Shamu Tinei, Chimbetete Cleophas, Shawarira-Bote Sandra, Mudzviti Tinashe, Luthy Ruedi
Newlands Clinic, Highlands, Harare, Zimbabwe.
School of Pharmacy, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe.
PLoS One. 2017 Oct 24;12(10):e0186726. doi: 10.1371/journal.pone.0186726. eCollection 2017.
Data on long-term outcomes of patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are few. We describe outcomes of patients commenced on ART at Newlands Clinic between 2004 and 2006 after ≥10 years of comprehensive care including, psychosocial, adherence and food support.
In this retrospective cohort study, patient data from an electronic medical record collected during routine care were analysed. We describe baseline characteristics, virological and clinical outcomes, attrition rates, and treatment adverse effects until November 2016. We defined virological suppression as viral load <50 copies/ml and virological failure as >1000 copies/ml after ≥6 months of ART.
We analysed data for 605 patients (67% female) who commenced ART, and were followed-up for 5819 person-years (median: 10.7 years, IQR: 10.1-11.4). Median age at ART initiation was 34 years (IQR: 17-42). Pre-ART, 129 (21.3%) patients had history of pulmonary tuberculosis (PTB). In care, 66 (11%) developed PTB, and 24 (4%) developed extrapulmonary tuberculosis. 385 (63.6%) patients experienced ≥1 adverse event, the most frequent being stavudine-induced peripheral neuropathy (n = 252, 41.7%). At database closure on 14 November 2016, 474 (78.3%) patients were still in care, 428 (90.3%) being virologically suppressed, and 21 (4.4%) failing. While 483 (79.8%) remained on first line, 122 (20.2%) were switched to second line ART. Fifty-nine patients (9.8%) were transferred to other ART facilities, 45 (7.4%) were lost to follow-up, 25 (4.1%) died, and two stopped ART.
Comprehensive HIV care can result in low mortality, high retention in care and virologic suppression rates in resource limited settings.
撒哈拉以南非洲地区接受抗逆转录病毒疗法（ART）患者的长期预后数据较少。我们描述了2004年至2006年期间在纽兰兹诊所开始接受ART治疗的患者在接受包括心理社会、依从性和食物支持在内的10年以上综合护理后的预后情况。
在这项回顾性队列研究中，分析了常规护理期间从电子病历中收集的患者数据。我们描述了截至2016年11月的基线特征、病毒学和临床结局、损耗率以及治疗不良反应。我们将病毒学抑制定义为ART治疗≥6个月后病毒载量<50拷贝/毫升，病毒学失败定义为病毒载量>1000拷贝/毫升。
我们分析了605例开始接受ART治疗的患者（67%为女性）的数据，随访了5819人年（中位数：10.7年，四分位间距：10.1 - 11.4年）。开始ART治疗时的中位年龄为34岁（四分位间距：17 - 42岁）。ART治疗前，129例（21.3%）患者有肺结核（PTB）病史。在接受护理期间，66例（11%）发生PTB，24例（4%）发生肺外结核。385例（63.6%）患者经历了≥1次不良事件，最常见的是司他夫定引起的周围神经病变（n = 252，41.7%）。在2016年11月14日数据库关闭时，474例（78.3%）患者仍在接受护理，428例（90.3%）病毒学得到抑制，21例（4.4%）治疗失败。虽然483例（79.8%）仍在接受一线治疗，但122例（20.2%）转为二线ART治疗。59例（9.8%）患者被转至其他ART治疗机构，45例（7.4%）失访，25例（4.1%）死亡，2例停止ART治疗。
在资源有限的环境中，全面的HIV护理可导致低死亡率、高护理保留率和病毒学抑制率。
