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在全国范围内扩大规模并提前开始治疗后，接受抗逆转录病毒疗法的艾滋病毒感染者的死亡率和失访率仍然很高吗？缅甸政府医院背景下的一项大型队列研究：2013-2016 年。

Are death and loss to follow-up still high in people living with HIV on ART after national scale-up and earlier treatment initiation? A large cohort study in government hospital-based setting, Myanmar: 2013-2016.

机构信息

National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.

International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.

出版信息

PLoS One. 2018 Sep 25;13(9):e0204550. doi: 10.1371/journal.pone.0204550. eCollection 2018.

DOI:10.1371/journal.pone.0204550
PMID:30252904
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6155560/
Abstract

SETTING: Myanmar National AIDS Program has had significant scale-up of services and changes in CD4 eligibility criterion for ART initiation from 2013 to 2016. This study assessed early death within 6 months and attrition (death and loss to follow-up, LTFU) after ART initiation and their associated factors. DESIGN: A retrospective cohort study on people living with HIV (PLHIV >15 year of age) enrolled at three specialist hospitals in Yangon from 1st June 2013 to 30th June 2016. Cox regression was used to calculate hazard ratios (HRs) of early death and attrition. RESULTS: Of 11,727 adults enrolled, 11,186 (95%) were initiated on ART, providing 15,964 person-years of follow-up. At baseline, median age was 36 years [IQR: 30-43], 58% were men and median CD4 count was 151 cells/mm3 (IQR: 54-310). There were 733(6%) early deaths, 961(9%) total deaths and 1371 (12%) LTFU during the study period. Independent risk factors for early death were older age (41-50 and ≥51 years) [aHR 1.38, 1.07-1.78 and 1.68, 1.21-2.34], male (1.84, 1.44-2.35), low weight (2.06, 1.64-2.59), bedridden, (3.81, 2.57-5.66) and CD4 count ≤ 50 cells/mm3 (6.83, 2.52-18.57). In addition to above factors, high attrition was associated with an abacavir-based regimen. CONCLUSION: Although there was a low rate of early deaths, patients were being diagnosed late and there was a high attrition rate from specialist hospitals. Concerted effort is required to increase early diagnosis and ART initiation, and strengthen community systems for HIV care to achieve ambitious goal of ending AIDS epidemic by 2030.

摘要

背景：缅甸国家艾滋病规划署（Myanmar National AIDS Program）自 2013 年至 2016 年，在服务范围和 CD4 细胞启动抗逆转录病毒治疗（ART）的资格标准方面都有显著的扩展。本研究评估了 6 个月内的早期死亡和 ART 启动后的流失（死亡和失访，LTFU）情况及其相关因素。

设计：这是一项回顾性队列研究，研究对象为 2013 年 6 月 1 日至 2016 年 6 月 30 日期间在仰光三家专科医院就诊的年龄≥15 岁的艾滋病毒感染者（PLHIV）。采用 Cox 回归计算早期死亡和流失的风险比（HRs）。

结果：在纳入的 11727 名成年人中，有 11186 人（95%）开始接受 ART 治疗，随访 15964 人年。基线时，中位年龄为 36 岁[IQR：30-43]，58%为男性，中位 CD4 计数为 151 个细胞/mm3[IQR：54-310]。研究期间，共有 733 人（6%）发生早期死亡，961 人（9%）总死亡，1371 人（12%）失访。年龄较大（41-50 岁和≥51 岁）[调整后风险比（aHR）为 1.38、1.07-1.78 和 1.68、1.21-2.34]、男性（1.84、1.44-2.35）、体重过低（2.06、1.64-2.59）、卧床不起（3.81、2.57-5.66）和 CD4 计数≤50 个细胞/mm3（6.83、2.52-18.57）是早期死亡的独立危险因素。除上述因素外，基于阿巴卡韦的治疗方案与较高的流失率相关。

结论：尽管早期死亡率较低，但患者的诊断较晚，且从专科医院流失的比例较高。需要共同努力，提高早期诊断和 ART 启动率，并加强社区艾滋病毒护理系统，以实现到 2030 年终结艾滋病流行的宏伟目标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad7d/6155560/a8fcd9e5b10e/pone.0204550.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad7d/6155560/635fa46f1145/pone.0204550.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad7d/6155560/a8fcd9e5b10e/pone.0204550.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad7d/6155560/635fa46f1145/pone.0204550.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad7d/6155560/a8fcd9e5b10e/pone.0204550.g002.jpg

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[2]
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[3]
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AIDS Res Ther. 2023-3-30

[4]
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[5]
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[6]
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AIDS Res Ther. 2021-8-9

[7]
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