Increased Mortality with Delayed and Missed Switch to Second-Line Antiretroviral Therapy in South Africa.

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Abstract:

BACKGROUND:After failure of first-line antiretroviral therapy (ART) in the public sector, delayed or missed second-line ART switch is linked with poor outcomes in patients with advanced HIV. SETTING:We investigated delayed or missed second-line ART switch following confirmed virologic failure in the largest private sector HIV cohort in Africa. METHODS:We included HIV-infected adults with confirmed virologic failure after six months of non-nucleoside reverse-transcriptase inhibitor-based ART. We estimated the effect of timing of switch on the hazard of death using inverse probability of treatment weighting of marginal structural models. We adjusted for time-dependent confounding of CD4 count, viral load, and visit frequency. RESULTS:5748 patients (53% female) with confirmed virologic failure met inclusion criteria; the median age was 40 (interquartile range [IQR]: 35 - 47), advanced HIV was present in 48% and the prior duration of NNRTI-based ART was 1083 days (IQR: 665-1770). Median time to confirmation of virologic failure and to second-line switch was 196 (IQR: 136-316) and 220 days (IQR: 65-542), respectively. Switching to second-line ART after confirmed failure compared to remaining on first-line ART reduced risk of subsequent death [aHR: 0.47 (95% CI: 0.36-0.63)]. Compared to patients who experienced delayed switch, those switched immediately had a lower risk of death, regardless of CD4 cell count. CONCLUSIONS:Delayed or missed switch to second-line ART after confirmed first-line ART failure is common in the South African private sector and associated with mortality. Novel interventions to minimize switch delay should be tested and not limited to those with advanced disease at treatment failure.

南非延迟和错过二线抗逆转录病毒治疗的死亡率增加。

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摘要:

背景: 在公共部门一线抗逆转录病毒治疗 (ART) 失败后,延迟或错过二线 ART 转换与晚期 HIV 患者的不良结局有关。 设置: 我们调查了非洲最大的私营部门 HIV 队列中确认病毒学失败后延迟或错过的二线 ART 切换。 方法: 我们纳入了接受基于非核苷类逆转录酶抑制剂的 ART 治疗 6 个月后确诊病毒学失败的 HIV 感染成人。我们使用边缘结构模型的治疗加权的逆概率估计了开关时机对死亡风险的影响。我们调整了 CD4 计数、病毒载量和访视频率的时间依赖性混杂。 结果: 5748 例 (53% 为女性) 确诊病毒学失败的患者符合纳入标准; 中位年龄为 40 (四分位距 [IQR]: 35-47), 48% 存在晚期 HIV,基于 NNRTI 的 ART 的既往持续时间为 1083 天 (IQR: 665-1770)。确认病毒学失败和二线转换的中位时间分别为 196 (IQR: 136-316) 和 220 天 (IQR: 65-542)。与继续接受一线 ART 相比,在确认失败后转为二线 ART 可降低后续死亡风险 [aHR: 0.47 (95% CI: 0.36-0.63)]。与经历延迟转换的患者相比,无论 CD4 细胞计数如何,立即转换的患者死亡风险较低。 结论: 在确认一线 ART 失败后延迟或未切换到二线 ART 在南非私营部门很常见,并与死亡率相关。应测试尽量减少开关延迟的新型干预措施,而不限于治疗失败时的晚期疾病患者。

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JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES

研究方向:医学-传染病学
IF:3.731
IF值的bai意思是影响因子。是汤森路透(duThomson Reuters)出品的期刊引证报告zhi(Journal Citation Reports,JCR)中的一项数据。 影响因子dao目前的计算方法是:IF=C/(M+N)。以2017年IF的计算为例,M为该期刊2015年发表的文章数量,N为该期刊2016年发表的文章数量,C为该期刊2015和2016年两年发表的文章在2017年这一年被引用的
出版周期: UNITED STATES
中科院分区:Q4 来稿接收率:约 % 审稿周期:一般,3-6周
9.30%
YES
1999
1525-4135
出版地区: CiteScore:
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JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES 期刊简介

英文简介:

JAIDS: Journal of Acquired Immune Deficiency Syndromes​ seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.

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中文简介

JAIDS:《获得性免疫缺陷综合征杂志》试图通过介绍跨所有学科的重要新科学来结束艾滋病毒的流行,从而增进我们对全球艾滋病毒感染的生物学、治疗和预防的理解。 JAIDS:《获得性免疫缺陷综合征杂志》是值得信赖的、跨学科的HIV和aids相关信息资源,重点关注基础和转化科学、临床科学、流行病学和预防。JAIDS由临床病毒学、分子生物学和流行病学领域的顶尖领导者联合编辑,出版关于HIV感染诊断和治疗进展的重要信息,以及在治疗学和疫苗方法开发方面的最新研究。这本开创性的杂志汇集了来自世界各地经过严格同行评审的文章、对当前研究的评审、临床试验结果和流行病学报告。

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JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES期刊中科院评价数据

最新中科院JCR分区

大类(学科) 小类(学科) 学科排名
医学 IMMUNOLOGY(免疫学) 3区
INFECTIOUS DISEASES(传染病) 2区
49/155
20/88

最新公布的期刊年发文量

年度总发文量 年度论文发表量 年度综述发表量
341 335 6

总被引频次: 14479

特征因子: 0.037150

近年影响因子趋势图

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES期刊CiteScore评价数据

最新CiteScoere值

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引文计数(2018)

文献(2015-2017)

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篇文献

文献总数(2014-2016):

被引比率: %

SJR:
SCLmago期刊等级衡量经过加权后的期刊受引用次数,引用次数的加权值由施引期刊的学科领域和声望(SJR)决定。
SNIP:
每篇文章中来源出版物的标准化影响将实际受引用情况对照期刊所属学科领域中预期的受引用情况进行衡量。
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序号 类别(学科) 排名 百分位

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