Xia Qiang, Shah Dipal, Gill Balwant, Torian Lucia V, Braunstein Sarah L
New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, HIV Epidemiology and Field Services Program, Queens, NY.
Public Health Rep. 2016 Jul-Aug;131(4):566-73. doi: 10.1177/0033354916662215.
The HIV care continuum outlines the steps from HIV infection to diagnosis, linkage to care, and viral suppression among people living with HIV. We examined data for steps along the HIV care continuum among people living with perinatally acquired infection in New York City using surveillance data.
This study included data for people who acquired HIV infection perinatally and lived in New York City as of December 31, 2014. We defined "in care" as having ≥1 CD4 or viral load test in 2014, "in continuous care" as having ≥2 CD4 or viral load tests ≥3 months apart in 2014, and "virally suppressed" as having a viral load of #200 copies per milliliter in the most recent test in 2014. We estimated factors associated with viral suppression from a weighted log-binomial regression model that included sex, race/ethnicity, age, and country of birth as independent variables.
As of December 31, 2014, an estimated 1,596 people were living with perinatally acquired HIV infection in New York City. All were diagnosed, 96% were in care, 80% were in continuous care, and 61% were virally suppressed. The multivariable analysis showed significant differences in viral suppression by race/ethnicity and age. Black patients (59%, 534/907) were the least likely of all racial/ethnic groups examined to have a suppressed viral load. By age, compared with 73% (80/109) of children aged 0-12 years who were virally suppressed, 58% (568/987) of adults aged 20-29 years and 56% (54/96) of adults aged 30-39 years were virally suppressed; the adjusted prevalence ratio was 0.80 (95% confidence interval [CI] 0.69, 0.92) for those aged 20-29 years and 0.79 (95% CI 0.63, 0.99) for those aged 30-39 years.
The low level of viral suppression among people living with perinatally acquired infection found in this study warrants further exploration to identify the best management strategies to improve viral suppression in this population, especially those transitioning from pediatric to adult health care.
艾滋病病毒护理连续统概述了从感染艾滋病病毒到诊断、获得护理以及艾滋病病毒感染者实现病毒抑制的各个步骤。我们利用监测数据研究了纽约市围产期感染艾滋病病毒者在艾滋病病毒护理连续统各步骤方面的数据。
本研究纳入了截至2014年12月31日在纽约市围产期感染艾滋病病毒的人群数据。我们将“接受护理”定义为在2014年进行了≥1次CD4或病毒载量检测，“持续接受护理”定义为在2014年进行了≥2次CD4或病毒载量检测，且检测间隔≥3个月，“病毒得到抑制”定义为在2014年最近一次检测中病毒载量≤200拷贝/毫升。我们从一个加权对数二项回归模型中估计与病毒抑制相关的因素，该模型将性别、种族/族裔、年龄和出生国家作为自变量。
截至201月31日，估计纽约市有1596人围产期感染艾滋病病毒。所有人均已确诊，96%接受护理，80%持续接受护理，61%病毒得到抑制。多变量分析显示，在病毒抑制方面，种族/族裔和年龄存在显著差异。在所有接受检查的种族/族裔群体中，黑人患者（59%，534/907）病毒载量得到抑制的可能性最小。按年龄划分，与0至12岁病毒得到抑制的儿童中的73%（80/109）相比，20至29岁成年人中有58%（568/987）病毒得到抑制，30至39岁成年人中有56%（54/96）病毒得到抑制；20至29岁人群的调整患病率比为0.80（95%置信区间[CI]0.69，0.92），30至39岁人群为0.79（95%CI0.63，0.99）。
本研究发现围产期感染艾滋病病毒者的病毒抑制水平较低，这值得进一步探索，以确定改善该人群病毒抑制的最佳管理策略，尤其是那些从儿科医疗过渡到成人医疗的人群。
