参与科特迪瓦国家抗逆转录病毒治疗项目的HIV-1和HIV-2感染成人患者治疗结果的时间趋势。
Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Côte d'Ivoire's national antiretroviral therapy program.
作者信息
Auld Andrew F, Ekra Kunomboa A, Shiraishi Ray W, Tuho Moise Z, Kouakou Joseph S, Mohamed Fayama, Ettiègne-Traoré Virginie, Sabatier Jennifer, Essombo Joseph, Adjorlolo-Johnson Georgette, Marlink Richard, Ellerbrock Tedd V
机构信息
Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire.
出版信息
PLoS One. 2014 May 27;9(5):e98183. doi: 10.1371/journal.pone.0098183. eCollection 2014.
BACKGROUND
In Côte d'Ivoire during 2004-2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective chart review to assess trends in patient characteristics and attrition [death or loss to follow-up (LTFU)] over time, among a nationally representative sample of 3,682 adults (≥15 years) initiating ART during 2004-2007 at 34 health facilities. Among ART enrollees during 2004-2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/µL. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004-2007, pharmacy-based estimates of the percentage of new ART enrollees ≥95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%-4% and LTFU from 12%-28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality.
CONCLUSIONS
During 2004-2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU.
背景
2004年至2007年期间，科特迪瓦接受抗逆转录病毒治疗（ART）的人数从不到5000人增加到36943人。全国代表性抗逆转录病毒治疗项目的成果趋势尚未见报道。
方法/主要发现：我们进行了一项回顾性病历审查，以评估2004年至2007年期间在34个医疗机构开始接受抗逆转录病毒治疗的3682名成年人（≥15岁）的全国代表性样本中，患者特征和流失情况（死亡或失访）随时间的变化趋势。在2004年至2007年接受抗逆转录病毒治疗的患者中，中位年龄为36岁，女性比例为67%，感染HIV-2或HIV-1&2双重反应性的比例为5%，基线CD4+T细胞（CD4）计数中位数为135个细胞/微升。将2004年开始接受抗逆转录病毒治疗的队列与2007年开始接受抗逆转录病毒治疗的队列进行比较，基线体重中位数从55公斤降至52公斤（p = 0.008），体重<45公斤的比例从17%增加到22%（p = 0.014）。在2004年至2007年期间，基于药房的新抗逆转录病毒治疗参与者中≥95%坚持治疗的百分比估计值从74%降至60%（p = 0.026），12个月的留存率从86%降至69%，这是由于12个月死亡率从2%增加到4%，失访率从12%增加到28%。在单变量分析中，开始抗逆转录病毒治疗的年份与失访率和死亡率均呈正相关。在控制了基线CD4、体重、依从性和其他风险因素后，开始抗逆转录病毒治疗的年份仍与失访率密切相关，但与死亡率无关。在多变量分析中，体重<45公斤和依从性<95%仍然是失访率和死亡率的强有力预测因素。
结论
在2004年至2007年期间，接受抗逆转录病毒治疗的患者中，包括体重<45公斤和抗逆转录病毒治疗依从性<95%在内的可测量死亡风险因素的患病率增加，可能解释了死亡率随时间的上升。然而，可以解释在较晚年份失访率增加的关联，并非本分析中评估的风险因素。未经记录的转移、政治不稳定以及患者对拥挤设施的不满可能解释了失访率的增加。
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