美国接受艾滋病护理的成年人中断抗逆转录病毒治疗的情况。
Discontinuation of antiretroviral therapy among adults receiving HIV care in the United States.
机构信息
*San Francisco Department of Public Health, San Francisco, CA; and †Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA.
出版信息
J Acquir Immune Defic Syndr. 2014 May 1;66(1):80-9. doi: 10.1097/QAI.0000000000000084.
BACKGROUND
Continuous antiretroviral therapy (ART) is important for maintaining viral suppression. This analysis estimates prevalence of and reason for ART discontinuation.
METHODS
Three-stage sampling was used to obtain a nationally representative, cross-sectional sample of HIV-infected adults receiving HIV care. Face-to-face interviews and medical record abstractions were collected from June 2009 to May 2010. Data were weighted based on known probabilities of selection and adjusted for nonresponse. Patient characteristics of ART discontinuation, defined as not currently taking ART, stratified by provider-initiated versus non-provider-initiated discontinuation, were examined. Weighted logistic regression models predicted factors associated with ART discontinuation.
RESULTS
Of adults receiving HIV care in the United States who reported ever initiating ART, 5.6% discontinued treatment. Half of those who discontinued treatment reported provider-initiated discontinuation. Provider-initiated ART discontinuation patients were more likely to have a nadir CD4 ≥ 200 cells per cubic millimeter. Non-provider-initiated ART discontinuation patients were more likely to have unmet need for supportive services and to have not received HIV care in the past 3 months. Among all patients who discontinued, younger age, female gender, not having continuous health insurance, incarceration, injection drug use, nadir CD4 count ≥ 2 00 cells per cubic millimeter, unmet need for supportive services, no care in the past 3 months and HIV diagnosis ≥ 5 years before interview were independently associated with ART discontinuation.
CONCLUSIONS
These findings inform development of interventions to increase ART persistence by identifying groups at increased risk of ART discontinuation. Evidence-based interventions targeting vulnerable populations are needed and are increasingly important as recent HIV treatment guidelines have recommended universal ART.
背景
持续的抗逆转录病毒治疗（ART）对于维持病毒抑制至关重要。本分析旨在评估停止 ART 的流行率和原因。
方法
采用三阶段抽样方法，从 2009 年 6 月至 2010 年 5 月获得了接受 HIV 护理的 HIV 感染成人的全国代表性横断面样本。通过面对面访谈和病历摘录收集数据。根据已知的选择概率对数据进行加权，并针对无应答情况进行调整。根据提供者发起与非提供者发起的停药，对停药患者（即目前未服用 ART）的特征进行分层，并进行检查。使用加权逻辑回归模型预测与 ART 停药相关的因素。
结果
在美国接受 HIV 护理并报告曾经开始接受 ART 的成年人中，有 5.6%停止了治疗。一半停药的患者报告了提供者发起的停药。提供者发起的 ART 停药患者的 CD4 细胞计数的最低点（nadir）≥200 个细胞/立方毫米的可能性更高。非提供者发起的 ART 停药患者更有可能需要支持性服务，并且在过去 3 个月中未接受 HIV 护理。在所有停药的患者中，年龄较小、女性、没有连续的健康保险、监禁、注射吸毒、CD4 细胞计数最低点（nadir）≥200 个细胞/立方毫米、未满足支持性服务需求、过去 3 个月内没有接受护理以及 HIV 诊断在访谈前≥5 年与 ART 停药独立相关。
结论
这些发现为通过确定具有更高 ART 停药风险的人群来制定增加 ART 持续时间的干预措施提供了信息。需要针对弱势群体的循证干预措施，并且随着最近的 HIV 治疗指南建议普遍使用 ART，这些措施变得越来越重要。
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