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首页> 外文期刊>World Journal of AIDS >Factors Associated with First-Line Antiretroviral Therapy Failure amongst HIV-Infected African Patients: A Case-Control Study
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Factors Associated with First-Line Antiretroviral Therapy Failure amongst HIV-Infected African Patients: A Case-Control Study

机译：艾滋病毒感染的非洲患者一线抗逆转录病毒疗法治疗失败相关因素：病例对照研究

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Background: Since 2001, anti-retroviral therapy (ART) has been provided to over 75,000 HIV-infected patients at the USAID-Academic Model Providing Access to Healthcare (AMPATH) Partnership in western Kenya. Over 1000 of these patients have switched to second-line ART. We therefore set out to determine factors associated with first-line ART failure amongst these patients. Methods: This case controlled study matched patients (in the ratio 1:2) from the electronic AMPATH Medical Record System on the basis of age, gender, and ART initiation date. Cases were adults (≥18 years) who initiated second-line ART between January 1, 2007 and July 31, 2011 after at least one viral load measurement >5000 copies/ml or satisfying the WHO immunological or clinical failure criteria. Controls were those on non-failing first-line ART with a CD4 count > 400 /ml within the last 12 months, at the time of case incidence. Conditional logistic regression for paired data was used to assess association. We evaluated the strength of association of risk factors using stratified Cox model. Results: Of the 1084 cases and 2149 controls included in the analysis, 62% were female. Median age was 36.5 years (IQR = 30.7 - 43.1); median baseline CD4 cell count was 161 /ml (IQR = 72 - 277); Median time to ART failure was 37 months (IQR = 24 - 47). Low baseline CD4 count < 50 /ml (H.R = 7.07, (95% CI = 4.92 - 10.15); Zidovudine based ART (H.R 1.76, 95% CI = 1.25 - 2.48) and imperfect ART adherence (H.R = 2.77, 95% CI = 2.20 - 3.49) were independently associated with treatment failure. Conclusion: In this setting, low baseline CD4 count, zidovudine-based ART and imperfect adherence are associated with first-line ART treatment failure.
机译：背景：自2001年以来，在肯尼亚西部的美国国际开发署-提供医疗保健服务（AMPATH）合作伙伴关系的美国学术模式下，已为75,000多名感染HIV的患者提供了抗逆转录病毒疗法（ART）。这些患者中有超过1000位已切换到二线抗逆转录病毒疗法。因此，我们着手确定这些患者中与一线抗病毒治疗失败相关的因素。方法：该病例对照研究根据年龄，性别和ART起始日期匹配了电子AMPATH医疗记录系统中的患者（比例为1：2）。病例为成年人（≥18岁），他们在至少一项病毒载量测量> 5000拷贝/ ml或满足WHO免疫学或临床失败标准后，于2007年1月1日至2011年7月31日开始进行二线抗病毒治疗。对照是发生病例时最近12个月内CD4计数> 400 / ml的未失败一线抗逆转录病毒疗法的患者。配对数据的条件逻辑回归用于评估关联。我们使用分层Cox模型评估了风险因素关联的强度。结果：在分析的1084例病例和2149例对照中，女性占62％。中位年龄为36.5岁（IQR = 30.7-43.1）; CD4细胞基线中位数为161 / ml（IQR = 72-277）; ART失败的中位时间为37个月（IQR = 24-47）。低基线CD4计数<50 / ml（HR = 7.07，（95％CI = 4.92-10.15）;基于齐多夫定的ART（HR 1.76，95％CI = 1.25-2.48）和ART依从性不完善（HR = 2.77，95 ％CI = 2.20-3.49）与治疗失败独立相关结论：在这种情况下，基线CD4计数低，基于齐多夫定的抗逆转录病毒治疗和依从性不良与一线抗病毒治疗失败相关。

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