Omole Olufemi B, Semenya Mary-Anne M L
Department of Family Medicine, University of the Witwatersrand, South Africa.
South Afr J HIV Med. 2016 May 27;17(1):414. doi: 10.4102/sajhivmed.v17i1.414. eCollection 2016.
To assess the treatment outcomes of an HIV clinic in rural Limpopo province, South Africa.
A retrospective cohort study involving medical records review of HIV-positive patients initiated on antiretroviral treatment (ART) was conducted from December 2007 to November 2008 at Letaba Hospital. Data on socio-demographic characteristics, CD4 counts, viral loads (VLs), opportunistic infections, adverse effects of treatment, hospital admissions, and patient retention at 6, 12, 24, and 36 months on ART were collected. Analysis included descriptive statistics, chi-square and -tests.
Of 124 patient records sampled, the majority of patients were female (69%), single (49%), unemployed (56%), living at least 10 km from the hospital (52.4%), and were on treatment at 36 months (69%). Approximately 84% of patients achieved viral suppression (VLs < 400 copies/mL) by 6 months of ART and the mean CD4 count increased from 128 at baseline to 470 cells/mm at 24 months. There was a mean weight gain of 5.9 kg over the 36 months and the proportion of patients with opportunistic infections decreased from 54.8% ( = 68) at baseline to 15.3% ( = 19) at 36 months. Although the largest improvements in CD4, VLs, and weights were recorded in the first 6 months of ART, viral rebound became evident thereafter. Of all variables, only age < 50 years and being pregnant were significantly associated with higher VLs ( = 0.03).
Good treatment outcomes are achievable in a rural South African ART clinic. However, early viral rebound and higher VLs in pregnancy highlight the need for enhanced treatment adherence support, especially for pregnant women to reduce the risk of mother to child transmission.
评估南非林波波省农村地区一家艾滋病诊所的治疗效果。
2007年12月至2008年11月在莱塔巴医院开展了一项回顾性队列研究，涉及对开始接受抗逆转录病毒治疗（ART）的HIV阳性患者的病历进行审查。收集了关于社会人口学特征、CD4细胞计数、病毒载量（VL）、机会性感染、治疗不良反应、住院情况以及患者在接受ART治疗6个月、12个月、24个月和36个月时的留存率的数据。分析包括描述性统计、卡方检验和t检验。
在抽取的124份患者病历中，大多数患者为女性（69%）、单身（49%）、失业（56%）、居住在距离医院至少10公里处（52.4%），并且在36个月时仍在接受治疗（69%）。约84%的患者在接受ART治疗6个月时实现了病毒抑制（VL<400拷贝/毫升），CD4细胞计数的平均值从基线时的128增加到24个月时的470个细胞/立方毫米。在36个月期间平均体重增加了5.9千克，机会性感染患者的比例从基线时的54.8%（n=68）降至36个月时的15.3%（n=19）。尽管在ART治疗的前6个月CD4细胞计数、VL和体重改善最为明显，但此后病毒反弹变得明显。在所有变量中，只有年龄<50岁和怀孕与较高的VL显著相关（P=0.03）。
在南非农村地区的ART诊所可以实现良好的治疗效果。然而，早期病毒反弹和孕期较高的VL突出表明需要加强治疗依从性支持，特别是对于孕妇，以降低母婴传播风险。
