Dragovic Gordana, Smith Colette, Jevtovic Djordje, Kusic Jovana, Salemovic Dubravka, Ranin Jovan
Department of Pharmacology and Clinical Pharmacology, School of Medicine, University of Belgrade, Belgrade, Serbia and Montenegro.
Research Department of Infection and Population H, UCL Medical School, London, UK.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19620. doi: 10.7448/IAS.17.4.19620. eCollection 2014.
Antiretroviral (ARV) treatment available in low-middle income countries differs as suggested in international HIV-treatment guidelines. Thus, we compared ARV regimens introduced as a first-line therapy, time of initiation, frequency of making combination antiretroviral therapy (cART) switches, frequency of viral and immunological monitoring and treatment outcome in south east European (SEE) country (i.e. HIV Centre in Belgrade, Serbia, (HCB)) and west European country (i.e. Royal Free Centre for HIV Medicine at the Royal Free Hospital London, UK (RFH)).
ARV naïve patients starting cART from 2003 to 2012 were included. Comparisons of the two cohorts were made using a chi-square test or Fisher's exact test for categorical variables and a Mann-Witney U test for continuous variables. Kaplan Meier survival curves were compared using the log rank test.
Of 597 patients from HCB, 361 (61%) initiated cART with prior AIDS diagnosed, while 337 (19%) of 1763 patients from RFH. Average baseline CD4+ T cell counts were significantly lower in Serbia than in UK (177 cells/mm(3) vs 238 cells/mm(3)). The total (mediana, IQR) CD4+ T cell count measurements in the first year of cART was 2 (1, 2) at the HCB, while it was statistically significant higher at the RFH 5 (3, 7), respectively (p<0.0001). At the RFH, it appeared that the cART switching is due to patient's preference or toxicity (46%), while the lack of supply and toxicity (37%) were the most important reasons for treatment change in HCB, within the same period of time (p<0.05). Mortality rates were higher at the HCB versus RFH (p<0.0001). After 12, 24 and 36 months of cART, 3%, 5% and 8% of patients died in HCB, whereas 2%, 3% and 4% of patients died in RFH, respectively (Figure 1).
In south European countries, as a consequence of low testing rate, ARV treatment is introduced at an advanced stage of disease, having a high mortality rate as a consequence. Switching within ARV drugs appears often due to lack of drug supplies and frequently drug-related toxicity in south east Europe, while in the east European country due to patient's preferences and rarely due to drug-related toxicity.
正如国际艾滋病治疗指南所建议的那样，中低收入国家可用的抗逆转录病毒（ARV）治疗方法存在差异。因此，我们比较了作为一线治疗引入的抗逆转录病毒治疗方案、开始治疗的时间、联合抗逆转录病毒治疗（cART）换药的频率、病毒和免疫监测的频率以及东南欧（SEE）国家（即塞尔维亚贝尔格莱德的艾滋病中心（HCB））和西欧国家（即英国伦敦皇家自由医院的皇家自由艾滋病医学中心（RFH））的治疗结果。
纳入2003年至2012年开始接受cART治疗的初治抗逆转录病毒患者。对两组队列进行比较时，分类变量采用卡方检验或费舍尔精确检验，连续变量采用曼-惠特尼U检验。使用对数秩检验比较Kaplan-Meier生存曲线。
在HCB的597名患者中，361名（61%）在确诊艾滋病之前开始接受cART治疗，而在RFH的1763名患者中，这一比例为337名（19%）。塞尔维亚患者的平均基线CD4+T细胞计数显著低于英国（177个细胞/mm³对238个细胞/mm³）。cART治疗第一年的CD4+T细胞计数总数（中位数，四分位间距）在HCB为2（1，2），而在RFH显著更高，为5（3，7）（p<0.0001）。在RFH，cART换药似乎是由于患者的偏好或毒性（46%），而在同一时期，药物供应不足和毒性（37%）是HCB治疗改变的最重要原因（p<0.05）。HCB的死亡率高于RFH（p<0.0001）。在cART治疗12、24和36个月后，HCB分别有3%、5%和8%的患者死亡，而RFH分别有2%、3%和4%的患者死亡（图1）。
在南欧国家，由于检测率低，抗逆转录病毒治疗在疾病晚期引入，导致死亡率很高。在东南欧，抗逆转录病毒药物的换药往往是由于药物供应不足以及频繁出现的与药物相关的毒性，而在东欧国家，换药是由于患者的偏好，很少是由于与药物相关的毒性。
