Médecins Sans Frontières, Paris, France.
Médecins Sans Frontières, Brussels, Belgium.
Clin Infect Dis. 2018 Mar 4;66(suppl_2):S126-S131. doi: 10.1093/cid/ciy103.
Human immunodeficiency virus (HIV) remains an important cause of hospitalization and death in low- and middle- income countries. Yet morbidity and in-hospital mortality patterns remain poorly characterized, with prior antiretroviral therapy (ART) exposure and treatment failure status largely unknown.
We studied HIV-infected inpatients aged ≥13 years from cohorts in Kenya and the Democratic Republic of Congo (DRC), assessing clinical and demographic characteristics and hospitalization outcomes. Kenyan inpatients were prospectively enrolled during hospitalization; identical retrospective data were extracted for Congolese patients meeting the study criteria using routine medical information.
Among 338 HIV-infected patients in Kenya and 411 in DRC, 83.7% (95% confidence interval [CI], 79.4%-87.3%) and 97.3% (95% CI, 95.2%-98.5%), were admitted with advanced disease (defined as CD4 <200 cells/µL or World Health Organization stage 3/4 illness). Among inpatients with advanced HIV, 35.4% and 21.7% were ART-naive at admission. Patients under care had a median time of 44.1 (interquartile range [IQR], 18.4-90.5) months and 55.9 (IQR, 28.1-99.6) months on treatment; 17.2% (95% CI, 13.5%-21.6%) and 29.6% (95% CI, 25.4%-34.3%) died, 25.9% (95% CI, 16.0%-39.0%) and 22.5% (95% CI, 15.8%-31.0%) of these within 48 hours.
Across 2 diverse clinical contexts in sub-Saharan Africa, advanced HIV inpatients were frequently admitted with low CD4 counts, often failing first-line ART. Earlier identification of treatment failure and rapid switching to second-line ART are needed.
在中低收入国家，人类免疫缺陷病毒（HIV）仍然是导致住院和死亡的重要原因。然而，发病率和住院死亡率模式仍未得到充分描述，先前的抗逆转录病毒治疗（ART）暴露和治疗失败状况在很大程度上未知。
我们研究了来自肯尼亚和刚果民主共和国（DRC）队列的年龄≥13 岁的 HIV 感染住院患者，评估了临床和人口统计学特征以及住院结局。肯尼亚住院患者在住院期间进行前瞻性入组；对于符合研究标准的刚果患者，使用常规医疗信息提取相同的回顾性数据。
在肯尼亚的 338 名 HIV 感染患者和 DRC 的 411 名患者中，83.7%（95%置信区间[CI]，79.4%-87.3%）和 97.3%（95%CI，95.2%-98.5%）因晚期疾病（定义为 CD4<200 个细胞/µL 或世界卫生组织 3/4 期疾病）入院。在患有晚期 HIV 的住院患者中，35.4%和 21.7%入院时未接受过 ART。在接受治疗的患者中，中位治疗时间分别为 44.1（四分位距[IQR]，18.4-90.5）和 55.9（IQR，28.1-99.6）个月；17.2%（95%CI，13.5%-21.6%）和 29.6%（95%CI，25.4%-34.3%）死亡，其中 25.9%（95%CI，16.0%-39.0%）和 22.5%（95%CI，15.8%-31.0%）在 48 小时内死亡。
在撒哈拉以南非洲的 2 个不同临床环境中，晚期 HIV 住院患者经常因低 CD4 计数入院，且经常首次一线 ART 治疗失败。需要更早地发现治疗失败并迅速切换至二线 ART。
