Early Mortality in HIV Infected Patients Starting Antiretroviral Therapy in Afric

非洲开始抗逆转录病毒治疗的艾滋病毒感染者的早期死亡率

• 批准号: 8306796
• 负责人: Elvin H. Geng
• 金额: $ 12.37万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-25 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8306796
• 关键词: Africa; Africa South of the Sahara; African; Bartonella; Biological; Blood; CD4 Positive T Lymphocytes; Cell Count; Cells; Cessation of life; Clinic; Clinical; Clinical Investigator; Commit; Cryptococcus neoformans infection; Cytomegalovirus; Diagnosis; Effectiveness; Evidence based intervention; Funding; Future; HIV; HIV Infections; High Prevalence; Histoplasma capsulatum; Human Herpesvirus 8; Individual; Infection; Intervention; Kenya; Laboratory Finding; Lead; Link; Medical History; Mentors; Methods; Modeling; Opportunistic Infections; Organism; Outcome; Patients; Persons; Pharmaceutical Preparations; Physical Examination; Pneumocystis; Positioning Attribute; Randomized Clinical Trials; Reporting; Resources; Risk; Role; Sampling; San Francisco; Scientist; Site; Specimen; Sputum; Statistical Models; Symptoms; Techniques; Testing; Time; Training; Tuberculosis; Uganda; United States National Institutes of Health; Work; antiretroviral therapy; base; career development; clinical decision-making; cohort; demographics; follow-up; high risk; improved; mortality; outcome forecast; pathogen; prognostic; public health emergency; theories; Africa; Africa South of the Sahara; African; Bartonella; Biological; Blood; CD4 Positive T Lymphocytes; Cell Count; Cells; Cessation of life; Clinic; Clinical; Clinical Investigator; Commit; Cryptococcus neoformans infection; Cytomegalovirus; Diagnosis; Effectiveness; Evidence based intervention; Funding; Future; HIV; HIV Infections; High Prevalence; Histoplasma capsulatum; Human Herpesvirus 8; Individual; Infection; Intervention; Kenya; Laboratory Finding; Lead; Link; Medical History; Mentors; Methods; Modeling; Opportunistic Infections; Organism; Outcome; Patients; Persons; Pharmaceutical Preparations; Physical Examination; Pneumocystis; Positioning Attribute; Randomized Clinical Trials; Reporting; Resources; Risk; Role; Sampling; San Francisco; Scientist; Site; Specimen; Sputum; Statistical Models; Symptoms; Techniques; Testing; Time; Training; Tuberculosis; Uganda; United States National Institutes of Health; Work; antiretroviral therapy; base; career development; clinical decision-making; cohort; demographics; follow-up; high risk; improved; mortality; outcome forecast; pathogen; prognostic; public health emergency; theories

DESCRIPTION (provided by applicant): Antiretroviral therapy is finally reaching millions of persons with HIV infection in Africa. While countless lives have been saved, it is becoming increasingly clear that deaths in the first 6 months on ART are dramatically elevated as compared to industrialized settings, - perhaps claiming as many as five-fold more than in industrialized settings. Even these alarming estimates, however, are likely underestimates because high losses to follow up in resource limited settings mean that many deaths are not ascertained. The causes of these early deaths, furthermore, are not well explained. Therefore the proposed Aims seek to (1) evaluate a sampling-based technique that we have developed to understand the true magnitude of early mortality; (2) determine whether undiagnosed opportunistic infections are the cause of early mortality on ART by collecting biological specimens and investigating them intensively in San Francisco and (3) develop a clinical prediction rule to risk stratify individual patients for early mortality at the time or ART initiation. Overall, this study seeks to understand the magnitude and determinants of early mortality on ART in HIV infected patients in Africa in order to develop a targeted intervention in the future to reduce it. These Aims will also provide a platform for completing further career development toward independence as a scientist. RELEVANCE: Early mortality on ART may claim 1 in 10 patients of the millions of patients starting ART in Africa. These deaths are likely due to treatable infections. Therefore, a better understanding of early mortality on ART in Africa has the potential to improve ART delivery and save many lives.

描述（由申请人提供）：抗逆转录病毒疗法终于吸引了数百万在非洲感染HIV的人。尽管无数的生命得到了挽救，但与工业化环境相比，最初6个月的艺术死亡人数大幅提高了，这越来越明显，这可能比工业化环境高出多达五倍。但是，即使是这些令人震惊的估计值也可能低估了，因为在资源有限的设置中遭受的高损失意味着未确定许多死亡。此外，这些早期死亡的原因没有很好地解释。因此，拟议的目的旨在（1）评估我们开发的基于抽样的技术，以了解早期死亡的真正程度； （2）确定未诊断的机会性感染是否是通过收集生物学标本并在旧金山进行大量调查的ART早期死亡率的原因，并且（3）制定了一项临床预测规则，以便在当时或艺术启动时风险将患者分类为早期死亡率。总体而言，这项研究旨在了解非洲艾滋病毒感染患者早期死亡率的大小和决定因素，以便将来开发针对性的干预措施以减少其。这些目标还将提供一个平台，以完成作为科学家独立的进一步职业发展。 相关性：早期对艺术的死亡率可能会声称数百万患者在非洲开始ART的10名患者中有1名。这些死亡可能是由于可治疗的感染。因此，更好地了解非洲艺术的早期死亡率有可能改善艺术品并挽救许多生命。