Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)

Background: Combined antiretroviral therapy (AVR) has shown a protective effect (PE) on morbidity and survival in HIV (+) patients of industrialised countries where triple-drug therapy (ARV-3) is standard. In Chile the public health system began providing double-drug therapy in 1997 (ARV-2) with 2 r...

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Autores principales:	Wolff R,Marcelo, Bustamante M,Claudia, Bidart H,Teresa, Dabanch P,Jeannette, Diomedi P,Alexis, Northland A,Rebeca
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2000
Materias:	HIV antibodies HIV seropositivity Retroviridae infections Reverse transcriptase inhibitors
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000800002
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spelling	oai:scielo:S0034-988720000008000022005-11-29Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)Wolff R,MarceloBustamante M,ClaudiaBidart H,TeresaDabanch P,JeannetteDiomedi P,AlexisNorthland A,Rebeca HIV antibodies HIV seropositivity Retroviridae infections Reverse transcriptase inhibitors Background: Combined antiretroviral therapy (AVR) has shown a protective effect (PE) on morbidity and survival in HIV (+) patients of industrialised countries where triple-drug therapy (ARV-3) is standard. In Chile the public health system began providing double-drug therapy in 1997 (ARV-2) with 2 reverse transcriptase inhibitors. Aim: To assess the impact of ARV in morbimortality of HIV (+) patients in Chile after a year of follow up. Patients and methods: Retrospective case-control (1:1) study. Cases were 97 patients followed during 1997 for 6 or more months and dying during that period. Each case had a control of the same gender and CDC stage, similar age and CD4 count, but surviving a same period of follow up. A comparison of ARV before and during follow up (rate and type) was done. P carinii prophylaxis, pneumococcal immunization at baseline or follow up, frequency of hospital admissions and occurrence of opportunistic infections in both groups were assessed. Odds ratio (OR) for mortality, hospitalisation and opportunistic infections in ARV user, as well as treatment PE were calculated. Results: Twenty four (24.7%) cases and sixty six (68%) controls received ARV during follow up (p< 0.001), OR was 0.15 (CI 95% 0.08-0.3), p < 0.001, the PE was 6.6 for ARV users versus non users, among cases 19 patients received ARV-2 and five received ARV-3. Among controls, 41 patients received ARV-2 and 25 received ARV-3. These differences established an OR of 0.20 (CI 95% 0.09-0.04) and a PE of 5 for ARV-2 versus no ARV. For ARV-3 compared with no ARV the OR was 0.08 (CI 95% 0.003-0.26), and the PE 12.5. Fifty three (54.6%) cases and 13 (13.4%) controls required hospital admission, OR 0.49 (CI 95% 0.25-0.94), p=0.03, and PE of 2.04 of ARV versus no ARV; 82 (85.3%) cases and 50 (51%) controls had opportunistic infections, OR 0.5 (CI 95% 0.26-0.96), p=0.03 and PE of 2 for ARV versus no ARV. There were no significant differences in prior ARV, prophylaxis and immunisation between cases and controls. Conclusions: This study showed the high impact of ARV in short term morbimortality of HIV(+) patients and the need to implement antiretroviral therapy to all patients as an official health policy. This study did not answer the question of the role, if any, of weaker-than standard antiretroviral therapy. (Rev Méd Chile 2000; 128: 839-45).info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.128 n.8 20002000-08-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000800002es10.4067/S0034-98872000000800002
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	HIV antibodies HIV seropositivity Retroviridae infections Reverse transcriptase inhibitors
spellingShingle	HIV antibodies HIV seropositivity Retroviridae infections Reverse transcriptase inhibitors Wolff R,Marcelo Bustamante M,Claudia Bidart H,Teresa Dabanch P,Jeannette Diomedi P,Alexis Northland A,Rebeca Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)
description	Background: Combined antiretroviral therapy (AVR) has shown a protective effect (PE) on morbidity and survival in HIV (+) patients of industrialised countries where triple-drug therapy (ARV-3) is standard. In Chile the public health system began providing double-drug therapy in 1997 (ARV-2) with 2 reverse transcriptase inhibitors. Aim: To assess the impact of ARV in morbimortality of HIV (+) patients in Chile after a year of follow up. Patients and methods: Retrospective case-control (1:1) study. Cases were 97 patients followed during 1997 for 6 or more months and dying during that period. Each case had a control of the same gender and CDC stage, similar age and CD4 count, but surviving a same period of follow up. A comparison of ARV before and during follow up (rate and type) was done. P carinii prophylaxis, pneumococcal immunization at baseline or follow up, frequency of hospital admissions and occurrence of opportunistic infections in both groups were assessed. Odds ratio (OR) for mortality, hospitalisation and opportunistic infections in ARV user, as well as treatment PE were calculated. Results: Twenty four (24.7%) cases and sixty six (68%) controls received ARV during follow up (p< 0.001), OR was 0.15 (CI 95% 0.08-0.3), p < 0.001, the PE was 6.6 for ARV users versus non users, among cases 19 patients received ARV-2 and five received ARV-3. Among controls, 41 patients received ARV-2 and 25 received ARV-3. These differences established an OR of 0.20 (CI 95% 0.09-0.04) and a PE of 5 for ARV-2 versus no ARV. For ARV-3 compared with no ARV the OR was 0.08 (CI 95% 0.003-0.26), and the PE 12.5. Fifty three (54.6%) cases and 13 (13.4%) controls required hospital admission, OR 0.49 (CI 95% 0.25-0.94), p=0.03, and PE of 2.04 of ARV versus no ARV; 82 (85.3%) cases and 50 (51%) controls had opportunistic infections, OR 0.5 (CI 95% 0.26-0.96), p=0.03 and PE of 2 for ARV versus no ARV. There were no significant differences in prior ARV, prophylaxis and immunisation between cases and controls. Conclusions: This study showed the high impact of ARV in short term morbimortality of HIV(+) patients and the need to implement antiretroviral therapy to all patients as an official health policy. This study did not answer the question of the role, if any, of weaker-than standard antiretroviral therapy. (Rev Méd Chile 2000; 128: 839-45).
author	Wolff R,Marcelo Bustamante M,Claudia Bidart H,Teresa Dabanch P,Jeannette Diomedi P,Alexis Northland A,Rebeca
author_facet	Wolff R,Marcelo Bustamante M,Claudia Bidart H,Teresa Dabanch P,Jeannette Diomedi P,Alexis Northland A,Rebeca
author_sort	Wolff R,Marcelo
title	Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)
title_short	Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)
title_full	Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)
title_fullStr	Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)
title_full_unstemmed	Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)
title_sort	impacto de la terapia anti retroviral en la mortalidad de pacientes vih (+) chilenos: estudio caso-control (mortar)
publisher	Sociedad Médica de Santiago
publishDate	2000
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000800002
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Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH (+) chilenos: estudio caso-control (MORTAR)

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