高效抗逆转录病毒疗法的疗效及其预测因素:一项聚焦于埃塞俄比亚西南部结核合并感染的队列研究。
Outcomes of highly active antiretroviral therapy and its predictors: a cohort study focusing on tuberculosis co-infection in South West Ethiopia.
作者信息
Lenjisa Jimma Likisa, Wega Sultan Suleman, Lema Tefera Belachew, Ayana Gemeda Abebe
机构信息
Pharmacy Department, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
Pharmacy Department, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
出版信息
BMC Res Notes. 2015 Sep 15;8:446. doi: 10.1186/s13104-015-1417-0.
BACKGROUND
In this study, we hypothesized that TB co-infection independently increases the risk of poor treatment outcomes in such patients even if they are on antiretroviral therapy (ART). Therefore, this study was aimed at investigating this hypothesis among cohort of adult PLWHs in South West Ethiopia.
METHODOLOGY
Cohort study comparing the immunologic and clinical outcomes of 130 HIV/TB co-infected and 520 only HIV patients starting ART was enrolled. Chi square and student t test were used to compare outcome variables and logistic regression was used to assess the effect of TB on treatment failure.
RESULTS
In this study, TB co-infection didn't increase immunologic failure even in univariate analysis at both 6 [OR, 1.10 (0.59-1.69), P = 0.85] and 12 months [OR, 1.06 (0.58-1.93), P = 0.89] of ART initiation. However, it increased the risk of clinical failure at both 6 [Adjusted Odd Ratio (AOR), 2.90 (1.41-6.09), P = 0.028] and 12 months [AOR, 2.93 (1.41-6.09), P = 0.004] of ART initiation.
CONCLUSION
This study showed that TB co-infection didn't adversely affect the immunologic outcomes, weight and hemoglobin responses even though it increased the risk of clinical failure nearly three times. Therefore, beside the concern given for TB prevention and treatment, several patient and policy related factors need to be addressed to maximally benefit from highly active antiretroviral therapy rollout in resource limited settings.
背景
在本研究中,我们假设结核合并感染会独立增加此类患者治疗效果不佳的风险,即便他们正在接受抗逆转录病毒治疗(ART)。因此,本研究旨在埃塞俄比亚西南部的成年艾滋病毒感染者队列中调查这一假设。
方法
开展队列研究,比较130例开始接受ART的艾滋病毒/结核合并感染患者和520例仅感染艾滋病毒患者的免疫和临床结局。采用卡方检验和学生t检验比较结局变量,并使用逻辑回归评估结核对治疗失败的影响。
结果
在本研究中,结核合并感染即使在开始ART的6个月[比值比(OR),1.10(0.59 - 1.69),P = 0.85]和12个月[OR,1.06(0.58 - 1.93),P = 0.89]时的单因素分析中也未增加免疫失败风险。然而,在开始ART的6个月[调整后比值比(AOR),2.90(1.41 - 6.09),P = 0.028]和12个月[AOR,2.93(1.41 - 6.09),P = 0.004]时,它增加了临床失败的风险。
结论
本研究表明,结核合并感染虽使临床失败风险增加近三倍,但并未对免疫结局、体重和血红蛋白反应产生不利影响。因此,在资源有限的环境中,除了关注结核的预防和治疗外,还需要解决一些与患者和政策相关的因素,以便从高效抗逆转录病毒治疗的推广中最大程度地获益。