Deconinck L, Yazdanpanah Y, Gilson R J, Melliez H, Viget N, Joly V, Sabin C A
UCL Research Department of Infection and Population Health, University College London, London, UK; Decision Sciences in Infectious Disease: Prevention, Control, and Care, IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France; Department of Infectious Diseases, Lille School of Medicine, Tourcoing Hospital, Tourcoing, France.
HIV Med. 2015 Apr;16(4):219-29. doi: 10.1111/hiv.12201. Epub 2014 Dec 18.
The aim of the study was to identify factors associated with the time between opportunistic disease (OD) diagnosis and antiretroviral therapy (ART) initiation in HIV-infected patients presenting for care with an OD, and to evaluate the outcomes associated with any delay.
A multicentre cohort study was undertaken in London, Paris and Lille/Tourcoing. The medical records of patients diagnosed from 2002 to 2012 were reviewed.
A total of 437 patients were enrolled in the study: 70% were male, the median age was 40 years, 42% were from sub-Saharan Africa, 68% were heterosexual, the median CD4 count was 40 cells/μL, and the most common ODs were Pneumocystis pneumonia (37%), tuberculosis (24%), toxoplasmosis (12%) and Kaposi's sarcoma (11%). Of these patients, 400 (92%) started ART within 24 weeks after HIV diagnosis, with a median time from OD diagnosis to ART initiation of 30 [interquartile range (IQR) 16-58] days. Patients diagnosed between 2009 and 2012 had a shorter time to ART initiation than those diagnosed in earlier years [hazard ratio (HR) 2.07; 95% confidence interval (CI) 1.58-2.72]. Factors associated with a longer time to ART initiation were a CD4 count ≥ 200 cells/μL (HR 0.30; 95% CI 0.20-0.44), tuberculosis (HR 0.40; 95% CI 0.30-0.55) and diagnosis in London (HR 0.62; 95% CI 0.48-0.80). Patients initiating 'deferred' ART (by ≥ 30 days) exhibited no difference in disease progression or immunovirological response compared with patients who had shorter times to ART initiation. Patients in the 'deferred' group were less likely to have ART modifications (HR 0.69; 95% CI 0.48-1.00) and had shorter in-patient stays (mean 14.2 days shorter; 95% CI 8.9-19.5 days) than patients in the group whose ART was not deferred.
The time between OD diagnosis and ART initiation remains heterogeneous and relatively long, particularly in individuals with a high CD4 count or tuberculosis or those diagnosed in London. Deferring ART was associated with fewer ART modifications and shorter in-patient stays.
本研究旨在确定在因机会性疾病（OD）就诊的HIV感染患者中，与OD诊断至开始抗逆转录病毒治疗（ART）的时间相关的因素，并评估任何延迟所带来的后果。
在伦敦、巴黎和里尔/图尔宽进行了一项多中心队列研究。回顾了2002年至2012年期间确诊患者的病历。
共有437名患者纳入研究：70%为男性，中位年龄为40岁，42%来自撒哈拉以南非洲，68%为异性恋，中位CD4细胞计数为40个/μL，最常见的OD为肺孢子菌肺炎（37%）、结核病（24%）、弓形虫病（12%）和卡波西肉瘤（11%）。在这些患者中，400名（92%）在HIV诊断后24周内开始ART，从OD诊断到开始ART的中位时间为30[四分位间距（IQR）16 - 58]天。2009年至2012年期间确诊的患者开始ART的时间比早年确诊的患者短[风险比（HR）2.07；95%置信区间（CI）1.58 - 2.72]。与开始ART时间较长相关的因素包括CD4细胞计数≥200个/μL（HR 0.30；95% CI 0.20 - 0.44）、结核病（HR 0.40；95% CI 0.30 - 0.55）以及在伦敦确诊（HR 0.62；95% CI 0.48 - 0.80）。与开始ART时间较短的患者相比，开始“延迟”ART（延迟≥30天）的患者在疾病进展或免疫病毒学反应方面无差异。“延迟”组患者进行ART调整的可能性较小（HR 0.69；95% CI 0.48 - 1.00），住院时间较短（平均短14.2天；95% CI 8.9 - 19.5天）。
OD诊断至开始ART的时间仍然存在差异且相对较长，尤其是在CD4细胞计数高或患有结核病的个体或在伦敦确诊的患者中。延迟ART与较少的ART调整和较短的住院时间相关。
