计划外护理中断对尼日利亚队列中抗逆转录病毒治疗开始后早期CD4反应的影响。
Impact of Unplanned Care Interruption on CD4 Response Early After ART Initiation in a Nigerian Cohort.
作者信息
Ahonkhai Aimalohi A, Adeola Juliet, Banigbe Bolanle, Onwuatuelo Ifeyinwa, Adegoke Abdulkabir B, Bassett Ingrid V, Losina Elena, Freedberg Kenneth A, Okonkwo Prosper, Regan Susan
机构信息
1 Division of infectious Disease, Massachusetts General Hospital, Boston, MA, USA.
2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
出版信息
J Int Assoc Provid AIDS Care. 2017 Jan/Feb;16(1):98-104. doi: 10.1177/2325957416672010. Epub 2016 Oct 10.
The authors conducted a retrospective cohort study of unplanned care interruption (UCI) among adults initiating antiretroviral therapy (ART) from 2009 to 2011 in a Nigerian clinic. The authors used repeated measures regression to model the impact of UCI on CD4 count upon return to care and rate of CD4 change on ART. Among 2496 patients, 83% had 0, 15% had 1, and 2% had ≥2 UCIs. Mean baseline CD4 for those with 0, 1, or ≥2 UCIs was 228/cells/mm, 355/cells/mm, and 392/cells/mm ( P < .0001), respectively. The UCI was associated with a 62 CD4 cells/mm decrease (95% confidence interval [CI]: -78 to -45) at next measurement. In months 1 to 6 on ART, patients with 0 UCI gained 10 cells/µL/mo (95% CI: 7-4). Those with 1 and ≥2 UCIs lost 2 and 5 cells/µL/mo (95% CI: -18 to 13 and -26 to 16). Patients with UCI did not recover from early CD4 losses associated with UCI. Preventing UCI is critical to maximize benefits of ART.
作者对2009年至2011年在尼日利亚一家诊所开始接受抗逆转录病毒治疗（ART）的成年人中的计划外治疗中断（UCI）进行了一项回顾性队列研究。作者使用重复测量回归来模拟UCI对恢复治疗时CD4细胞计数的影响以及ART治疗中CD4变化率的影响。在2496名患者中，83%的患者有0次UCI，15%的患者有1次UCI，2%的患者有≥2次UCI。0次、1次或≥2次UCI患者的平均基线CD4分别为228个细胞/mm³、355个细胞/mm³和392个细胞/mm³（P <.0001）。UCI与下次测量时CD4细胞/mm³减少62个细胞（95%置信区间[CI]：-78至-45）相关。在接受ART治疗的第1至6个月，0次UCI的患者每月增加10个细胞/µL（95% CI：7 - 4）。有1次和≥2次UCI的患者分别每月减少2个和5个细胞/µL（95% CI：-18至13和-26至1
6）。UCI患者未从与UCI相关的早期CD4损失中恢复。预防UCI对于最大化ART的益处至关重要。
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