Vogt Florian, Rehman Andrea M, Kranzer Katharina, Nyathi Mary, Van Griensven Johan, Dixon Mark, Ndebele Wedu, Gunguwo Hilary, Colebunders Robert, Ndlovu Mbongeni, Apollo Tsitsi, Ferrand Rashida A
*Institute of Tropical Medicine Antwerp, Antwerp, Belgium; †London School of Hygiene and Tropical Medicine, London, United Kingdom; ‡National and Supranational Reference Laboratory, Research Centre Leibnitz, Borstel, Germany; §Mpilo Central Hospital, Bulawayo, Zimbabwe; ‖National University of Science and Technology, Bulawayo, Zimbabwe; ¶University of Antwerp, Antwerp, Belgium; #Ministry of Health and Child Welfare, Harare, Zimbabwe; **University of Zimbabwe, Harare, Zimbabwe; and ††Biomedical Research and Training Institute, Harare, Zimbabwe.
J Acquir Immune Defic Syndr. 2017 Apr 1;74(4):390-398. doi: 10.1097/QAI.0000000000001274.
Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents.
We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models.
Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively.
Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.
特定年龄阶段的留存挑战使得青少年开始抗逆转录病毒治疗（ART）变得困难，通常需要漫长的准备过程。这需要与迅速开始治疗的益处相权衡。目前尚不清楚青少年开始治疗的最佳时间和持续时间。
评估开始ART的时间对符合治疗条件的青少年死亡率和失访（LTFU）的影响。
我们对2004年至2011年期间在津巴布韦布拉瓦约的一个公共部门艾滋病毒项目中登记的1499名年龄≥10至<19岁且符合ART条件的青少年进行了回顾性队列分析。使用多变量Cox回归模型计算不同ART持续时间的死亡率和LTFU的风险比（HR）。
中位随访时间为1.6年。与7至≤14天的参照组相比，在0至≤7天、>14天至≤1个月、>1至≤2个月、>2个月以及开始治疗前开始治疗的患者的死亡率HR分别为1.59、1.19、1.56、1.08和0.94。LTFU的HR分别为1.02、1.07、0.85、0.97和3.96。在未接受ART的患者中，88%的死亡和85%的LTFU发生在符合ART条件后的前3个月内，但在接受ART的青少年中分别仅为37%和29%。
死亡率和LTFU均与ART开始时间的变化无关。开始治疗的过程可以根据青少年的需求和个人生活情况进行调整，而不会增加不良治疗结果的风险。尽管迅速开始ART，但早期死亡率仍然很高，这就需要通过扩大艾滋病毒检测来更早而非更快地开始治疗。
