Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
Comprehensive Care Clinic Department, ACK Maseno Hospital, Maseno, Kenya.
J Microbiol Immunol Infect. 2017 Dec;50(6):781-788. doi: 10.1016/j.jmii.2015.10.009. Epub 2015 Dec 2.
BACKGROUND/PURPOSE: This study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients.
We conducted a retrospective nested case-control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5 years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS.
Only 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2-105.1]. Patients with low latest CD4 count (≤350 cells/mm) had a seven-times greater risk of developing KS than did their counterparts (HRs: 7.1, 95% CI: 1.4-36.2).
Imperfect HAART adherence and low latest CD4 count are significantly associated with KS development.
背景/目的：本研究旨在评估高效抗逆转录病毒治疗（HAART）依从性与人类免疫缺陷病毒（HIV）/艾滋病患者卡波西肉瘤（KS）发展之间的关联。
我们对 2005 年 1 月至 2013 年 10 月在肯尼亚马塞纳医院接受 HAART 治疗的 165 名参与者（33 例病例和 132 例对照）进行了回顾性巢式病例对照研究。病例为 HIV 阳性且患有 KS 的成年人，他们根据年龄（每个病例±5 岁）、性别和 KS 诊断日期与对照组以 1:4 的比例匹配。通过患者自我报告和药丸计数，在每次就诊时评估 HAART 的完美依从性。卡方检验用于比较病例和对照组的社会经济和临床状况。采用条件逻辑回归评估 HAART 的完美依从性、最新 CD4 计数、教育水平、距离医疗机构、初始世界卫生组织分期和固定性伴侣数量对 KS 发展的影响。
只有 63.6%的参与者报告了完美的依从性，对照组的完美依从性比例（75.0%）明显高于病例组（18.2%）。在调整了基线和临床特征的潜在不平衡后，不完美 HAART 依从性的患者发生 KS 的风险是完美 HAART 依从性患者的 20 倍[风险比：21.0，95%置信区间：4.2-105.1]。最新 CD4 计数低（≤350 个细胞/mm）的患者发生 KS 的风险是其对应者的 7 倍[风险比：7.1，95%置信区间：1.4-36.2]。
不完美的 HAART 依从性和低最新 CD4 计数与 KS 的发生显著相关。
