Ahonkhai Aimalohi A, Banigbe Bolanle, Adeola Juliet, Adegoke Abdulkabir B, Regan Susan, Bassett Ingrid V, Idigbe Ifeoma, Losina Elena, Okonkwo Prosper, Freedberg Kenneth A
Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
J Adolesc Health. 2016 Sep;59(3):298-304. doi: 10.1016/j.jadohealth.2016.05.002. Epub 2016 Jun 18.
Interruptions in HIV care are a major cause of morbidity and mortality, particularly in resource-limited settings. We compared engagement in care and virologic outcomes between HIV-infected adolescents and young adults (AYA) and older adults (OA) one year after starting antiretroviral therapy (ART) in Nigeria.
We conducted a retrospective cohort study of AYA (15-24 years) and OA (>24 years) who initiated ART from 2009-2011. We used negative binomial regression to model the risk of inconsistent care and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first year on ART. Regular care included monthly ART pickup and 3-monthly clinical visits. Patients with ≤3 months between consecutive visits were considered in care. Those with inconsistent care had >3 months between consecutive visits.
The cohort included 354 AYA and 2,140 OA. More AYA than OA were female (89% vs. 65%, p < .001). Median baseline CD4 was 252/μL in AYA and 204/μL in OA (p = .002). More AYA had inconsistent care than OA (55% vs. 47%, p = .001). Adjusting for sex, baseline CD4, and education, AYA had a greater risk of inconsistent care than OA (Relative Risk [RR]: 1.15, p = .008). Among those in care after one year on ART, viremia was more common in AYA than OA (40% vs. 26% p = .003, RR: 1.53, p = .002).
In a Nigerian cohort, AYA were at increased risk for inconsistent HIV care. Of patients remaining in care, youth was the only independent predictor of viremia at 1 year. Youth-friendly models of HIV care are needed to optimize health outcomes.
艾滋病护理中断是发病和死亡的主要原因，在资源有限的环境中尤其如此。我们比较了尼日利亚开始抗逆转录病毒治疗（ART）一年后，感染艾滋病毒的青少年和青年（AYA）与老年人（OA）在护理参与度和病毒学结果方面的差异。
我们对2009年至2011年开始接受ART治疗的AYA（15 - 24岁）和OA（>24岁）进行了一项回顾性队列研究。我们使用负二项回归模型来模拟AYA和OA在ART治疗第一年中护理不一致和病毒血症（HIV RNA>1000拷贝/mL）的风险。常规护理包括每月领取ART药物和每三个月进行一次临床就诊。连续就诊间隔≤3个月的患者被视为接受护理。护理不一致的患者连续就诊间隔>3个月。
该队列包括354名AYA和2140名OA。AYA中女性比例高于OA（89%对65%，p<.001）。AYA的基线CD4中位数为252/μL，OA为204/μL（p =.002）。AYA中护理不一致的比例高于OA（55%对47%，p =.001）。在调整性别、基线CD4和教育程度后，AYA护理不一致的风险高于OA（相对风险[RR]：1.15，p =.008）。在接受ART治疗一年后仍接受护理的患者中，AYA的病毒血症比OA更常见（分别为40%和26%，p =.003，RR：1.53，p =.002）。
在尼日利亚队列中，AYA接受不一致艾滋病毒护理的风险增加。在仍接受护理的患者中，年轻是一年时病毒血症的唯一独立预测因素。需要建立对青年友好的艾滋病毒护理模式以优化健康结果。
