Palmer Alexis K, Cescon Angela, Chan Keith, Cooper Curtis, Raboud Janet M, Miller Caroline L, Burchell Ann N, Klein Marina B, Machouf Nima, Montaner Julio S G, Tsoukas Chris, Hogg Robert S, Loutfy Mona R
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
J Int Assoc Provid AIDS Care. 2014 Jan-Feb;13(1):56-62. doi: 10.1177/2325957413510606. Epub 2013 Dec 5.
Initiating highly active antiretroviral therapy (HAART) with low CD4 counts or AIDS-defining illnesses (ADIs) increases risk of treatment failure and death. We examined factors associated with late initiation among 18- to 29-year-olds within the Canadian Observational Cohort (CANOC) collaboration, a multi-site study of HIV-positive persons who initiated HAART after 2000. Late initiation was defined as beginning HAART with a CD4 count <200 cells/mm(3) and/or having a baseline ADI. Multivariable logistic regression was used to identify independent correlates of late initiation. In total, 1026 individuals (422 from British Columbia, 400 from Ontario, and 204 from Quebec) met our age criteria. At HAART initiation, median age was 27 years (interquartile range, 24, 28 years). A total of 412 individuals (40%) identified as late initiators. Late initiation was associated with female gender, age >25 years at initiation, initiating treatment in earlier years, and having higher baseline viral load. The high number of young adults in our cohort starting HAART late indicates important target populations for specialized services, increased testing, and linkages to care.
在CD4细胞计数较低或患有艾滋病界定疾病（ADI）时开始高效抗逆转录病毒治疗（HAART）会增加治疗失败和死亡的风险。我们在加拿大观察性队列（CANOC）合作研究中调查了18至29岁人群中与延迟开始治疗相关的因素，该合作研究是一项对2000年后开始接受HAART的HIV阳性者进行的多中心研究。延迟开始治疗的定义为开始HAART时CD4细胞计数<200个细胞/mm³和/或有基线ADI。采用多变量逻辑回归来确定延迟开始治疗的独立相关因素。共有1026人（来自不列颠哥伦比亚省422人、安大略省400人、魁北克省204人）符合我们的年龄标准。开始接受HAART时，中位年龄为27岁（四分位间距为24至28岁）。共有412人（40%）被确定为延迟开始治疗者。延迟开始治疗与女性性别、开始治疗时年龄>25岁、在较早年份开始治疗以及基线病毒载量较高有关。我们队列中大量开始HAART较晚的年轻人表明，针对这些人群提供专门服务、增加检测以及建立医疗联系具有重要意义。
