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埃塞俄比亚南奥莫金卡医院接受抗逆转录病毒治疗的人类免疫缺陷病毒患者的生存情况及死亡预测因素:一项六年回顾性队列研究

Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study.

作者信息

Tachbele Erdaw, Ameni Gobena

机构信息

Department of Nursing and Midwifery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.

Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.

出版信息

Epidemiol Health. 2016 Nov 6;38:e2016049. doi: 10.4178/epih.e2016049. eCollection 2016.

Abstract

OBJECTIVES

The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia.

METHODS

A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models.

RESULTS

Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97).

CONCLUSIONS

Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.

摘要

目的

在埃塞俄比亚,接受治疗的人类免疫缺陷病毒(HIV)感染患者的生存率情况鲜为人知。本研究旨在确定埃塞俄比亚南部奥莫地区金卡医院接受抗逆转录病毒疗法(ART)的HIV感染成年患者的生存率及死亡预测因素。

方法

进行了一项为期6年的回顾性队列研究,使用从2010年9月至2015年8月在金卡医院接受ART治疗的1899名患者中抽取的350份患者记录。数据采用Kaplan-Meier统计法和Cox回归模型进行分析。

结果

在350名研究参与者中,315名(90.0%)被截尾,35名(10.0%)死亡。22名(62.9%)死亡发生在治疗的第一年。总随访时间为1995人年,发病率为每100人年1.75例死亡。接受高效抗逆转录病毒疗法(HAART)患者的平均生存时间为30.84±19.57个月。在随访72个月时,接受HAART患者的总体生存率为64.00%(95%置信区间[CI],61.85%至66.21%)。死亡的显著预测因素包括未披露HIV感染状况(调整后风险比[aHR],5.82;95%CI,1.91至17.72)、有结核病病史(aHR,1.82;95%CI,1.41至3.51)、非卧床(aHR,2.97;95%CI,1.20至8.86)或卧床(aHR,4.67;95%CI,1.30至17.27)功能状态、世界卫生组织(WHO)临床IV期疾病(aHR,24.97;95%CI,2.75至26.45)以及药物滥用者(aHR,3.72;95%CI,1.39至9.97)。

结论

有结核病治疗史、非卧床或卧床功能状态、WHO临床晚期疾病以及药物滥用者的患者应受到密切监测,尤其是在开始抗逆转录病毒治疗后的头几个月。还应鼓励患者向其亲属披露自身状况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f10e/5309728/b8b7352ea225/epih-38-e2016049f1.jpg

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