在 TREAT Asia HIV 观察性数据库（TAHOD）中，针对高效抗逆转录病毒治疗（HAART）后病毒学抑制、免疫反应和 HIV 疾病进展的情况，位点资源测量可预测结果。
Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD).
机构信息
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
出版信息
HIV Med. 2010 Sep;11(8):519-29. doi: 10.1111/j.1468-1293.2010.00822.x. Epub 2010 Mar 21.
OBJECTIVES
Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes.
METHODS
Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (> or = 3, 1-2 or <1) or CD4 (> or = 3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively.
RESULTS
Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting 'Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001).
CONCLUSION
Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.
目的
HIV 疾病进展的替代标志物是血浆病毒载量（VL）中的 HIV RNA 和 CD4 细胞计数（免疫功能）。尽管国际上获得抗逆转录病毒药物的机会有所增加，但在资源有限的环境中，替代标志物诊断仍未常规提供。因此，本研究旨在评估经济和诊断资源对患者治疗结果的影响。
方法
本分析基于 2000 年以来开始接受高效抗逆转录病毒治疗（HAART）的 2333 例患者。根据世界银行国家收入标准（高/低）和 VL（≥3、1-2 或<1）或 CD4（≥3 或<3）检测的年度频率对检测点进行分类。终点是 AIDS/死亡时间以及 12 个月时 CD4 细胞计数和 VL 抑制（<400 HIV-1 RNA 拷贝/ml）的变化。人口统计学、疾病控制和预防中心（CDC）分类、基线 VL/CD4 细胞计数、乙型肝炎/丙型肝炎合并感染和 HAART 方案是协变量。采用比例风险模型分析 AIDS/死亡时间。采用线性和逻辑回归分别分析 CD4 和 VL 终点。
结果
与每年报告 VL 检测次数少于一次的检测点相比，检测点报告 VL 检测次数少于一次（风险比[HR]=1.4；P=0.032）、严重症状性 HIV 感染（HR=1.4；P=0.003）和丙型肝炎病毒合并感染（HR=1.8；P=0.011）与较高的疾病进展风险相关。共有 1120 例患者（48.2%）的 CD4 细胞计数数据发生变化。与年龄较大（P<0.001）和包括注射吸毒和血液制品在内的“其他”HIV 来源暴露相关的较小增加（P=0.043）。共有 785 例患者（33.7%）参与了 VL 抑制分析。每年 VL 检测次数少于一次的患者（比值比[OR]=0.30；P<0.001）和报告“其他”HIV 暴露的患者，VL 抑制率降低（OR=0.28；P<0.001）。
结论
检测点资源的低水平与较差的患者结局相关，包括每年 VL 检测次数少于一次的患者的疾病进展增加 35%。
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