Early Mortality and AIDS Progression Despite High Initial Antiretroviral Therapy Adherence and Virologic Suppression in Botswana 英文参考文献.docVIP

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Early Mortality and AIDS Progression Despite High Initial Antiretroviral Therapy Adherence and Virologic Suppression in Botswana 英文参考文献.doc

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Early Mortality and AIDS Progression Despite High Initial Antiretroviral Therapy Adherence and Virologic Suppression in Botswana 英文参考文献

EarlyMortalityandAIDSProgressionDespiteHighInitial AntiretroviralTherapyAdherenceandVirologic SuppressioninBotswana KatherineT.Steele1,2,AndrewP.Steenhoff2,3,4,CraigW.Newcomb5,TumeloRantleru2 ,Rudo Nthobatsang2,GloriaLesetedi2,ScarlettL.Bellamy5,JeanB.Nachega6,RobertGross2,5,7,GregoryP. Bisson2,5,7 * 1University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America, 2Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, 3Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America, 4Center for AIDS Research, UniversityofPennsylvania,Philadelphia,Pennsylvania,UnitedStatesofAmerica,5CenterforClinicalEpidemiologyandBiostatistics,UniversityofPennsylvaniaSchoolof Medicine, Philadelphia, Pennsylvania, United States of America, 6Departments of International Health and Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland,UnitedStatesofAmerica,7DivisionofInfectiousDiseases,UniversityofPennsylvaniaSchoolofMedicine,Philadelphia,Pennsylvania,United StatesofAmerica Abstract Background: Adverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa,despitereportsofhighlevelsofARTadherenceinthissetting.Wesoughttodeterminetherelationshipbetweenvery earlyARTadherenceandearlyadverseoutcomesinHIV-infectedadultsinBotswana. Methods: This prospective cohort study of 402 ART-na?¨ve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone,BotswanaevaluatedtherelationshipbetweensuboptimalearlyARTadherenceandHIVtreatmentoutcomesin theinitialmonthsafterARTinitiation.EarlyadherenceduringtheintervalbetweeninitialARTdispensationandfirstART refillwascalculatedusingpillcounts.Intheprimaryanalysispatientsnotreturningtorefillandthosewithadherence,0.95 wereconsideredtohavesuboptimalearlyadherence.Theprimaryoutcomewasdeathorlosstofollow-upduringthefirst6 monthsofART;asecondarycompositeoutcomeincl