在资源有限的国家接受二线艾滋病毒治疗的患者的治疗失败和死亡因素
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
概括
在非洲和亚洲的艾滋病毒患者中,二线抗逆转录病毒治疗 (ART) 的失败与低CD4计数,低于最佳的治疗方案和不良坚持有关. 治疗失败显著增加了这些人群的死亡风险.
科学领域:
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
- 艾滋病毒/艾滋病研究研究
背景情况:
- 长期使用抗逆转录病毒疗法 (ART) 导致在资源有限的环境中增加了对二线HIV治疗的需求.
- 有限的治疗选择需要对二线疗法疗效进行评估.
研究的目的:
- 研究二线艾滋病毒治疗患者的失败率.
- 确定与治疗失败和死亡率相关的因素.
主要方法:
- 在非洲和亚洲的27个ART项目中,对632名成年患者进行了多队列研究 (2001-2008).
- 评估了临床,免疫学和病毒学失败率和死亡率.
- 敏感性分析使用了替代的CD4值和对队列消耗的定义.
主要成果:
- 18.8%的患者符合世卫组织的失败标准;5.4%的患者死亡.
- 观察到较高的失败率与较低的CD4计数在治疗开始和较差的坚持.
- 在切换两种核酸逆转录酶抑制剂 (NRTIs) 和一种核酸逆转录酶抑制剂 (NRTIs) 时,出现较低的失败率.
- 治疗失败的患者的死亡率更高,女性的死亡率更低.
结论:
- 在二线HIV治疗中,治疗失败与低基线CD4计数,低于最佳的治疗方案和不良坚持有关.
- 诊断出治疗失败是死亡率的重要预测因素.
- 调查结果强调需要优化二线策略和坚持支持.
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