Médecins Sans Frontières/Doctors Without Borders, Harare, Zimbabwe.
Médecins Sans Frontières/Doctors Without Borders, Berlin, Germany.
PLoS One. 2019 Apr 10;14(4):e0214739. doi: 10.1371/journal.pone.0214739. eCollection 2019.
HIV continues to be one of the leading causes of infectious death worldwide and presentation with advanced HIV disease is associated with increased morbidity and mortality. Recommendations for the management of advanced HIV disease include prompt screening and treatment of opportunistic infections, rapid initiation of ART and intensified adherence support. We present treatment outcomes of a cohort of patients presenting with advanced HIV disease in a semi-urban Zimbabwean polyclinic.
Retrospective cohort analysis of adult patients enrolled for care at Epworth polyclinic, Zimbabwe between 2007 and end June 2016. Treatment outcomes at 6 and 12 months were recorded. Multivariate logistical regression analysis was undertaken to identify risk factors for presentation with advanced HIV Disease (CD4 count less than 200 cells/mm3 or WHO stage 3 or 4) and risks for attrition at 12 months.
16,007 anti-retroviral therapy naive adult patients were included in the final analysis, 47.4% of whom presented with advanced HIV disease. Patients presenting with advanced HIV disease had a higher mortality rate at 12 months following enrollment compared to early stage patients (5.11% vs 0.45%). Introduction of a package of differentiated care for patients with a CD4 count of less than 100 cells/mm3 resulted in diagnosis of cryptococcal antigenaemia in 7% of patients and a significant increase in the diagnosis of TB, although there was no significant difference in attrition at 6 or 12 months for these patients compared to those enrolled prior to the introduction of the differentiated care.
The burden of advanced HIV disease remained high over the study period in this semi-urban polyclinic in Zimbabwe. Introduction of a package of differentiated care for those with advanced HIV disease increased the diagnosis of opportunistic infections and represents a model of care which can be replicated in other polyclinics in the resource constrained Zimbabwean context.
艾滋病病毒仍然是全球主要传染病死因之一，晚期艾滋病的出现与发病率和死亡率的增加有关。晚期艾滋病管理的建议包括及时筛查和治疗机会性感染、迅速启动抗逆转录病毒治疗和加强遵医嘱服药支持。我们介绍了在津巴布韦一个半城市的综合诊所中，一组出现晚期艾滋病的患者的治疗结果。
对 2007 年至 2016 年 6 月底期间在津巴布韦 Epworth 综合诊所登记的成年患者进行回顾性队列分析。记录了 6 个月和 12 个月的治疗结果。采用多变量逻辑回归分析，确定出现晚期艾滋病（CD4 计数<200 个细胞/mm3 或世界卫生组织 3 或 4 期）的危险因素，以及 12 个月时退出治疗的风险因素。
最终分析纳入了 16007 名未接受过抗逆转录病毒治疗的成年患者，其中 47.4%的患者出现了晚期艾滋病。与早期阶段的患者相比，晚期艾滋病患者在登记后 12 个月的死亡率更高（5.11%比 0.45%）。对于 CD4 计数<100 个细胞/mm3 的患者，引入了一套差异化护理方案，结果导致 7%的患者诊断出隐球菌抗原血症，结核病的诊断显著增加，尽管与引入差异化护理方案之前登记的患者相比，这些患者在 6 个月或 12 个月时的退出率没有显著差异。
在津巴布韦这个半城市综合诊所，在研究期间，晚期艾滋病的负担仍然很高。为晚期艾滋病患者引入一套差异化护理方案增加了机会性感染的诊断，为资源有限的津巴布韦背景下的其他综合诊所提供了一种护理模式。
