Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America.
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2023 Oct 11;18(10):e0292660. doi: 10.1371/journal.pone.0292660. eCollection 2023.
For adults and adolescents, the World Health Organization defines advanced HIV disease (AHD) as a CD4 (cluster of differentiation 4) count of <200 cells/mm3 or a clinical stage 3 or 4 event. We describe clinical outcomes in a cohort of AHD patients at two regional hospitals in Lesotho. From November 2018-June 2019, we prospectively enrolled eligible patients (≥15 years) not on antiretroviral therapy (ART) presenting with WHO-defined AHD into a differentiated model of care for AHD (including rapid ART initiation) and followed them for six months. All patients received Tuberculosis (TB) symptom screening with further diagnostic testing; serum cryptococcal antigen (CrAg) screening was done for CD4 <100 cells/mm3 or WHO clinical stage 3 or 4. Medical record data were abstracted using visit checklist forms. Categorical and continuous variables were summarized using frequencies, percentages, and means, respectively. Kaplan-Meier was used to estimate survival. Of 537 HIV-positive patients screened, 150 (27.9%) had AHD of which 109 were enrolled. Mean age was 38 years and 62 (56.9%) were men. At initial clinic visit, 8 (7.3%) were already on treatment and 33% (36/109) had presumptive TB per symptom screening. Among 39/109 (40.2%) patients screened for CrAg at initial visit, five (12.8%) were CrAg-positive. Among 109 enrolled, 77 (70.6%) initiated ART at their initial clinic visit, while 32 delayed ART initiation (median delay: 14 days). Of the 109 participants enrolled, 76 (69.7%) completed the 6-month follow-up, 17 (15.6%) were lost to follow-up, 5 (4.6%) transferred to other health facilities and 11 (10.1%) died. The 6-month survival was 87.4%; among 74 patients with a viral load result, 6-month viral suppression (<1,000 copies/ml) was 85.1%. Our study found that even after the implementation of Test and Treat of ART in 2016 in Lesotho, over 25% of patients screened had AHD. Patients with AHD had a high prevalence of TB and CrAg positivity, underscoring the need to assess for AHD and rapidly initiate ART within a package of AHD care for optimal patient outcomes.
对于成人和青少年，世界卫生组织将晚期 HIV 疾病 (AHD) 定义为 CD4（分化群 4）计数<200 个细胞/mm3 或临床分期 3 或 4 期。我们描述了莱索托两家地区医院的一组 AHD 患者的临床结局。从 2018 年 11 月至 2019 年 6 月，我们前瞻性招募了未接受抗逆转录病毒治疗 (ART)、符合世卫组织定义的 AHD 标准且年龄在 15 岁及以上的患者进入 AHD 的差异化护理模式（包括快速开始 ART），并对他们进行了六个月的随访。所有患者均接受结核病 (TB) 症状筛查和进一步的诊断性检测；对于 CD4<100 个细胞/mm3 或世卫组织临床分期 3 或 4 期的患者，进行血清隐球菌抗原 (CrAg) 筛查。使用就诊检查表表格提取病历数据。使用频率、百分比和平均值分别总结分类和连续变量。使用 Kaplan-Meier 估计生存率。在筛查的 537 名 HIV 阳性患者中，有 150 名（27.9%）患有 AHD，其中 109 名入组。平均年龄为 38 岁，62 名（56.9%）为男性。在初次就诊时，8 名（7.3%）已经在接受治疗，33%（36/109）根据症状筛查有疑似结核病。在 39/109 名（40.2%）初次就诊时接受 CrAg 筛查的患者中，有 5 名（12.8%）CrAg 阳性。在 109 名入组患者中，有 77 名（70.6%）在初次就诊时开始接受 ART 治疗，而 32 名延迟了 ART 治疗（中位延迟时间：14 天）。在 109 名入组患者中，有 76 名（69.7%）完成了 6 个月的随访，17 名（15.6%）失访，5 名（4.6%）转至其他医疗机构，11 名（10.1%）死亡。6 个月生存率为 87.4%；在有病毒载量结果的 74 名患者中，6 个月时病毒抑制率（<1,000 拷贝/ml）为 85.1%。我们的研究发现，即使在 2016 年莱索托实施了“检测即治疗”ART 之后，仍有超过 25%的筛查患者患有 AHD。患有 AHD 的患者结核病和 CrAg 阳性率较高，这表明需要评估 AHD，并在 AHD 护理套餐中快速开始 ART，以实现最佳患者结局。
