Cherutich Peter, Kim Andrea A, Kellogg Timothy A, Sherr Kenneth, Waruru Anthony, De Cock Kevin M, Rutherford George W
National AIDS/STI Control Programme, Ministry of Health, Nairobi, Kenya.
US Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Nairobi, Kenya.
PLoS One. 2016 May 18;11(5):e0154318. doi: 10.1371/journal.pone.0154318. eCollection 2016.
At the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.
Between October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.
Overall, 61·2% (95% CI: 56·4-66·1) of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0-51,596) and 81,750 copies/mL (59,366-104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.
This report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the ten administrative and HIV programmatic regions on levels of detectable viral load. Timely initiation of ART and retention in care are crucial for the elimination of transmission of HIV through sex, needle and syringe use or from mother to child. Further refinement of geospatial mapping of populations with highest risk of transmission is necessary.
在个体层面，有明确证据表明降低病毒载量可大幅减少人类免疫缺陷病毒（HIV）传播。然而，描述人群水平HIV病毒血症的数据很少，尤其是在HIV感染诊断严重不足的高负担环境中。第二次肯尼亚艾滋病指标调查（KAIS 2012）提供了一个独特的机会，以评估抗逆转录病毒疗法（ART）覆盖率对病毒血症的影响，并研究病毒复制抑制失败的风险。我们使用KAIS 2012的数据报告人群水平的HIV病毒载量抑制情况。
2012年10月至2013年2月期间，KAIS 2012对家庭成员进行了调查，发放问卷并采集血清样本检测HIV，对于那些被发现感染HIV的人，测量血浆病毒载量（PVL）。我们的主要结局是未抑制的HIV病毒血症，定义为PVL≥550拷贝/毫升。暴露变量包括当前接受ART治疗、既往HIV诊断史以及参与HIV护理。所有点估计值均进行了调整，以考虑KAIS 2012的整群抽样设计和调查无应答情况。
总体而言，15 - 64岁感染HIV的肯尼亚人中有61.2%（95%CI：56.4 - 66.1）未实现病毒学抑制。以10为底的中位数（四分位间距[IQR]）和平均（95%CI）病毒载量分别为4,633拷贝/毫升（0 - 51,596）和81,750拷贝/毫升（59,367 - 104,134）。在266名接受ART治疗的人中，26.1%（95%CI：20.0 - 32.1）有可检测到的病毒血症。未使用ART、年龄较小以及对HIV感染状况缺乏知晓与可检测到病毒载量的显著较高几率独立相关。在对接受ART治疗患者的子样本进行的多变量分析中，可检测到的病毒血症与年龄较小以及对ART的依从性欠佳独立相关。
本报告补充了全国代表性调查中关于人群水平病毒学抑制的有限数据。我们确定了十个行政和HIV规划区域在可检测病毒载量水平上的异质性。及时启动ART治疗并坚持护理对于消除通过性行为传播HIV、使用针头和注射器传播或母婴传播至关重要。有必要进一步完善对传播风险最高人群的地理空间绘图。
