喀麦隆接受维持性血液透析的HIV感染患者的生存情况：一项对比研究。
Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study.
作者信息
Halle Marie Patrice, Edjomo Anais Mfoula, Fouda Hermine, Djantio Hilaire, Essomba Noel, Ashuntantang Gloria Enow
机构信息
Faculty of Medicine and Pharmaceutical Sciences, Department of internal medicine-Douala general hospital Cameroon, University of Douala, Douala, PO Box: 4856, Cameroon.
Faculty of Medicine and Biomedical Sciences, Department of internal medicine- Douala general hospital Cameroon, Douala, University of Yaoundé I, Cameroon.
出版信息
BMC Nephrol. 2018 Jul 5;19(1):166. doi: 10.1186/s12882-018-0964-8.
BACKGROUND
There are conflicting reports on the impact of HIV in the era of combined antiretroviral (c-ART) on survival of patient with ESKD. We aimed to compare the one-year survival of HIV positive patients to that of their HIV negative counterparts with ESKD on maintenance haemodialysis in Cameroon.
METHODS
This was a retrospective cohort study conducted in the haemodialysis units of the Douala and Yaoundé General Hospitals. All HIV positive patients treated by maintenance haemodialysis between January 2007 and March 2015 were included. A comparative group of HIV negative patients with ESKD were matched for age, sex, co morbidities, year of dialysis initiation and haemodialysis unit. Relevant data at the time of haemodialysis initiation and during the first year of haemodialysis was noted. Survival was analysed using the Kaplan Meier and Cox regression hazard ratio estimator. A p value < 0.05 was considered statistically significant.
RESULTS
A total of 57 patients with HIV and 57 without HIV were included. Mean age was 46.25 ± 11.41 years, and 52.6% were females in both groups. HIV nephropathy (50.9%) was the main presumed aetiology of ESKD in the HIV group, while chronic glomerulonephritis (33.3%) and diabetes (21.1%) were the main aetiologies in the HIV negative group. At initiation of dialysis, the median CD4 count was 212 cell/mm (IQR; 138-455) and 77.2% were receiving c-ART. The proportion of patients who initiated dialysis with a temporary venous catheter was similar in both groups (p = 0.06). After one year on haemodialysis, survival rate was lower in the HIV positive group compared to the HIV negative group (61.4%/78.9%, HR: 2.05; 95% CI: 1.03-4.08; p = 0.042).Kaplan Meier survival curve was in direction of a lower survival in HIV positive group (p = 0.052).
CONCLUSION
The one year survival of HIV positive patients on maintenance haemodialysis in Cameroon seems to be lower compared to their HIV negative counterparts.
背景
关于在联合抗逆转录病毒治疗（c-ART）时代，HIV对终末期肾病（ESKD）患者生存的影响，存在相互矛盾的报道。我们旨在比较喀麦隆接受维持性血液透析的HIV阳性患者与HIV阴性的ESKD患者的一年生存率。
方法
这是一项在杜阿拉和雅温得总医院血液透析科进行的回顾性队列研究。纳入了2007年1月至2015年3月期间接受维持性血液透析治疗的所有HIV阳性患者。选取一组年龄、性别、合并症、透析起始年份和血液透析科室相匹配的HIV阴性ESKD患者作为对照组。记录血液透析起始时及血液透析第一年的相关数据。使用Kaplan Meier法和Cox回归风险比估计器分析生存率。p值<0.05被认为具有统计学意义。
结果
共纳入57例HIV阳性患者和57例HIV阴性患者。两组的平均年龄均为46.25±11.41岁，女性占比均为52.6%。HIV肾病（50.9%）是HIV组ESKD的主要推测病因，而慢性肾小球肾炎（33.3%）和糖尿病（21.1%）是HIV阴性组的主要病因。透析起始时，CD4细胞计数中位数为212个/mm³（四分位间距；138 - 455），77.2%的患者正在接受c-ART治疗。两组中起始透析时使用临时静脉导管的患者比例相似（p = 0.06）。血液透析一年后，HIV阳性组的生存率低于HIV阴性组（61.4%/78.9%，风险比：2.05；95%置信区间：1.03 - 4.08；p = 0.042）。Kaplan Meier生存曲线显示HIV阳性组的生存率较低（p = 0.052）。
结论
在喀麦隆，接受维持性血液透析的HIV阳性患者的一年生存率似乎低于HIV阴性患者。
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