ART died during follow-up. The independent determinants of mortality were male sex (hazard ratio (HR) 4.55, 95% CI 2.43-8.51), poor baseline performance scale (bedridden <50% of the day during the past month, HR 2.05, 95% CI 1.19-3.52; bedridden >50% of the day during the past month, HR 3.41, 95% CI 1.67-6.98 compared to normal activity), one standard deviation decrease in baseline bodyweight (HR 1.04, 95% CI 1.01-1.07), and poor WHO clinical stage (stage III, HR 2.96, 95% CI 1.31-6.69; stage IV, HR 3.28, 95% CI 1.30-8.29 compared to WHO clinical stage I or II).
High mortality was observed within the first 3 months of ART initiation. Patients with poor baseline clinical characteristics had higher mortality, especially men. Earlier initiation of ART through expanded testing and counselling should be encouraged in HIV-infected patients.
尽管在财政和政策层面已努力免费扩大抗逆转录病毒治疗（ART）服务，但尼泊尔尚未对ART项目的生存结果进行系统评估。本研究评估了尼泊尔远西区接受ART治疗的成年HIV感染患者的死亡率及其决定因素。
这项回顾性队列研究纳入了1024名（51.2%为男性）年龄≥15岁的HIV感染患者，他们于2006年5月15日至2011年5月15日期间在尼泊尔远西区的五个ART治疗点开始接受ART治疗。随访时间从开始ART治疗之日计算至死亡或失访（随访失访、转出或2011年11月15日）。计算死亡率（每100人年）。采用Kaplan-Meier法和Cox回归模型估计生存率并探索死亡率的决定因素。
中位随访时间为19.1个月。粗死亡率为6.3（95%置信区间（CI）5.3 - 7.6），但在开始ART治疗后的前3个月内死亡率高出三倍多（21.9（95%CI 16.6 - 28.8））。约12%（83%为男性）新开始接受ART治疗的患者在随访期间死亡。死亡率的独立决定因素包括男性（风险比（HR）4.55，95%CI 2.43 - 8.51）、基线表现量表评分差（过去一个月卧床时间<50%，HR 2.05，95%CI 1.19 - 3.52；过去一个月卧床时间>50%，与正常活动相比，HR 3.41，95%CI 1.67 - 6.98）、基线体重下降一个标准差（HR
