Castel Amanda D, Kalmin Mariah M, Hart Rachel L D, Young Heather A, Hays Harlen, Benator Debra, Kumar Princy, Elion Richard, Parenti David, Ruiz Maria Elena, Wood Angela, D'Angelo Lawrence, Rakhmanina Natella, Rana Sohail, Bryant Maya, Hebou Annick, Fernández Ricardo, Abbott Stephen, Peterson James, Wood Kathy, Subramanian Thilakavathy, Binkley Jeffrey, Happ Lindsey Powers, Kharfen Michael, Masur Henry, Greenberg Alan E
a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA.
b Cerner Corporation , Kansas City , MO , USA.
AIDS Care. 2016 Nov;28(11):1355-64. doi: 10.1080/09540121.2016.1189496. Epub 2016 Jun 13.
One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load < 200 copies/ml) at least once, and Kaplan-Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL ≥ 200 copies/ml after achievement of VS). Among the 4311 participants, 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03-1.06 per five-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04-1.06 per 100 cells/mm(3)). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51-0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p ≤ .001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum.
艾滋病病毒治疗连续过程的一个目标是实现病毒抑制(VS),然而在艾滋病病毒感染者的亚群体中,病毒抑制存在差异。我们试图确定在接受治疗的城市艾滋病病毒感染队列中,实现和维持病毒抑制能力方面的差异。分析了2011年1月至2014年6月期间在13个华盛顿特区队列研究临床站点登记的艾滋病病毒感染者的数据。进行单变量和多变量逻辑回归以确定与至少一次实现病毒抑制(病毒载量<200拷贝/毫升)相关的因素,并使用Kaplan-Meier(KM)曲线和Cox比例风险模型来确定与维持病毒抑制和病毒学失败时间(实现病毒抑制后病毒载量≥200拷贝/毫升)相关的因素。在4311名参与者中,95.4%在研究入组时病毒被抑制或在随访期间能够实现病毒抑制。在多变量分析中,实现病毒抑制与年龄显著相关(调整后比值比:1.04;每增加五岁的95%置信区间:1.03 - 1.06)以及CD4水平较高(调整后比值比:1.05,每100个细胞/立方毫米的95%置信区间1.04 - 1.06)。与男男性行为者相比,围产期传播感染的患者实现病毒抑制的可能性较小(调整后比值比:0.63,95%置信区间0.51 - 0.79)。一旦实现病毒抑制,大多数参与者(74.4%)在随访期间维持病毒抑制。在KM生存分析中,与其他种族和风险组相比,黑人和围产期感染的人维持病毒抑制的可能性较小(两者的对数秩卡方p≤0.001)。在女性、黑人、公共保险者、围产期感染者、艾滋病病毒感染时间较长者以及被诊断患有精神健康问题或抑郁症的人中,观察到失败时间更早。在这个艾滋病病毒感染队列中,大多数人实现并维持了病毒抑制;然而,在患者年龄、种族、艾滋病病毒传播风险和合并症方面存在差异。确定结果不同的人群有助于合理分配资源,以改善治疗连续过程中的结果。