資源が限られた国々で二次HIV治療を受けている患者の治療失敗と死亡率の要因
Mar Pujades-Rodríguez1, Suna Balkan, Line Arnould
1Epicentre, Médecins Sans Frontières 42-bis, Bd, 8 rue Saint Sabin, 75011 Paris, France. mar.pujades@epicentre.msf.org
JAMA
|July 20, 2010
まとめ
アフリカとアジアのHIV患者におけるセカンドライン抗レトロウイルス治療 (ART) の失敗は,CD4カウントの低下,最適以下のレジメン,および不十分な遵守に関連しています. 治療が失敗すると,これらの集団における死亡リスクが著しく増加します.
科学分野:
- 感染症 感染症は感染症です.
- 公衆衛生は公衆衛生である.
- HIV/AIDSに関する研究 HIV/AIDSに関する研究
背景:
- 長期にわたる抗レトロウイルス療法 (ART) の使用は,資源の限られた環境で,二次線HIV治療の必要性を増加させます.
- 限られた治療選択肢があるため,セカンドライン療法の有効性の評価が必要である.
研究 の 目的:
- 2次線HIV治療を受けている患者の失敗率を調査する.
- 治療失敗と死亡率に関連する要因を特定する.
主な方法:
- アフリカとアジアの27のARTプログラムで632人の成人患者を対象としたマルチコホート研究 (2001年~2008年).
- 臨床的,免疫的,ウイルス学的失敗率と死亡率の評価.
- 敏感性分析では,CD4の代替的値とコホート消耗の定義が使用されました.
主要な成果:
- 患者の18.8%がWHOの失敗基準を満たし,5.4%が死亡しました.
- 治療開始時にCD4カウントが低下し,従順性が低下すると,より高い失敗率が観察されました.
- 2つのヌクレオシド逆転写酵素阻害剤 (NRTIs) と1つのヌクレオシド逆転写酵素阻害剤 (NRTIs) のスイッチングで観察された失敗率の低下.
- 死亡率は,治療が失敗した患者で高く,女性では低かった.
結論:
- セカンドラインのHIV治療における治療の失敗は,低ベースラインのCD4カウント,サブ最適のレジメン,および不十分な遵守と関連しています.
- 診断された治療失敗は,死亡率の重要な予測因子です.
- 結論は,最適化されたセカンドライン戦略と遵守支援の必要性を強調しています.
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