Rachael M Burke, Nadia Sabet, Jayne Ellis, Ajay Rangaraj, David S Lawrence, Joseph N Jarvis, Jane Falconer, Lillian Tugume, Gabriella Bidwell, Rebecca H Berhanu, Peter MacPherson, Nathan Ford
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引用次数: 0
摘要
背景：尽管抗逆转录病毒治疗（ART）的可及性有所改善，但艾滋病毒相关的发病率和死亡率仍然很高。之前的一项审查（2007- 2014年）发现，艾滋病相关疾病是导致住院的主要原因。我们的目的是总结2014年至2023年艾滋病毒感染者住院的原因。方法：为了进行meta分析，我们于2023年4月26日检索了8个数据库（Ovid Medline ALL、Ovid Embase Classic和Ovid Embase、Ovid Global Health、EBSCOhost CINAHL Complete、EBSCOhost Africa-Wide Information、Clarivate Analytics Web of Science核心内容、Clarivate Analytics Web of Science SciELO和Global Index Medicus）。我们纳入了2014年1月1日以后报告至少20人入院原因的任何设计的研究。我们提取了关于CD4细胞计数、抗逆转录病毒治疗使用、入院原因和死亡发生率的汇总数据，并使用改进的纽卡斯尔-渥太华量表评估了偏倚风险。我们构建了随机效应模型来估计作为住院原因的各种疾病的患病率。研究结果：从确定的19629条记录中，我们获得了来自110项研究的数据，代表100628例住院病例。加权中位数CD4计数为111个/ μL（中位数范围25 ~ 713）；60%的入院者（95% Cl 54-66）是接受抗逆转录病毒治疗的人。最常见的入院原因是艾滋病相关疾病（占入院人数的42%，95% CI 35-49），包括结核病（19%,15-23）。第二常见的原因是细菌感染（26%，20-33岁）。与欧洲（30%,23-37）和北美（13%,6-25）相比，艾滋病相关疾病在世卫组织南美洲和中美洲区域（62%,53-71）、非洲区域（49%,39-60）、西太平洋区域（68%,57-77）和东南亚区域（40%,31-50）更为常见。消瘦和寄生虫感染在儿童中更为常见(营养不良占31%，11-63；寄生虫感染13%(4-37)，高于成人。住院死亡率为17%(13-20)，地区差异很大。解释：我们的研究结果表明，应该优先为患有艾滋病毒相关疾病（艾滋病相关疾病和严重细菌感染）的住院患者提供高质量的护理。资助：比尔和梅林达·盖茨基金会。
Causes of hospitalisation among people living with HIV worldwide, 2014-23: a systematic review and meta-analysis.
Background: Despite improved access to antiretroviral therapy (ART), HIV-related morbidity and mortality remain high. A previous review (2007-14) found that AIDS-related illnesses were the leading causes of hospitalisations. We aimed to summarise the causes of hospitalisations among people living with HIV from 2014 to 2023.
Methods: For this meta-analysis we searched eight databases (Ovid Medline ALL, Ovid Embase Classic and Ovid Embase, Ovid Global Health, EBSCOhost CINAHL Complete, EBSCOhost Africa-Wide Information, Clarivate Analytics Web of Science Core Content, Clarivate Analytics Web of Science SciELO, and Global Index Medicus) on April 26, 2023. We included studies of any design that reported on the cause of admission to hospital for at least 20 people after Jan 1, 2014. We extracted summary-level data about CD4 cell counts, ART use, cause of admission, and incidence of death, and assessed risk of bias with the use of a modified Newcastle-Ottowa Scale. We constructed random effects models to estimate prevalence of various diseases as a cause of hospital admission.
Findings: From the 19 629 records identified, we obtained data from 110 studies representing 100 628 hospital admissions. The weighted median CD4 count was 111 cells per μL (range of medians 25-713); 60% of admissions (95% Cl 54-66) were people receiving ART. The most common cause of admission was AIDS-related illnesses (42% of admissions, 95% CI 35-49), including tuberculosis (19%, 15-23). The second most common cause was bacterial infection (26%, 20-33). AIDS-related illnesses were more common in WHO regions of South and Central America (62%, 53-71), Africa (49%, 39-60), Western Pacific (68%, 57-77), and South-East Asia (40%, 31-50) than in Europe (30%, 23-37) and North America (13%, 6-25). Wasting and parasitic infections were more common in children (malnutrition 31%, 11-63; parasitic infection 13%, 4-37) than in adults. In-hospital mortality was 17% (13-20), with substantial regional variation.
Interpretation: Our results indicate providing high-quality care to hospitalised people with HIV-related conditions (AIDS-related illness and severe bacterial infections) should be prioritised.
期刊介绍：
The Lancet HIV is an internationally trusted source of clinical, public health, and global health knowledge with an Impact Factor of 16.1. It is dedicated to publishing original research, evidence-based reviews, and insightful features that advocate for change in or illuminates HIV clinical practice. The journal aims to provide a holistic view of the pandemic, covering clinical, epidemiological, and operational disciplines. It publishes content on innovative treatments and the biological research behind them, novel methods of service delivery, and new approaches to confronting HIV/AIDS worldwide. The Lancet HIV publishes various types of content including articles, reviews, comments, correspondences, and viewpoints. It also publishes series that aim to shape and drive positive change in clinical practice and health policy in areas of need in HIV. The journal is indexed by several abstracting and indexing services, including Crossref, Embase, Essential Science Indicators, MEDLINE, PubMed, SCIE and Scopus.
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