Joseph Davey D, Abrahams Z, Feinberg M, Prins M, Serrao C, Medeossi B, Darkoh E
1 BroadReach, Cape Town, South Africa.
2 University of Cape Town, Cape Town, South Africa.
Int J STD AIDS. 2018 May;29(6):603-610. doi: 10.1177/0956462417748859. Epub 2018 Jan 16.
Unsuppressed viral load (VL) in patients on antiretroviral therapy (ART) occurs when treatment fails to suppress a person's VL and is associated with decreased survival and increased HIV transmission. The objective of this study was to evaluate factors associated with unsuppressed VL (VL > 400 copies/ml) in patients currently in care on first-line ART for ≥ 6 months attending South African public healthcare facilities. We analysed electronic medical records of ART patients with a VL result on record who started ART between January 2004 and April 2016 from 271 public health facilities. We present descriptive and multivariable logistic regression for unsuppressed VL at last visit using a priori variables. We included 244,370 patients (69% female) on first-line ART in April 2016 for ≥ 6 months. Median age at ART start was 33 years (7% were < 15 years old). Median duration on ART was 3.7 years. Adjusting for other variables, factors associated with having an unsuppressed VL at the most recent visit among patients in care included: (1) < 15 years old at ART start (adjusted odds ratio [aOR]=2.58; 95% CI = 2.37, 2.81) versus 15-49 years at ART start, (2) male gender (aOR = 1.29; 95% CI = 1.25, 1.35), (3) 6-12 months on ART versus longer (aOR = 1.34; 95% CI = 1.29, 1.40), (4) on tuberculosis (TB) treatment (aOR = 1.78; 95% CI = 1.48, 2.13), and (5) prior ART exposure versus none (aOR = 1.20; 95% CI = 1.08, 1.32). Approximately 85% of the ART cohort who were in care had achieved viral suppression, though men, youth/adolescents, patients with prior ART exposure, those with short duration of ART, and patients on TB treatment had increased odds of not achieving viral suppression. There is a need to develop and evaluate targeted interventions for ART patients in care who are at high risk of unsuppressed VL.
接受抗逆转录病毒治疗（ART）的患者若病毒载量（VL）未得到抑制，即治疗未能抑制患者的病毒载量，这与生存率降低及HIV传播增加相关。本研究的目的是评估在南非公共医疗机构接受一线ART治疗≥6个月的现症患者中，与未抑制的VL（VL＞400拷贝/毫升）相关的因素。我们分析了2004年1月至2016年4月期间在271家公共卫生机构开始接受ART治疗且有VL检测结果记录的ART患者的电子病历。我们使用先验变量对末次就诊时未抑制的VL进行描述性分析和多变量逻辑回归分析。我们纳入了2016年4月正在接受一线ART治疗≥6个月的244,370名患者（69%为女性）。开始接受ART治疗时的中位年龄为33岁（7%年龄＜15岁）。ART治疗的中位时长为3.7年。在对其他变量进行校正后，在接受治疗的患者中，与末次就诊时未抑制的VL相关的因素包括：（1）开始接受ART治疗时年龄＜15岁（校正比值比[aOR]=2.58；95%置信区间[CI]=2.37, 2.81），而开始接受ART治疗时年龄为15 - 49岁；（2）男性（aOR = 1.29；95%CI = 1.25, 1.35）；（3）接受ART治疗6 - 12个月相较于更长时间（aOR = 1.34；95%CI = 1.29, 1.40）；（4）正在接受结核病（TB）治疗（aOR = 1.78；95%CI = 1.48, 2.13）；以及（5）既往接受过ART治疗相较于未接受过（aOR = 1.20；95%CI = 1.08, 1.32）。接受治疗的ART队列中约85%的患者实现了病毒抑制，不过男性、青年/青少年、既往接受过ART治疗的患者、ART治疗时长较短的患者以及正在接受TB治疗的患者未实现病毒抑制的几率增加。有必要针对接受治疗但有未抑制VL高风险的ART患者制定并评估有针对性的干预措施。
