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Effectiveness of antiretroviral treatment in a South African program: a cohort study.

机译:抗逆转录病毒治疗的有效性南非项目:队列研究。

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BACKGROUND: The effectiveness of the South African government's expanding antiretroviral treatment program is unknown. Observational studies of treatment effectiveness are prone to selection bias, rarely compare patients receiving antiretroviral treatment with similar patients not receiving antiretroviral treatment, and underestimate mortality rates unless patients are actively followed up. METHODS: We followed up 14 267 patients in the Public Sector Anti-Retroviral Treatment project in Free State, South Africa, for up to 20 months after enrollment. A total of 3619 patients received highly active triple antiretroviral treatment (HAART) for up to 19 months (median, 6 months; interquartile range, 3-9 months) after enrollment. Patients' clinical data were linked with the national mortality register. Marginal structural regression models adjusted for baseline and time-varying covariates. RESULTS: Of 4570 patients followed up for at least 1 year, 53.2% died. Eighty-seven percent of patients who died had notreceived HAART. HAART was associated with lower mortality (hazard ratio, 0.14; 95% confidence interval [CI], 0.11-0.18) and with the presence of tuberculosis (hazard ratio, 0.61; 95% CI, 0.46-0.81) after adjusting for age, sex, weight, clinic, district, CD4 cell count, cotrimoxazole therapy, tuberculosis at baseline, and previous antiretroviral therapy. Cotrimoxazole therapy was associated with lower mortality (hazard ratio, 0.37; 95% CI, 0.32-0.42). Each month of HAART was associated with an increase in CD4 cell count of 15.1 cells/microL (95% CI, 14.7-15.5 cells/microL) and with an increase in body weight of 602 g (95% CI, 548-658 g). CONCLUSIONS: HAART provided through these South African government health services seems as effective as that provided in high-income countries. Delays starting HAART contributed to high mortality rates. Faster expansion and timely commencement of HAART are needed.
机译:背景:南非的有效性政府扩大抗逆转录病毒治疗项目是未知的。治疗效果很容易选择偏见,很少患者进行比较抗逆转录病毒治疗的患者相似没有接受抗逆转录病毒治疗,低估,除非患者死亡率积极跟进。267名患者在公共部门抗逆转录病毒南非自由州的治疗项目,入学后长达20个月。3619名患者得到高度活跃的三倍抗逆转录病毒治疗(HAART) 19个月(平均6个月;入学后3 - 9个月)。数据与国家死亡率登记。调整基线和时变协变量。至少1年,53.2%死亡。%的患者有notreceived去世鸡尾酒疗法。(风险比,0.14;(CI), 0.11 - -0.18)的存在肺结核(风险比,0.61;0.46 - -0.81)在调整了年龄、性别、体重、诊所,区,CD4细胞计数、复方磺胺甲恶唑治疗,肺结核在基线,和之前的抗逆转录病毒治疗。降低死亡率(风险比,0.37;与CD4细胞计数增加15.1细胞/ microL (95% CI, 14.7 - -15.5细胞/ microL)和体重的增加602克(95%可信区间,548 - 658克)。结论:鸡尾酒疗法通过这些南非政府提供卫生服务似乎是有效的在高收入国家提供。开始HAART导致高死亡率利率。鸡尾酒疗法是必要的。

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