Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
PLoS One. 2013 Aug 15;8(8):e72257. doi: 10.1371/journal.pone.0072257. eCollection 2013.
Successful treatment reduces morbidity, mortality and transmission of HIV. We evaluated trends in the treatment status of HIV infected individuals enrolled in care in Sweden and Denmark during the years 1995-2010. Our aim was to assess the proportion of HIV-infected individuals who received services along the continuum of care in Denmark in 2010, and to discuss the findings in relation to the organization of the health care system.
We analyzed CD4 counts and viral loads (VL) among all HIV patients enrolled in the cohort. For each month of the study period we estimated the proportions of patients who 1) had initiated highly active antiretroviral treatment (HAART) and had VL<500 copies/mL, 2) were not eligible for HAART, 3) had initiated HAART but had VL≥500 copies/mL, 4) were eligible for, but had not initiated HAART and 5) had initiated HAART but no VL monitoring for >13 months or 6) no HAART or monitoring of CD4 for >13 months. Patients fulfilling criteria 1 or 2 were considered successfully managed.
The proportion of successfully managed patients continued to increase throughout the study period and reached 83% in 2010, 92% of Swedish/Danish men who have sex with men and heterosexual patients, but only 74% of immigrants and 78% of injection drug users were successfully managed due to higher rates of inadequate monitoring in the latter two groups. In 2010, 70% of all individuals diagnosed with HIV in Denmark were virally suppressed.
In a public health care system with free access to specialized care, successful management of the majority of HIV patients is achievable. Interventions tailored to retain immigrants and injection drug users in care are needed to further reduce the proportion of sub-optimally treated HIV patients.
成功的治疗可降低 HIV 的发病率、死亡率和传播率。我们评估了 1995-2010 年期间在瑞典和丹麦接受护理的 HIV 感染者的治疗状况趋势。我们的目的是评估 2010 年丹麦沿着护理连续体接受服务的 HIV 感染者的比例，并结合卫生保健系统的组织讨论这些发现。
我们分析了所有入组队列的 HIV 患者的 CD4 计数和病毒载量（VL）。对于研究期间的每个月，我们估计了以下患者的比例：1）已启动高效抗逆转录病毒治疗（HAART）且 VL<500 拷贝/ml，2）不适合 HAART，3）已启动 HAART 但 VL≥500 拷贝/ml，4）适合但尚未启动 HAART，5）已启动 HAART，但 VL 监测>13 个月，6）未启动 HAART 或 CD4 监测>13 个月。符合标准 1 或 2 的患者被认为得到了成功管理。
成功管理患者的比例在整个研究期间持续增加，到 2010 年达到 83%，瑞典/丹麦男男性行为者和异性恋患者的比例为 92%，但由于后两组监测不足的比例较高，移民和注射吸毒者中只有 74%和 78%得到了成功管理。2010 年，丹麦诊断出的所有 HIV 患者中有 70%病毒受到抑制。
在一个拥有免费获得专业护理的公共卫生保健系统中，大多数 HIV 患者的成功管理是可以实现的。需要采取有针对性的干预措施，让移民和注射吸毒者继续留在护理中，以进一步减少治疗效果不理想的 HIV 患者的比例。
