Petoumenos Kathy, Watson Jo, Whittaker Bill, Hoy Jennifer, Smith Don, Bastian Lisa, Finlayson Robert, Sloane Andrew, Wright Stephen T, McManus Hamish, Law Matthew G
The Kirby Institute, UNSW Australia, Sydney, Australia;
National Association of People with HIV Australia (NAPWHA), Sydney, Australia.
J Int AIDS Soc. 2015 Feb 12;18(1):19392. doi: 10.7448/IAS.18.1.19392. eCollection 2015.
HIV-positive (HIV+) temporary residents living in Australia legally are unable to access government subsidized antiretroviral treatment (ART) which is provided via Medicare to Australian citizens and permanent residents. Currently, there is no information systematically being collected on non-Medicare eligible HIV+ patients in Australia. The objectives of this study are to describe the population recruited to the Australian HIV Observational Database (AHOD) Temporary Residents Access Study (ATRAS) and to determine the short- and long-term outcomes of receiving (subsidized) optimal ART and the impact on onwards HIV transmission.
ATRAS was established in 2011. Eligible patients were recruited via the AHOD network. Key HIV-related characteristics were recorded at baseline and prospectively. Additional visa-related information was also recorded at baseline, and updated annually. Descriptive statistics were used to describe the ATRAS cohort in terms of visa status by key demographic characteristics, including sex, region of birth, and HIV disease status. CD4 cell count (mean and SD) and the proportion with undetectable (<50 copies/ml) HIV viral load are reported at baseline, 6 and 12 months of follow-up. We also estimate the proportion reduction of onward HIV transmission based on the reduction in proportion of people with detectable HIV viral load.
A total of 180 patients were recruited to ATRAS by June 2012, and by July 2013 39 patients no longer required ART via ATRAS, 35 of whom became eligible for Medicare-funded medication. At enrolment, 63% of ATRAS patients were receiving ART from alternative sources, 47% had an undetectable HIV viral load (<50 copies/ml) and the median CD4 cell count was 343 cells/µl (IQR: 222-479). At 12 months of follow-up, 85% had an undetectable viral load. We estimated a 75% reduction in the risk of onward HIV transmission with the improved rate of undetectable viral load.
The immunological and virological improvements highlight the importance of supplying optimal ART to this vulnerable population. The increase in proportion with undetectable HIV viral load shows the potentially significant impact on HIV transmission in addition to the personal health benefit for each individual.
合法居住在澳大利亚的HIV阳性（HIV+）临时居民无法获得通过医疗保险向澳大利亚公民和永久居民提供的政府补贴抗逆转录病毒治疗（ART）。目前，澳大利亚没有系统收集关于不符合医疗保险资格的HIV+患者的信息。本研究的目的是描述纳入澳大利亚HIV观察数据库（AHOD）临时居民准入研究（ATRAS）的人群，并确定接受（补贴）最佳ART的短期和长期结果以及对后续HIV传播的影响。
ATRAS于2011年设立。符合条件的患者通过AHOD网络招募。在基线时前瞻性记录关键的HIV相关特征。在基线时还记录了额外的签证相关信息，并每年更新。描述性统计用于按关键人口统计学特征（包括性别、出生地区和HIV疾病状态）的签证状态描述ATRAS队列。在基线、随访6个月和12个月时报告CD4细胞计数（均值和标准差）以及HIV病毒载量不可检测（<50拷贝/毫升）的比例。我们还根据可检测HIV病毒载量人群比例的降低来估计后续HIV传播风险的降低比例。
到2012年6月，共有180名患者被纳入ATRAS，到2013年7月，39名患者不再需要通过ATRAS接受ART，其中35人有资格获得医疗保险资助的药物治疗。入组时，63%的ATRAS患者从其他来源接受ART，47%的患者HIV病毒载量不可检测（<50拷贝/毫升），CD4细胞计数中位数为343个细胞/微升（四分位间距：222 - 479）。在随访12个月时，85%的患者病毒载量不可检测。我们估计随着病毒载量不可检测率的提高，后续HIV传播风险降低了75%。
免疫和病毒学方面的改善突出了为这一脆弱人群提供最佳ART的重要性。HIV病毒载量不可检测的比例增加表明，除了对个体的个人健康有益外，对HIV传播可能有重大影响。
