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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.
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最新影响因子:3.771 | 期刊ISSN:1525-4135 | CiteScore: |
出版周期:Monthly | 是否OA:YES | 出版年份:1999 |
期刊官方网址:http://journals.lww.com/jaids/pages/default.aspx
期刊投稿地址:http://journals.lww.com/jaids/Pages/informationforauthors.aspx
自引率:9.30% | 研究方向:医学-传染病学 |
出版地区:UNITED STATES |
SCI期刊coverage:Science Citation Index Expanded(科学引文索引扩展)
专业编辑在线一对一答疑及时解决您的问题
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.
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。
大类(学科) | 小类(学科) | 学科排名 |
医学 |
IMMUNOLOGY (免疫学) 3区 INFECTIOUS DISEASES (传染病学) 2区 |
49/155 20/88 |
年度总发文量 | 年度论文发表量 | 年度综述发表量 |
341 | 335 | 6 |
引文计数(2018)
文献(2015-2017)
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影响因子:2.493
ISSN:0925-4927
研究方向:医学-精神病学
发表一篇学和医学成像类SCI论文
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