Farmer Charles, Yehia Baligh R, Fleishman John A, Rutstein Richard, Mathews W Christopher, Nijhawan Ank, Moore Richard D, Gebo Kelly A, Agwu Allison L
Johns Hopkins School of Medicine, Baltimore, Maryland.
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
J Pediatric Infect Dis Soc. 2016 Mar;5(1):39-46. doi: 10.1093/jpids/piu102. Epub 2014 Oct 19.
The transmission of human immunodeficiency virus (HIV) among youth through high-risk behaviors continues to increase. Retention in Care is associated with positive clinical outcomes and a decrease in HIV transmission risk behaviors. We evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention 1 year after initiating care and in the 2 years thereafter. We also assessed the impact retention in year 1 had on retention in years 2 and 3.
This was a retrospective analysis of treatment-naive nPHIV-infected 12- to 24-year-old youth presenting for care in 16 US HIV clinical sites within the HIV Research Network between 2002 and 2008. Multivariate logistic regression identified factors associated with retention.
Of 1160 nPHIV-infected youth, 44.6% were retained in care during the first year, and 22.4% were retained in all 3 years. Retention in the first year was associated with starting antiretroviral therapy in the first year (adjusted odds ratio [AOR], 3.47 [95% confidence interval (CI), 2.57-4.67]), Hispanic ethnicity (AOR, 1.66 [95% CI, 1.08-2.56]), men who have sex with men (AOR, 1.59 [95% CI, 1.07-2.36]), and receiving care at a pediatric site (AOR, 5.37 [95% CI, 3.20-9.01]). Retention in years 2 and 3 was associated with being retained 1 year after initiating care (AOR, 7.44 [95% CI, 5.11-10.83]).
A high proportion of newly enrolled nPHIV-infected youth were not retained for 1 year, and only 1 in 4 were retained for 3 years. Patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care. Interventions that target those at risk of being lost to follow up are essential for this high-risk population.
人类免疫缺陷病毒（HIV）在青少年中通过高危行为的传播持续增加。坚持治疗与良好的临床结局以及HIV传播风险行为的减少相关。我们评估了非围生期感染HIV（nPHIV）的青少年在开始治疗1年后及之后2年坚持治疗的临床和人口统计学特征。我们还评估了第1年的坚持治疗情况对第2年和第3年坚持治疗的影响。
这是一项对2002年至2008年期间在美国HIV研究网络内16个HIV临床站点接受治疗的初治nPHIV感染的12至24岁青少年进行的回顾性分析。多因素逻辑回归确定了与坚持治疗相关的因素。
在1160例nPHIV感染的青少年中，44.6%在第1年坚持治疗，22.4%在所有3年中都坚持治疗。第1年的坚持治疗与第1年开始抗逆转录病毒治疗相关（调整后的优势比[AOR]，3.47[95%置信区间（CI），2.57 - 4.67]），西班牙裔种族（AOR，1.66[95%CI，1.08 - 2.56]），男男性行为者（AOR，1.59[95%CI，1.07 - 2.36]），以及在儿科站点接受治疗（AOR，5.37[95%CI，3.20 - 9.01]）。第2年和第3年的坚持治疗与开始治疗1年后的坚持治疗相关（AOR，7.44[95%CI，5.11 - 10.83]）。
很大比例新登记的nPHIV感染青少年未能坚持治疗1年，只有四分之一的人坚持治疗3年。西班牙裔、男男性行为者或在儿科诊所就诊的患者更有可能坚持治疗。针对有失访风险人群的干预措施对于这个高危人群至关重要。
