Chakraborty Hrishikesh, Iyer Medha, Duffus Wayne A, Samantapudi Ashok Varma, Albrecht Helmut, Weissman Sharon
1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
AIDS Patient Care STDS. 2015 Jan;29(1):26-32. doi: 10.1089/apc.2014.0158.
On a population level, trends in viral load (VL) and CD4 cell counts can provide a marker of infectivity and an indirect measure of retention in care. Thus, observing the trend of CD4/VL over time can provide useful information on disparities in populations across the HIV care continuum when stratified by demography. South Carolina (SC) maintains electronic records of all CD4 cell counts and HIV VL measurements reported to the state health department. We examined temporal trends in individual HIV VLs reported in SC between January 1, 2005 and December 31, 2012 by using mixed effects models adjusting for gender, race/ethnicity, age, baseline CD4 count, HIV risk category, and residence. Overall VL levels gradually decreased over the observation period. There were significant differences in the VL decline by gender, age groups, rural/urban residence, and HIV risk exposure group. There were significant differences in CD4 increases by race/ethnicity, age groups, and HIV risk exposure group. However, the population VL declines were slower among individuals aged 13-19 years compared to older age groups (p<0.0001), among men compared to women (p=0.002), and among people living with HIV/AIDS (PLWHA) with CD4 count ≤200 cell/mm(3) compared to those with higher CD4 counts (p<0.0001). Significant disparities were observed in VL decline by gender, age, and CD4 counts among PLWHA in SC. Population based data such as these can help streamline and better target local resources to facilitate retention in care and adherence to medications among PLWHA.
在人群层面，病毒载量（VL）和CD4细胞计数的趋势可提供传染性指标以及护理留存率的间接衡量指标。因此，按人口统计学分层观察CD4/VL随时间的变化趋势，可为HIV护理连续过程中不同人群的差异提供有用信息。南卡罗来纳州（SC）保存了所有向州卫生部门报告的CD4细胞计数和HIV病毒载量测量的电子记录。我们通过使用混合效应模型，对性别、种族/民族、年龄、基线CD4计数、HIV风险类别和居住地进行调整，研究了2005年1月1日至2012年12月31日期间SC报告的个体HIV病毒载量的时间趋势。在观察期内，总体病毒载量水平逐渐下降。在病毒载量下降方面，性别、年龄组、农村/城市居住地和HIV风险暴露组存在显著差异。在CD4增加方面，种族/民族、年龄组和HIV风险暴露组存在显著差异。然而，与年龄较大的年龄组相比，13 - 19岁个体的人群病毒载量下降较慢（p<0.0001），男性比女性慢（p = 0.002），CD4计数≤200个细胞/mm³的HIV/AIDS患者比CD4计数较高的患者慢（p<0.0001）。在SC的HIV/AIDS患者中，观察到病毒载量下降在性别、年龄和CD4计数方面存在显著差异。这类基于人群的数据有助于优化并更好地定位当地资源，以促进HIV/AIDS患者的护理留存率并提高其服药依从性。
