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- 李侗曾副主任医师
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医院:
首都医科大学附属北京佑安医院
科室:
综合感染科
- Q 热(羊流感)
- 狂犬病暴露后预防
- 霍乱诊疗常规
- 麻疹
- 眼泪或为艾滋病传播新途径 专家...
- 又一项艾滋病疫苗研制计划受阻
- 李兰娟:《柳叶刀》人感染禽源性...
- 《人类感染活禽市场来源的新发H...
- 第二例被治愈的艾滋病感染者
- 艾滋病将要被治愈?
- 霍乱诊疗常规
- 布氏杆菌病诊疗常规
- 手足口2012
- 艾滋病实名检测之我见
- 艾滋病---抗病毒治疗可以减少...
- 关于柳叶刀一篇HIV-N亚型个...
- 艾滋病合并结核时---尽快抗病...
- CD4细胞计数的意义?
- 共享性伴侣是导致 HIV 发生...
- HIV药物导致未老先衰
- 为什么有半年甚至一年窗口期的说...
- 医生的严谨和随意
- 初筛阳性,确证阴性
- 未知病毒之我见
- HCV诊治指南
- 艾滋病HAART治疗免疫重建炎...
- 欧洲肝脏研究学会《丙型肝炎诊疗...
- 恐艾者分型分期,你是哪型哪期?
- 关于HIV检测
- 关于抗体阴性感染者文献
- 博茨瓦纳一例抗体阴性的HIV-...
- 观看电影《盗梦空间》后的感想,...
- 中国医生面临威胁(Lancet...
- CD4达到100以上就可以停用...
- 手足口病最严重的情况
- 转卫生部手足口知识问答
- 麻疹(五)宝宝8个月时接种麻疹...
- 麻疹(四)今年麻疹为什么这么多
- Q热(羊流感)临床表现多样
- Q 热(羊流感)
- 关于原发性胆汁性肝硬化
- 我院年龄最小的呼吸机支持患儿顺...
- 特殊人群如何降低自己在甲型H1...
- 甲型H1N1流感感染者任何年龄...
- 甲型H1N1流感诊疗方案(第三...
- 转帖:关于HIV-1 O/N的...
- 关于HIV的O,N ,M亚群检...
- 美国研究者称艾滋病有望被治愈
- 全球艾滋病防控已经取得重大进步
- 新英格兰医学杂志论文:人类出现...
- 美国感染A/H1N1流感可能已...
- 合并其它疾病可能是猪流感致死的...
- 什么是猪流感(Swine fl...
- HIV感染者开始抗病毒治疗的时...
- HIV毒性正在增加?
- 尽早开始抗逆转录病毒治疗可以减少HIV感染者死亡率,发病率
- 作者:李侗曾|发布时间:2011-02-17|浏览量:2043次
Early Initiation of Antiretroviral Therapy and Associated Reduction in Mortality, Morbidity and Defaulting in a Nurse-managed, Community Cohort in Lesotho
Abstract
Introduction: The latest WHO guidelines recommend initiating antiretroviral therapy (ART) at CD4 cell counts less than 350 cells/μl. However, donors and national governments are reluctant to support implementation owing to uncertainty regarding feasibility and relative benefit. Lesotho has supported earlier initiation since 2008. We assessed outcomes comparing early (CD4 cell counts >200 cells/μl) and late (CD4 cell counts ≤200 cells/μl) initiation.
Methods: We describe survival probability among patients initiating ART at CD4 cell counts 200 or less and more than 200 cells/μl and assess associations between baseline CD4 cell counts and mortality, morbidity, loss to follow-up and hospitalization using Cox regression adjusting for confounders identified a priori.
Results: Our analysis included 1177 patients; median age was 38 years and the majority (67%) were women. Median time on ART for the overall cohort was 506 days (interquartile range 396–608). Five hundred and thirty eight patients initiated ART at a CD4 cell count 200 cells/μl or less (interquartile range 54–160) and 639 patients initiated at CD4 cell count more than 200 cells/μl (interquartile range 238–321). In multivariate analysis, we found that patients initiating at CD4 cell count more than 200 cells/μl were 68% less likely to die (adjusted hazard ratio 0.32, 95% confidence interval 0.20–0.50), and 39% less likely to be lost to follow-up (adjusted hazard ratio 0.61, 95% confidence interval 0.43–0.87). Initiating ART at CD4 cell count more than 200 cells/μl was also associated with a 27% reduction in the rate of incident morbidity (adjusted hazard ratio 0.73, 95% confidence interval 0.65–0.82) and a 63% decreased rate of hospitalization (adjusted hazard ratio 0.37, 95% confidence interval 0.19–0.73).
Conclusion: Earlier initiation is feasible in a low resource, high HIV prevalence setting, and provides important benefits in terms of reduced mortality, morbidity, retention and hospitalization. Donors should fully support the implementation of the latest WHO recommendations.
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