Wright Stephen T, Law Matthew G, Cooper David A, Keen Phillip, McDonald Ann, Middleton Melanie, Woolley Ian, Kelly Mark, Petoumenos Kathy
The Kirby Institute, UNSW Australia, Sydney, Australia;
The Kirby Institute, UNSW Australia, Sydney, Australia.
J Int AIDS Soc. 2015 Apr 10;18(1):19463. doi: 10.7448/IAS.18.1.19463. eCollection 2015.
HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART.
We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis. We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification.
Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV.
Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.
艾滋病病毒（HIV）预防策略正朝着降低所有HIV阳性者的血浆HIV RNA病毒载量发展，包括未确诊者、初治者、正在接受或未接受抗逆转录病毒治疗者。那些未确诊者的一个替代人群是晚期就诊且患有晚期HIV的患者。本分析的目的是检查与晚期HIV患者相关的因素，并确定开始抗逆转录病毒治疗（ART）后治疗中断和调整的发生率。
我们将澳大利亚HIV观察数据库中的记录与澳大利亚国家HIV登记处进行确定性关联，以获取与HIV诊断相关的信息。采用逻辑回归来确定与晚期HIV诊断相关的因素。我们使用生存方法来评估按诊断时CD4细胞计数分层以及按HIV诊断历年的ART启动率。使用Cox模型来确定首次ART治疗中断（持续时间>30天）的风险以及首次重大ART调整的时间。
与晚期HIV诊断几率增加相关（p<0.05）的因素包括性别、年龄较大、HIV暴露的异性传播方式、出生在海外以及农村 - 地区医疗环境。在所有诊断CD4细胞计数组中，后期（2007 - 2012年）ART启动的比例更高。与1996 - 2001年相比，我们发现2007 - 2012年首次治疗中断的风险降低了83%（69，91%）（p<0.001），并且晚期HIV诊断患者的ART调整没有差异。
与早期相比，近期所有诊断CD4细胞计数组的HIV诊断患者更早开始治疗，这可能降低社区病毒载量。我们发现首次治疗中断的风险显著降低，并且近期按HIV表现状态进行的重大ART调整率没有差异。
