接受抗逆转录病毒治疗的成人和儿童的HIV病毒载量抑制——来自IeDEA合作项目的结果
HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy-Results From the IeDEA Collaboration.
作者信息
Jiamsakul Awachana, Kariminia Azar, Althoff Keri N, Cesar Carina, Cortes Claudia P, Davies Mary-Ann, Do Viet Chau, Eley Brian, Gill John, Kumarasamy Nagalingeswaran, Machado Daisy Maria, Moore Richard, Prozesky Hans, Zaniewski Elizabeth, Law Matthew
机构信息
*The Kirby Institute, UNSW, Sydney, New South Wales, Australia; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Fundacion Huesped, Buenos Aires, Argentina; §University of Chile School of Medicine & Fundación Arriaran, Santiago, Chile; ‖School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; ¶Children's Hospital 2, Ho Chi Minh City, Vietnam; #Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; **University of Calgary, Calgary, Alberta, Canada; ††YRGCARE Medical Centre, Chennai, India; ‡‡Pediatric Infectious Disease Division, Escola Paulista de Medicina-Universidade Federal de SãoPaulo, São Paulo, Brazil; §§Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD; ‖‖Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; and ¶¶Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
出版信息
J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):319-329. doi: 10.1097/QAI.0000000000001499.
BACKGROUND
Having 90% of patients on antiretroviral therapy (ART) and achieving an undetectable viral load (VL) is 1 of the 90:90:90 by 2020 targets. In this global analysis, we investigated the proportions of adult and paediatric patients with VL suppression in the first 3 years after ART initiation.
METHODS
Patients from the IeDEA cohorts who initiated ART between 2010 and 2014 were included. Proportions with VL suppression (<1000 copies/mL) were estimated using (1) strict intention to treat (ITT)-loss to follow-up (LTFU) and dead patients counted as having detectable VL; and (2) modified ITT-LTFU and dead patients were excluded. Logistic regression was used to identify predictors of viral suppression at 1 year after ART initiation using modified ITT.
RESULTS
A total of 35,561 adults from 38 sites/16 countries and 2601 children from 18 sites/6 countries were included. When comparing strict with modified ITT methods, the proportion achieving VL suppression at 3 years from ART initiation changed from 45.1% to 90.2% in adults, and 60.6% to 80.4% in children. In adults, older age, higher CD4 count pre-ART, and homosexual/bisexual HIV exposure were associated with VL suppression. In children, older age and higher CD4 percentage pre-ART showed significant associations with VL suppression.
CONCLUSIONS
Large increases in the proportion of VL suppression in adults were observed when we excluded those who were LTFU or had died. The increases were less pronounced in children. Greater emphasis should be made to minimize LTFU and maximize patient retention in HIV-infected patients of all age groups.
背景
到2020年，让90%的患者接受抗逆转录病毒治疗（ART）并实现病毒载量（VL）检测不到是“90:90:90”目标之一。在这项全球分析中，我们调查了成人和儿童患者在开始ART后的前3年中病毒载量得到抑制的比例。
方法
纳入了2010年至2014年间开始接受ART的国际流行病学数据库到抗击艾滋病计划（IeDEA）队列中的患者。使用以下两种方法估计病毒载量得到抑制（<1000拷贝/毫升）的比例：（1）严格的意向性治疗（ITT）——失访（LTFU）和死亡患者被视为病毒载量可检测到；（2）改良的ITT——排除失访和死亡患者。使用改良的ITT，通过逻辑回归确定开始ART后1年时病毒抑制的预测因素。
结果
共纳入了来自38个地点/16个国家的35561名成人和来自18个地点/6个国家的2601名儿童。将严格的ITT方法与改良的ITT方法进行比较时，从开始ART起3年时实现病毒载量抑制的比例在成人中从45.1%变为90.2%，在儿童中从60.6%变为80.4%。在成人中，年龄较大、ART前CD4细胞计数较高以及同性恋/双性恋HIV暴露与病毒载量抑制相关。在儿童中，年龄较大和ART前较高的CD4百分比与病毒载量抑制显著相关。
结论
当我们排除失访或死亡的患者时，观察到成人中病毒载量抑制比例大幅增加。儿童中的增加不太明显。应更加重视尽量减少失访，并在所有年龄组的HIV感染患者中最大限度地提高患者留存率。
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