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Báo cáo y học: " Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study. | Schutz et al. AIDS Research and Therapy 2010 7 13 http www.aidsrestherapy.eom content 7 1 13 AIDS RESEARCH AND THERAPY RESEARCH Open Access Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme a retrospective observational study Charlotte Schutz 1 2 Andrew Boulle3 Dave Stead1 2 Kevin Rebe1 2 Meg Osler3 and Graeme Meintjes1 2 4 Abstract Background Interventions to promote prevention and earlier diagnosis of severe symptomatic hyperlactataemia SHL were implemented in the Western Cape provincial antiretroviral programme South Africa from 2004. Interventions included clinician education point-of-care lactate meters switch from stavudine to zidovudine in high risk patients and stavudine dose reduction. This study assessed trends in referral rate severity at presentation and case fatality rate for severe SHL. Methods Retrospective study of severe SHL cases diagnosed at a referral facility from 1 January 2003 to 31 December 2008. Severe SHL was defined as patients with compatible symptoms and serum lactate 5 mmol l attributable to antiretroviral therapy ART . Cumulative ART exposure at referring ART clinics was used to calculate referral rates. Results There were 254 severe SHL cases. The referral rate per thousand patient years py ART exposure peaked in 2005 20.4 1000py but fell to 1.3 1000py by 2008 incidence rate ratio IRR 0.07 95 CI 0.04-0.11 . In 2003 66.7 of cases presented with a standard bicarbonate SHCO3 level 15 mmol l but this fell to 12.5 by 2008 p for trend 0.001 . Case fatality rate fell from a peak of 33.3 in 2004 to 0 in 2008 p for trend 0.002 . Conclusions These trends suggest the interventions were associated with reduced referral less severe metabolic acidosis at presentation and improved survival. Background Recent studies from large antiretroviral therapy ART cohorts in resource-limited countries have reported symptomatic hyperlactataemia SHL and lactic acidosis LA .