Memiah Peter, Mbizo Justice, Komba Patience, Telwa Euphrasia, Mwakyusa Sekela, Maghimbi Abuu, Etienne Martine, Phillips Aimee, Swain Courtney, Hill Aaron, Shumba Constance, Biadgilign Sibhatu
University of West Florida, Public Health Program, Pensacola, FL USA.
University of Maryland, School of Medicine-Institute of Human Virology, Dare salaam, Tanzania.
J Res Appl Sci. 2016;3(1):178-185.
Development of HAART in the mid-1990's and its continued scale up has revolutionized the treatment of HIV-infected patients and led to remarkable reductions in HIV associated morbidity and mortality. However, recent studies have suggested a higher risk for early mortality in adults receiving ART in low-income countries as compared to those in high-income countries. There is dearth of data from developing countries where the burden of disease is high. The objective is to describe the burden and correlation between early vs. delayed mortality associated with HIV/AIDS in resource poor settings using data from Tanzania in East Africa. We performed a cross-sectional evaluation of routinely collected program data for 991 HIV-positive deceased adult patients who were placed on ART treatment, and died between January 1, 2007 and December 31, 2012. Data used were abstracted from records of patients who were treated at six health facilities in the Lake-zone Region of Tanzania in the timeframe. Bivariate and multivariate regression models were used to identify independent predictors of mortality and to calculate odds ratios. From the population, early deaths (within 3 months of ART initiation) occurred in 359 of the 991 cases, which represented 36.2%; while delayed deaths (after 3 months of ART initiation) occurred in 632 of 991 (63.8%). The average time to death for those who died within 3 months was 1 month compared to 22 months among those who died at > 3 months since initiation of ARV. In multivariate analysis, patients who were on WHO stage IV, had fever and cough symptoms at 6 months prior to death and patients with 0-1, 2-3, and 4-6 clinic visits had a higher risk of death in the first 3 months. Mortality among patients started on ART seems to be high. Where possible, healthcare providers should do more to vigorously monitor patients before starting them on ART for better outcomes. Additionally, public health efforts to encourage early testing and entry into treatment must be scaled up in resource poor countries to gain some lead-time and to keep the virus under control, sustain immune function, and delay the onset of opportunistic infections.
20世纪90年代中期高效抗逆转录病毒疗法（HAART）的出现及其持续推广，彻底改变了对HIV感染患者的治疗方式，并显著降低了与HIV相关的发病率和死亡率。然而，最近的研究表明，与高收入国家的成年人相比，低收入国家接受抗逆转录病毒治疗（ART）的成年人早期死亡风险更高。疾病负担较重的发展中国家缺乏相关数据。目的是利用东非坦桑尼亚的数据，描述资源匮乏地区与HIV/AIDS相关的早期死亡与延迟死亡之间的负担及相关性。我们对991例接受ART治疗且于2007年1月1日至2012年12月31日期间死亡的HIV阳性成年患者的常规收集项目数据进行了横断面评估。所使用的数据摘自该时间段内在坦桑尼亚湖区地区六个医疗机构接受治疗的患者记录。采用双变量和多变量回归模型来确定死亡率的独立预测因素并计算比值比。在这991例病例中，有359例（占36.2%）在开始ART治疗后的3个月内死亡，即早期死亡；而991例中有632例（占63.8%）在开始ART治疗3个月后死亡，即延迟死亡。开始ART治疗后3个月内死亡者的平均死亡时间为1个月，而开始抗逆转录病毒治疗3个月后死亡者的平均死亡时间为22个月。在多变量分析中，处于世界卫生组织IV期、在死亡前6个月有发热和咳嗽症状的患者，以及门诊就诊次数为0 - 1次、2 - 3次和4 - 6次的患者在开始治疗的前3个月死亡风险更高。开始接受ART治疗的患者死亡率似乎较高。在可能的情况下，医疗服务提供者应在患者开始接受ART治疗前更加积极地进行监测，以获得更好的治疗效果。此外，在资源匮乏的国家，必须加大公共卫生方面鼓励早期检测和开始治疗的力度，以争取一些时间优势，控制病毒、维持免疫功能并延缓机会性感染的发生。
