Kuzey Batı Etiyopya'da yüksek etkili antiretroviral tedavi alan HIV-enfekte hastaların immünolojik ve klinik gelişimi

Öz

The survival benefits of highly active antiretroviral therapy (HAART) in HIV infected patients have been studied well in the developed world. In resource poor settings like Ethiopia such treatment was started only in 2003. As a result, the existing treatment guidelines and recommendations are based on data from the developed world. The objective of this study was to determine the immunological and clinical progress in HIV/AIDS patients in one year data review of patients' card who initiated on HAART in Ethiopia. A retrospective cohort study was done based on past medical records of HIV/AIDS patients, using a structured data collection format. All patient cards of one year data with patients who initiated HAART from October 1, 2006 to November 30, 2007 were included in the study. The data collected was analyzed using SPSS for window version 16.0. The majority of the study population (383, 64.2%) were prescribed zidovudine/lamivudine/neverapine (ZDV/3TC/NVP) regimen initially. Overall functional status change showed that ability to work was increased by 31.5%, being ambulatory decreased by 93.4% and bedridden status decreased by 80%. A total of 240 (46.9%) patients have showed functional status improvement. Average mean weight change of 5.9 kg (increment by 11.9%) was seen during a one year follow-up. The patients showed immunological change from 132.883 mean CD4/mm3 count to 335.87 mean CD4/mm3. About 492 (82.4%) patients present with different type of opportunistic infections (OIs) at start of therapy which dramatically dropped to only 40 (6.7%) patient after one year of receiving HAART. HAART initiation has decreased progression of the diseases and improved the patients' quality of life. Most patients have showed a significant increment in their CD4 count. The restoration of CD4 in turn has improved the clinical status of most patients. Despite the significant progression of health of patients, greater immunological and clinical success should be attained by encouraging patients for effective use of those lifesaving drugs with maximal adherence.

Anahtar Kelimeler

• HIV,Antigens, CD4,Antiretroviral Therapy, Highly Active,Ethiopia

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Öz

HIV ile enfekte hastalarda yüksek etkili antiretroviral tedavinin (HAART, higly active antiretroviral therapy) yaşam üzerindeki faydaları gelişmiş ülkelerde çok çalışılmıştır. Etiyopya gibi kaynakları kısıtlı yerlerde bu gibi tedavi 2003'de başladı. Sonuç olarak, var olan tedavi kılavuzları ve tavsiyeler gelişmiş ülkedeki verilere dayanmaktadır. Bu çalışmanın amacı, Etiyopya'da HAART tedavisine başlanan hasta kartlarındaki bir yıllık veri incelenerek HIV/AIDS hastalarının immünolojik ve klinik gelişimi saptamaktı. Retrospektif kohort çalışma, yapılandırılmış veri toplama formatı kullanılarak HIV/AIDS hastalarının geçmişteki tıbbi kayıtlarına dayanarak yapıldı. 1 Ekim 2006'dan 30 Kasım 2007'ye kadar HAART tedavisi başlanan hastaların kartlarındaki bir yıllık veriler çalışmaya alındı. Toplanan veriler SPSS for Windows sürüm 16.0 kullanılarak analiz edildi. Çalışılan popülasyonun büyük çoğunluğu (383, %64.2) başlangıçta zidovudin/lamivudin/neverapin (ZDV/3TC/NVP) tedavisi verilmişti. Genelde fonksiyonel durum değişimi, çalışma yeteneğinin %31.5 arttığını, ayakta tedavi edilmenin %93.4 azaldığını, yatağa bağlı kalma durumunun %80 azaldığını gösterdi. Toplam 240 hasta fonksiyonel durum düzelmesi gösterdi. Bir yıllık izleme sırasında 5.9 kg ortalama ağırlık değişimi (%11.9 artma) gözlendi. Hastalar ortalama 132.883 CD4/mm3 sayımından ortalama 335.87 CD4/mm3'e immünolojik değişim gösterdi. Tedavinin başlamasında farklı tipte fırsatçı enfeksiyonu bulunan yaklaşık 492 (%82.4) hasta, HAART tedavisi başlamasından bir yıl sonra dramatik olarak sadece 40'a (%6.7) düştü. HAART tedavisi başlanması hastalığın ilerlemesini azalttı ve hastaların yaşam kalitesini iyileştirdi. Hastaların çoğu CD4 sayılarında anlamlı artışlar gösterdi. CD4'deki düzelme birçok hastanın klinik durumunu iyileştirdi. Hastaların sağlığındaki anlamlı iyileşmeye karşın, hayat kurtaran bu ilaçlara daha fazla etkin kullanılması için hastaların teşvik edilmesi ile daha fazla immünolojik ve klinik başarı elde edilmelidir.

Anahtar Kelimeler

• HIV,Antijenler, CD4,Antiretroviral sağaltım, yüksek etkili,Etiyopya

Kaynakça

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