Sewell J, Daskalopoulou M, Nakagawa F, Lampe F C, Edwards S, Perry N, Wilkins E, O'Connell R, Jones M, Collins S, Speakman A, Phillips A N, Rodger A J
Research Department of Infection & Population Health, University College London, London, UK.
Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
HIV Med. 2017 Aug;18(7):463-473. doi: 10.1111/hiv.12477. Epub 2016 Dec 22.
The aim of the study was to assess, among people living with HIV, knowledge of their latest HIV viral load (VL) and CD4 count.
Agreement between self-report and clinic record was assessed among 2771 HIV-diagnosed individuals on antiretroviral treatment (ART) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes Study (2011-2012). A confidential self-completed questionnaire collected information on demographic, socioeconomic, HIV-related and health-related factors. Participants were asked to self-report their latest VL [undetectable (≤ 50 copies/mL), detectable (> 50 copies/mL) or "don't know"] and CD4 count (< 200, 200-350, 351-500 or > 500 cells/μL, or "don't know"). Latest clinic-recorded VL and CD4 count were documented.
Of 2678 participants on ART, 434 (16.2%) did not accurately report whether their VL was undetectable. Of 2334 participants with clinic-recorded VL ≤ 50 copies/mL, 2061 (88.3%) correctly reported undetectable VL; 49 (2.1%) reported detectable VL; 224 (9.6%) did not know their VL. Of 344 participants with clinic-recorded VL > 50 copies/mL, 183 (53.2%) correctly reported detectable VL; 76 (22.1%) reported undetectable VL; 85 (24.7%) did not know their VL. Of 2137 participants who reported undetectable VL, clinic-recorded VL was ≤ 50 copies/mL for 2061 (96.4%) and <1000 copies/mL for 2122 (99.3%). In analyses adjusted for gender/sexual orientation, ethnicity, age and time since starting ART, factors strongly associated with inaccurate self-report of VL (including "don't know") included socioeconomic disadvantage [prevalence ratio (95% CI) for "not" vs. "always" having enough money for basic needs: 2.4 (1.9, 3.1)], poor English fluency [3.5 (2.4, 5.1) vs. UK born], nondisclosure of HIV status [1.7 (1.3, 2.1)], ART nonadherence [2.1 (1.7, 2.7) for three or more missed doses vs. none in the past 2 weeks] and depressive symptoms (PHQ-9 score ≥ 10) [1.9 (1.6, 2.2)]. Overall, 612 (22.9%) of 2667 participants on ART did not accurately self-report whether or not their CD4 count was ≤ 350 cells/μL.
There is a high level of accuracy of a self-report of undetectable VL in people on ART in the UK. Overall, accurate knowledge of personal VL level varied according to demographic, socioeconomic, HIV-related and health-related factors. Active identification of people who may benefit from increased levels of support and engagement in care is important.
本研究旨在评估艾滋病毒感染者对其最新艾滋病毒病毒载量（VL）和CD4细胞计数的了解情况。
在英国抗逆转录病毒药物、性传播风险与态度研究（2011 - 2012年）中，对2771名接受抗逆转录病毒治疗（ART）的艾滋病毒确诊患者的自我报告与临床记录之间的一致性进行了评估。通过一份保密的自我填写问卷收集了有关人口统计学、社会经济、艾滋病毒相关和健康相关因素的信息。参与者被要求自我报告其最新的病毒载量[不可检测（≤50拷贝/毫升）、可检测（>50拷贝/毫升）或“不知道”]以及CD4细胞计数（<200、200 - 350、351 - 500或>500个细胞/微升，或“不知道”）。记录了最新的临床记录的病毒载量和CD4细胞计数。
在2678名接受抗逆转录病毒治疗的参与者中，434人（16.2%）未准确报告其病毒载量是否不可检测。在2334名临床记录病毒载量≤50拷贝/毫升的参与者中，2061人（88.3%）正确报告病毒载量不可检测；49人（2.1%）报告病毒载量可检测；224人（9.6%）不知道自己的病毒载量。在344名临床记录病毒载量>50拷贝/毫升的参与者中，183人（53.2%）正确报告病毒载量可检测；76人（22.1%）报告病毒载量不可检测；85人（24.7%）不知道自己的病毒载量。在报告病毒载量不可检测的2137名参与者中，2061人（96.4%）的临床记录病毒载量≤50拷贝/毫升，2122人（99.3%）的临床记录病毒载量<1000拷贝/毫升。在对性别/性取向、种族、年龄和开始抗逆转录病毒治疗后的时间进行调整的分析中，与病毒载量自我报告不准确（包括“不知道”）密切相关的因素包括社会经济劣势[“没有”与“总是”有足够钱满足基本需求的患病率比值（95%置信区间）：2.4（1.9，3.1）]、英语流利程度差[3.5（2.4，5.1）与在英国出生相比]、未披露艾滋病毒感染状况[1.7（1.3，2.1）]、抗逆转录病毒治疗不依从[过去2周内漏服三剂或更多剂与无漏服相比为2.1（1.7，2.7）]以及抑郁症状（PHQ - 9评分≥10）[1.9（1.6，2.2）]。总体而言，在2667名接受抗逆转录病毒治疗的参与者中，612人（22.9%）未准确自我报告其CD4细胞计数是否≤350个细胞/微升。
在英国，接受抗逆转录病毒治疗的人群对不可检测的病毒载量的自我报告准确性较高。总体而言，对个人病毒载量水平的准确了解因人口统计学、社会经济、艾滋病毒相关和健康相关因素而异。积极识别可能从增加支持和参与护理中受益的人群很重要。
