背景:由于引入了高效抗逆转录病毒疗法(HAART),在发达国家,与人类免疫缺陷病毒(HIV)感染相关的死亡率和发病率已显著下降.然而,对于资源贫乏地区的HIV感染者来说,这仍然是一个巨大的公共卫生挑战.这项研究是为了确定汇总的人-时死亡率,分析趋势,并确定接受HAART的HIV感染成人的生存预测因子。
方法:在PubMed,Embase,Scopus,谷歌学者,非洲在线期刊,和WebofScience。JoanaBriggs研究所的关键评估工具用于评估所包含文章的质量。使用随机效应Dersimonian-Laird模型分析数据。
结果:分析了从35篇涉及39,988名受试者的文章中提取的数据。合并的人-时死亡率(全因)为4.25([95%不确定区间(UI),3.65至4.85])每100人年的观察。死亡率的预测因素是年龄≥45岁的患者(风险比(HR),1.70[95%UI,1.10to2.63]),作为女性(HR,0.82[95%UI,0.70to0.96]),物质使用史(HR,3.10[95%UI,1.31to7.32]),艾滋病毒阳性状态非披露(HR,3.10[95%UI,1.31to7.32]),分化簇4+T细胞-计数<200细胞/mm3(HR,3.23[95%UI,[2.29to4.75]),贫血(HR,2.63[95%UI,1.32to5.22]),世界卫生组织将HIV临床III期和IV期(HR,3.02[95%UI,2.29to3.99]),营养不良(HR,2.24[95%UI,1.61to3.12]),机会性感染(HR,1.89[95%UI,1.23to2.91]),结核合并感染(HR,3.34[95%UI,2.33to4.81]),卧床不起或卧床(HR,3.30[95%UI,2.29to4.75]),治疗依从性差(HR,3.37[95%UI,1.83to6.22]),和抗逆转录病毒药物毒性(HR,2.60[95%UI,1.82to3.71]).
结论:尽管早期在埃塞俄比亚引入了HAART,自2003年以来,死亡率一直很高。因此,应针对已确定的危险因素进行指南指导的干预,以改善总体预后并增加质量调整后的生命年.
BACKGROUND: Owing to the introduction of highly active antiretroviral therapy (HAART), the trajectory of mortality and morbidity associated with human immunodeficiency virus (HIV) infection has significantly decreased in developed countries. However, this remains a formidable public health challenge for people living with HIV in resource-poor settings. This
study was undertaken to determine the pooled person-time incidence rate of mortality, analyze the trend, and identify predictors of survival among HIV-infected adults receiving HAART.
METHODS: Quantitative studies were searched in PubMed, Embase, Scopus, Google Scholar, African Journals Online, and Web of Science. The Joana Briggs Institute critical appraisal tool was used to assess the quality of the included articles. The data were analyzed using the random-effects Dersimonian-Laird model.
RESULTS: Data abstracted from 35 articles involving 39,988 subjects were analyzed. The pooled person-time incidence rate of mortality (all-cause) was 4.25 ([95% uncertainty interval (UI), 3.65 to 4.85]) per 100 person-years of observations. Predictors of mortality were patients aged ≥ 45 years (hazard ratio (HR), 1.70 [95% UI,1.10 to 2.63]), being female (HR, 0.82 [95% UI, 0.70 to 0.96]), history of substance use (HR, 3.10 [95% UI, 1.31 to 7.32]), HIV positive status non disclosure (HR, 3.10 [95% UI,1.31 to 7.32]), cluster of differentiation 4 + T cell - count < 200 cells/mm3 (HR, 3.23 [95% UI, [2.29 to 4.75]), anemia (HR, 2.63 [95% UI, 1.32 to 5.22]), World Health Organisation classified HIV clinical stages III and IV (HR, 3.02 [95% UI, 2.29 to 3.99]), undernutrition (HR, 2.24 [95% UI, 1.61 to 3.12]), opportunistic infections (HR, 1.89 [95% UI, 1.23 to 2.91]), tuberculosis coinfection (HR, 3.34 [95% UI, 2.33 to 4.81]),bedridden or ambulatory (HR,3.30 [95% UI, 2.29 to 4.75]), poor treatment adherence (HR, 3.37 [95% UI,1.83 to 6.22]), and antiretroviral drug toxicity (HR, 2.60 [95% UI, 1.82 to 3.71]).
CONCLUSIONS: Despite the early introduction of HAART in Ethiopia, since 2003, the mortality rate has remained high. Therefore, guideline-directed intervention of identified risk factors should be in place to improve overall prognosis and increase quality-adjusted life years.